Aetna Expands Hospital Readmission Reduction Program for Medicare Advantage Members
An Aetna spokesperson reported that one hospital piloted the program for several months and achieved early successes, sparking interest from other healthcare operators.
Dive Brief:
- Aetna is expanding a program that integrates its nurses into hospitals to help prevent avoidable readmissions for Medicare Advantage members.
- The CVS-owned insurer plans to scale the program, called Aetna Clinical Collaboration (ACC), to 10 hospitals by the end of the year, with implementations underway at AdventHealth Shawnee Mission in Kansas, Houston Methodist in Texas, and WakeMed Health and Hospitals in North Carolina.
- The ACC program aims to reduce unnecessary 30-day readmissions and emergency room visits, improve patient outcomes, and lower healthcare costs.
- Some critics have raised concerns that programs like this could be designed to increase insurers’ profits at the expense of patients.
Dive Insight:
Avoidable hospital readmissions remain a significant issue, particularly for seniors. According to a study cited by Aetna, nearly 20% of Medicare beneficiaries are readmitted within 30 days of discharge, and other research indicates that up to three-quarters of adverse post-discharge events could be prevented or mitigated.
Aetna’s Clinical Collaboration (ACC) program embeds nurses directly within hospitals to improve care coordination and assist patients in managing new diagnoses, complex medications, and follow-up needs. The goal is to prevent complications that can lead to readmission, explained Dr. Ben Kornitzer, Aetna’s chief medical officer.
The program has been piloted for several months at one hospital, with early successes generating interest from additional hospitals, according to an Aetna spokesperson. However, the company declined to share a full list of current participants or the hospitals planning to implement ACC later this year.
The expansion signals the beginning of a broader rollout to Aetna’s more than 4 million members aged 65 and older, with plans to continue extending ACC into 2026 and beyond, including to commercial members. Once fully implemented, Aetna anticipates the program could reduce 30-day readmissions and hospital lengths of stay by 5% year-over-year.
ACC has the potential to benefit multiple stakeholders: patients may avoid preventable health issues post-discharge; hospitals could free up beds for more acute cases; and payers could reduce unnecessary healthcare spending, which continues to climb despite ongoing industry efforts.
However, there are concerns when insurers become overly aggressive in managing care, as this could limit access to necessary services. Such worries, particularly in the privatized Medicare Advantage program, have fueled public debate over programs like ACC and the balance between cost control and patient care.
UnitedHealthcare, for instance, is under scrutiny from lawmakers for a program that incentivized nursing homes to limit hospital transfers for its members. An investigation by The Guardian in May found that the program—which placed UnitedHealthcare medical teams within nursing homes—may have prevented some residents from receiving timely hospital care, potentially worsening their conditions.
UnitedHealth, the parent company of UnitedHealthcare, denies the claims and has filed a lawsuit against The Guardian over its reporting.
An Aetna spokesperson noted that while the insurer anticipates cost savings as its program scales, these benefits are “further out.”
“The primary motivation for launching this program now is to address critical challenges hospitals face regarding emergency department capacity and timely patient discharge,” the spokesperson said. “We aim to be a preferred payer for healthcare providers, and partnering with them to solve these issues will help us achieve that goal while also enhancing the experience for our members.”
