Aetna Health Insurance is instituting a physician comparison system for its self-insured members in 2022, in which primary care physicians, obstetrician-gynecologists, and orthopedic hip-and-knee specialists can earn a “designation” based on their performance in two categories.
The insurer began notifying physicians earlier this month about Aetna Smart Compare. Under the new system, Aetna will evaluate the three specialties in the categories of effectiveness and clinical quality. Positive results – i.e., results where physicians have exceeded Aetna’s benchmarks and earn the designation for delivering “high-quality effective care” – will be available through Aetna’s digital search tools so members can identify those physicians. Members will be able to see Quality Care and Effective Care labels for physicians as part of the member searches.
Smart Compare will evaluate physicians’ performances based on codes and measures unique to each specialty. Because of the COVID-19 pandemic, Aetna is excluding 2020 claims and is instead using 2018-19 claims data for its initial 2022 designations.
OB-Gyns and hip-and-knee specialists began receiving letters from Aetna notifying them of their 2022 Smart Compare status during the first week of November, and primary care physicians are scheduled to receive notifications at the end of November, Aetna told TMA staff. The letters tell physicians whether or not they earned the designation in each category, or if there was insufficient information for scoring.
Upon receiving the letter, physicians can request a more detailed overview of their results and can also request a reconsideration in writing within 45 days of receiving the letter.
More information on Aetna Smart Compare and its methodology is available on the insurer’s website.
Last Updated On
November 15, 2021
Originally Published On
November 15, 2021