Aetna's headquarters in Hartford, Connecticut. Credit: JHVEPhoto.com/Adobe Stock
Aetna is offering employer plan sponsors a program that will use copayment cuts to try to steer patients toward high-value doctors.
The CVS Health subsidiary is basing the new Informed Choices program on the Aetna Smart Compare provider grading program. The Smart Compare program came to life in 2021, where program managers give providers scores based on quality and cost-effectiveness.
The program now measures the performance of allergists, cardiologists, cardiothoracic surgeons, dermatologists, endocrinologists, gastroenterologists, general surgeons, medical oncologists, nephrologists, neurologists, neurosurgeons, orthopedic surgeons, otolaryngologists, plastic surgeons, primary care physicians, pulmonologists, rheumatologists, urologists and vascular surgeons.
The Informed Choice program will offer patients access to "lower copayments for all of these specialties, except medical oncology," according to a notice included in a bulletin sent to providers earlier this month.
The size of the copyament reductions was not immediately available.
The thinking: Traditionally, U.S. health plans have used copayment obligations — requirements that patients pay small, fixed amounts of cash up front when they get care — to discourage frivolous use of care.
Plans have used deductibles, or requirements that a patient pay for a significant amount of care before the plan begins providing full coverage, as their main tool for encouraging patients to think twice before getting expensive care.
Today, some health policy specialists argue that high deductibles may keep patients from getting the care they need to prevent small problems or chronic problems from turning into big, dangerous, costly problems.
Critics of high deductibles call for plans to shift toward "smart pricing" strategies, or use of copay provisions or other plan provisions to give patients gentle nudges toward use of what the plans believe to be necessary, high-value care from providers who do their best to keep costs under control.
Advocates of smart pricing hope it will encourage patients to use high-value providers without hurting their ability to get care from more expensive providers with specific skills or care from any qualified provider in areas with shortages of certain types of provider.
Variable copay plans: Some plans are now using "variable copay" strategies as their main strategy for managing patients' use of care.
Two of the best-known variable copay plan programs are HealthPartners' Simplica NextGen Copay plan and UnitedHealth's Surest plan.
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