CVS Health's Aetna supports industry actions to simplify prior authorization
Aetna, a CVS Health company, announced its support of initiatives championed by American’s Health Insurance Plans to improve the experience of doctors and patients. Aetna said it also is committed to leading the market through a comprehensive strategy to make it easier to navigate health care — reducing reviews, simplifying care site transitions and putting technology to work for healthcare professionals and their patients.
“The American healthcare system must work better for people, and we will improve it in distinctive ways that truly matter,” said Aetna president Steve Nelson. “We support the industry’s commitments to streamline, simplify and reduce prior authorization. We will go beyond prior authorization, building a health care experience for people we serve and introducing solutions that improve navigation and advocacy for Aetna members.”
Aetna said it already has one of the shortest lists of treatments and procedures requiring prior authorization in the industry. Of eligible prior authorizations, more than 95% are approved within 24 hours, with some completed in just a few hours.
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Aetna noted that one area it can simplify is the prior authorization process. For people with lung, breast or prostate cancer who need prior authorizations for MRI or CT scans, Aetna is bundling multiple authorization requests into one up front approval.
Later this year, the company plans to add additional bundles for cardiology and musculoskeletal conditions. This initial scope has the potential to help thousands of members across Aetna’s commercial and Medicare plans and the medical professionals caring for them.
“We have also introduced our Aetna Clinical Collaboration (ACC) program, which focuses on improving care transitions for patients moving between care settings. In this program, our nurses work with other medical professionals to help members get to the most appropriate care setting when they leave the hospital,” the company said. "Our goal is to reduce 30-day readmission rates and emergency room visits, resulting in improved care outcomes and cost savings.”
Aetna added that what makes this program unique is that Aetna nurses work on-site at healthcare facilities, collaborating directly with a patient’s care team to coordinate a transition from the hospital to their home or other community care program based on the individual’s health needs. “By comprehensively supporting a person’s healthcare touch points — medical, pharmacy, mental well-being and other areas — there is a seamless transition to care at home or in a community setting with a proactive care plan in place,” the company said.
Aetna added that it has successfully launched the ACC program providing support for Medicare Advantage members transitioning out of a hospital setting and reducing hospital readmissions. “We expect to expand this program later this year to other facilities, and to commercial members, people under 65 who get their health benefits from their employer,” the company said.
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Recent updates to the Aetna Health app give Aetna members access to features like Smart Compare that helps match members with medical professionals who are suited to the member’s health needs and budget. “In addition, we provide status badges showing prior authorization progress, expanded information about service quantities (such as hospital stays and physical therapy visits) and clearer explanations of coverage decisions. These improvements allow members to better track their care journey and understand their authorization status without repeatedly contacting their providers for updates,” Aetna explained.