Aetna Aexcel® Program
The Aexcel® program is a measurement and reporting initiative that serves as a provider tiering strategy for Aetna plan products. The program provides information about specialty physician performance and cost of care to help Aetna members with health care decision-making. Better decision-making can lead to improved health outcomes, contributing to increased productivity and decreased absenteeism. The program was first launched in three markets on January 1, 2004, and has expanded to 34 markets as of 2010.
The Aexcel® program uses a claims-based evaluation methodology in a peer-to-peer comparison of quality and efficiency measures for 12 specialty clinical areas. The measures for each clinical area are based on standards created by nationally recognized associations, such as NQF, Agency for Healthcare Research and Quality (AHRQ) and NCQA. Claims data is also used to evaluate the hospital readmission rate and rate of health complications, which is part of the evaluation criteria for the program.
Employer customers and Aetna members can use the physician performance results to select a physician from the network of specialist providers through the Aetna DocFind directory. Physicians that meet the program qualifications are denoted with a . In addition, patients may receive incentives, depending on the plan design created by the employer, for obtaining care from a physician in the Aexcel® network.
While the program has been expanding to more markets, the Aexcel® program faces several challenges, including physician inclusion at early stages and claim based reliability. The program has been adopted by many large employers since the program began in 2004. Due to the challenges in the healthcare industry, small employers may start to adopt this program as well. Since healthcare quality and efficiency are the focus of the recent health reform, Aetna may partner with organizations, such as Accountable Care Organizations, to improve quality and cost efficiency for patients.
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