A few days after finding itself in hot water with the Connecticut attorney general, Aetna US Healthcare announced its plan to improve relationships with physicians.
The nation's largest health insurance company says that the timing was coincidental and that it has always been dedicated to working with physicians.
The company recently appointed John Kelly, M.D., to head its physician relations unit. Kelly had worked with the American Medical Association as department director of the AMA's quality efforts.
"(Aetna has been) providing very practical information to physicians about the quality of care they provide," he says. The company will continue to send guidelines to physicians on caring for conditions such as asthma, diabetes and heart disease, Kelly says. The health plan also has sent physicians lists of enrollees whose diseases such as asthma or diabetes could be better managed.
Aetna has more than 20 million enrollees and contracts with more than 300,000 physicians.
"If we can get information to physicians about the recommended services or other kinds of practical information, it will make it easier for them to do business with us," Kelly says. The physician relations unit is "something that is a logical outgrowth of our standing commitment on the part of the organization to physicians," Kelly says.
The Connecticut State Medical Society doesn't see it that way. Appointing Kelly was a smart move, but it's not enough, says Tim Norbeck, executive director of the society, which represents 7,100 physicians.
"I think that Aetna did it because they understand their relationship with physicians is tenuous at best," he says. "The all-products clause has got to go. It's not friendly to patients or physicians."
The all-products clause requires that doctors who see patients covered under one Aetna plan must agree to see patients covered by all Aetna plans. This policy prompted the Connecticut attorney general to investigate the company to see whether the clause violates state or federal legislation.
Physicians also object to Aetna's practice of using data on how often physicians refer patients to specialists or hospitals to determine compensation, Norbeck says.
In a statement, Aetna says the company is "committed to providing access to high-quality care, and we believe our provider contracts support that commitment." The statement further says that the company is "surprised and disappointed at the Connecticut State Medical Society and American Medical Association's reaction to provider contracts that have been used successfully for many years."
In late September, the medical society took out full-page ads in each of Connecticut's daily newspapers. The ads read, in part, that "Aetna is playing doctor with our patients."
"We questioned the onerous and coercive" policies Aetna has, especially the all-products clause, Norbeck says.
Other insurers in the state have unfair policies as well, but "Aetna is the most egregious," Norbeck says. "We also think there are many insurers laying in wait to see if they can get away with it."