Aetna ends two Medicare advantage programs while a Medicare experiment grabs attention

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Oct 14 2009

A health insurer ends two Medicare Advantage programs in Connecticut, while providers nationwide examine a Medicare demonstration program in Texas.

The Hartford Courant reports: "Aetna Inc. said that it has terminated two Medicare Advantage plans, affecting about 200 individual plan members in Connecticut. One plan, an HMO, had 75 members and had fallen below the minimum of at least 100 members required by the federal government, Aetna said. The other, a private, fee-for-service plan, is being phased out by Aetna in all but five states. The termination of the plan is the result of the federal government's mandating that all fee-for-service plans become network-based by 2011, said Walter Cherniak, an Aetna spokesman." Cherniak said Aetna will only keep fee-for-service plans in states where it can build the required networks for Medicare Advantage plans by 2011. "The plan terminations in Connecticut, Cherniak said, aren't related to the debate over reducing Medicare reimbursements to fund health care reform" (Gosselin, 10/13).

Meanwhile, the San Antonio Express reports: "In an experiment taking place here and being closely watched across the country, Medicare is studying whether it can cut the cost of expensive procedures by letting everyone — patients, doctors, hospitals — share in the savings. To do that, the federal government has given participating hospitals the green light to do something they're normally forbidden by anti-kickback laws to do — give doctors some of the money they squeeze from the system. In turn, the hospital gives Medicare a discount. And Medicare sends the patient a check for half the money it saved."

"The five-hospital Baptist Health System has been taking part since June in what Medicare calls its three-year Acute Care Episode, or ACE, demonstration project. It is the second of five participating hospital systems to be up and running. The other systems are in Oklahoma, Colorado and New Mexico. 'We've got our own little reform going on here in San Antonio that is on the national stage,' said Michael Zucker, chief development officer of the Baptist system" (Finley, 10/13).

This article was reprinted from khn.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.