My post a few days ago complimenting Aetna on their progress in a number of areas struck a few nerves and elicited more than a few emails from ballistic providers (a couple of the printable ones are in the comment section of that post).
There’s a bit of conflation going on here – my comments were focused on the company’s overall strategy while several critics took the big healthplan to task for it’s poor contracting in workers comp (where the product is Aetna Work Comp Access, or AWCA).
Yet they have valid concerns, concerns that are consistent with problems experienced by Aetna’s WC customers, lousy provider directory data, providers refusing to accept WC patients, heavy handed contracting efforts.
I’ve posted on these issues months ago, yet these issues persist. One provider group in Pennsylvania is so frustrated that they contacted state regulators, only to find out that many other providers had the same problem. Now, they are banding together (albeit informally) and asking regulators to outlaw PPOs in the state.
Other complaints relate to Aetna’s practice of ‘negative affirmation’ (my term, but you can use it). Aetna sends their currently-contracted group health providers a letter stating that unless the provider responds within X days, they will be automatically enrolled in AWCA at their group health rates. In defense of Aetna, their contracts with the providers allow this, as does state law. And providers can opt out at any time, so the damage done is rather limited.
Aetna recently decided to use certified mail instead of regular post when sending these letters to providers – the last batch of letters, some 50,000 in all, went out certified about a month ago. When I discussed this with an Aetna exec, he agreed that the mailing of the negative affirmation letters likely contributed to the provider data issues; AWCA is hopeful that the new certified letter will help.
Still, it is a wonder that it took the big insurer this long. Two big payers view AWCA’s PA data as the worst they have ever encountered. Providers routinely get buckets of mail from networks, and it is certain that many of these ‘negative affirmation’ letters end up in the trash as junk. The WC payers get a contract load from AWCA, construct panels of providers, direct injured workers to these providers, who then either a) don’t accept WC, b) can’t spell WC, c) treat the injured worker and then scream when their bill is slashed and protest to the insurance commissioner et al.
Now that AWCA is the de facto network of choice (due to the Coventry deal), some payers’ concern is there may be little motivation for the company to clean up its act. Even less than it had before the deal was struck and AWCA was working hard to compete with Coventry – now it enjoys near-monopoly status in many states, a condition that some payers think makes it less likely it will invest in provider relations.
That’s not the case, according to AWCA. They are investing in the business – hiring more account managers and provider relations staff and continuing to work on their data issues. They have a ways to go, but appear to be committed to working at it.
If you are sensing a little ambivalence here, you’re right. Payers are notorious for blaming everything on vendors while accepting little responsibility themselves. Vendors suggest improvements in processes and systems that would improve results, only to be told its not a priority for the payer. And part of the negativity about AWCA is undoubtedly from payers that are not holding up their end of the deal.
Yet I expect more from Aetna. They should be better than CorVel and Coventry’s WC division. Here’s hoping they get there, and soon.
Mar
28
