Wednesday, June 14, 2006

Aetna Works to Provide Consumers with a Transparent View of Health Care Costs and Quality

Aetna Expands Efforts To Provide Consumers with A Transparent View Of Health Care Costs And Quality

Aetna is one of the nation’s leading diversified health care benefits companies, serving approximately 28.3 million people with information and resources to help them make better informed decisions about their health care.

Aetna offers a broad range of traditional and consumer-directed health insurance products and related services, including medical, pharmacy, dental, behavioral health, group life, long-term care and disability plans, and medical management capabilities. Our customers include employer groups, individuals, college students, part-time and hourly workers, health plans and government-sponsored plans.

HARTFORD, Conn., June 13, 2006 ― Aetna (NYSE: ΑET) today announced that it is enhancing its industry-leading health transparency initiatives to help consumers make informed health care decisions based on the actual costs of care and the clinical quality and efficiency of physicians. A recent study found that Americans are demanding more and better information on health care costs - with 84 percent wanting to know the price of health care.

Effective August 18, Aetna will provide online access to physician-specific cost, clinical quality and efficiency information in select markets, including:

Price, clinical quality and efficiency information for physicians in Connecticut; Washington, D.C.; Northern Virginia; Maryland; Cincinnati, Cleveland, Columbus, Dayton and Springfield, Ohio; Northern Kentucky; Southeast Indiana; and South Florida, including physician-specific pricing for up to 30 of the most widely accessed services by specialty and indicators based on adverse events, 30 day hospital re-admit rates, overall efficiency in use of medical services, and volume of Aetna members treated; Price information only for physicians in Kansas City, Kan. and Mo.; Las Vegas, Nev.; and Pittsburgh, Pa.

The combination of physician-specific cost, clinical quality and efficiency information is a first from a national health insurer. With these new enhancements, clinical quality and efficiency information will be available for more than 14,800 specialist physicians and specific pricing will be available for more than 70,000 physicians.

"While purchasing health care is a much different decision than buying a house or a car, we firmly believe that consumers should ultimately have access to exactly what they’re demanding -- the same kind of objective cost and quality information that is readily available when making other significant purchases," said Aetna CEO and President Ronald A. Williams. "However, in most instances, consumers have no way of determining what a procedure will cost until they receive the bill." "Aetna was the first insurer to offer physician-specific pricing information as part of a program in the greater Cincinnati area, and is still the only insurer to offer this level of pricing detail. Now, we’re delivering on our commitment to expand the program by extending its geographic reach and helping our members make health care purchasing decisions based on cost and quality."

Aetna launched true price transparency in August of 2005, providing consumers with the ability to research physician-specific pricing before receiving a service at the doctor’s office. Since that time, between 600 and 1,000 consumers a month have accessed the information for approximately 5,000 physicians and physician groups in the greater Cincinnati area.

As the company considered expanding the program, it solicited feedback from the physician and employer communities, including research with physicians in Ohio, Connnecticut, Washington, D.C., Maryland and Florida. Constituent feedback was incorporated into the program enhancements. “Physicians we spoke to were very clear that their patients needed to have enough information to make decisions based on overall value, not simply price alone. We agree, and the measures we are using are aligned with the Institute of Medicine’s criteria for efficiency and effectiveness. Using these two aspects of quality will provide our members with a much stronger starting point to make well-informed decisions,” said Aetna Chief Medical Officer Troyen A. Brennan, M.D.

The physician-specific clinical quality and efficiency information is taken from Aetna’s Aexcel network option. Aexcel was launched in 2003 to help mitigate increases in medical costs, and provide consumers with access to independent, objective information to aid them in selecting specialists.

Aexcel-designated specialists undergo an evaluation process that reviews their delivery of care based on measures of efficiency and clinical performance, including prevalence of complications and repeat procedures. “Consumers must have transparent health care cost and quality information to navigate the new health care economy,” said Grace-Marie Turner, president of the Galen Institute, a Washington, D.C.-based research organization focusing on health and tax policy. “In providing cost and quality tools to its members, Aetna is leading the way in introducing transparency into the health sector. And, Aetna is attuned to the need to provide information that is accessible and useful to consumers while being respectful to providers. My hope is that others in the health care marketplace see the value of following Aetna’s lead in providing these important tools to consumers.”

Beginning in mid-August, Aetna members can access the enhanced information by logging on to Aetna Navigator (, Aetna’s password-protected member website, searching for their physician using "DocFind," and choosing "Provider Detail."

Members who view rates will see the actual rates specific to their health plan for office visits, diagnostic tests, minor procedures, major procedures and other services. Members interested in clinical quality and efficiency will see whether the physician is Aexcel-designated.

For those who are Aexcel-designated, the page will show whether he or she has met the Aexcel criteria for clinical performance, efficiency and volume of Aetna members treated.

Aetna caters to potential customers seeking individual or family health insurance coverage by creating customized categories for specific stages of life. Aetna offers advice for the new graduate, those getting married, raising a family, the self-employed, individuals that find themselves between jobs, empty nesters, and those who are planning on early retirement. Compare Aetna health plan types to find one that suits your health care needs and financial situation.

Monday, June 12, 2006

Anthem BCBS Earns National Honor for Fighting Health Care Fraud

Indianapolis, Ind.—May 16, 2006—For the second consecutive year, Anthem Blue Cross and Blue Shield’s special investigations unit has received a BlueWorks® award for its efforts to root out health care fraud, a crime that costs the U.S. health care system $95 billion a year. The BlueWorks award was presented by the Blue Cross and Blue Shield Association (BCBSA) in collaboration with the Harvard Medical School’s Department of Healthcare Policy.

The BlueWorks program showcases initiatives from Blue Cross and Blue Shield plans across the country that result in keeping quality health care affordable. “We’re honored to receive this symbol of quality that’s recognized throughout the health insurance industry,” said Cynthia Lucas, director of the Special Investigations Unit for Anthem Blue Cross and Blue Shield in Indiana, Ohio and Kentucky. “By working to eliminate fraud and abuse, we’re keeping health care costs affordable for our customers while providing them access to high quality health care.”

The Centers for Medicare and Medicaid Services estimate that of the approximately $1.9 trillion spent on health care in the U.S. in 2004, about $95 billion was lost as a result of health care fraud. Harvard Medical School researchers and a panel of anti-fraud experts recognized Anthem Blue Cross and Blue Shield for its work in the case of Thomas E. Hoshour, an Indianapolis health care professional who specialized in substance abuse treatment at eight clinics known as Sober Life Alternatives. In 2001, Anthem anti-fraud investigators began to suspect that Hoshour was billing insurance for services that patients never actually received during an office visit, a fraudulent practice known as upcoding.

In 2003, a joint investigation was launched with Indianapolis police. After more than a dozen undercover clinical visits by law enforcement over a period of three months, it was discovered that the services received by the patients in the doctor’s office were different from the invoices that were submitted to the insurer. As a result, Hoshour was sentenced to six years in prison, and his medical license was suspended for 50 years. He was also sentenced to 14 months in federal prison for defrauding the state’s Medicaid program.

“We would not have been successful were it not for the cooperation of Indianapolis law enforcement authorities,” said Lucas. “It’s gratifying to be part of a team that makes a difference when it comes to rooting out fraud from the health care system.” “Health care fraud only benefits the bad guys,” said BCBSA President and CEO Scott P. Serota. “Blue Cross and Blue Shield companies across the country are leading the fight against health care fraud to protect health care quality, safety and affordability. Part of the answer is helping consumers understand the role they can play in preventing fraud. The more people know about health care fraud, the better for us all.”

Through the BlueWorks program, BCBSA and Harvard Medical School work together to evaluate Blue Cross and Blue Shield company initiatives that address health care affordability and quality. Each quarter, a panel of experts from Harvard Medical School’s Department of Healthcare Policy selects a number of Blue Plan initiatives that have proven effective in improving the affordability and quality of care.

Winning programs are published in Blue Works Quarterly and promoted throughout the Blue system and the health care industry as examples that can be replicated to help keep quality health care affordable in the United States. For more information about the BlueWorks program, visit The Blue Cross and Blue Shield Association is an association of independent Blue Cross and Blue Shield Plans.

Anthem Blue Cross and Blue Shield in Indiana is a subsidiary of WellPoint, Inc. (NYSE: WLP). WellPoint’s mission is to improve the lives of the people it serves and the health of its communities. WellPoint, Inc. is the largest health benefits company in terms of commercial membership in the United States.

Through its nationwide networks, the company delivers a number of leading health benefit solutions through a broad portfolio of integrated health care plans and related services, along with a wide range of specialty products such as life and disability insurance benefits, pharmacy benefit management, dental, vision, behavioral health benefit services, as well as long term care insurance and flexible spending accounts.

Headquartered in Indianapolis, Indiana, WellPoint is an independent licensee of the Blue Cross and Blue Shield Association and serves its members as the Blue Cross licensee for California; the Blue Cross and Blue Shield licensee for Colorado, Connecticut, Georgia, Indiana, Kentucky, Maine, Missouri (excluding 30 counties in the Kansas City area), Nevada, New Hampshire, New York (as Blue Cross Blue Shield in 10 New York City metropolitan and surrounding counties and as Blue Cross or Blue Cross Blue Shield in selected upstate counties only), Ohio, Virginia (excluding the Northern Virginia suburbs of Washington, D.C.), Wisconsin; and through UniCare. Additional information about WellPoint is available at