Aetna: We Need to Contain Costs

For years I have said managed care companies are misnamed since hardly any of them really focus on doing just that. Given the impending changes of health care reform (e.g. mandated medical loss ratios) managing care and therefore costs will be imperative. Aetna is one large carrier that understands this. For years the company has invested hundreds of millions of dollars in "data mining" to help them identify members who need certain kinds of preventive care to lessen the chances of the condition worsening. This of course would be a win both for the company and for the member and their employer. Aetna is still on this course according to the WSJ:

"Aetna M&A strategy includes investment in businesses that can help manage medical costs and quality, [Aetna chief executive Ronald A. Williams] said, noting that the health overhaul is designed to expand access to health coverage yet doesn't address affordability. ... As the new overhaul goes into effect, Aetna expects to continue to 'earn an appropriate profit,' which will allow the company to make investments aimed at lowering medical costs and improving quality, 'and make certain that we're delivering both value for our customers as well as value to you, the shareholders of Aetna stock,' he said" .

While I commend Aetna for this strategy I learned recently from an industry source that the company has yet to prove to large employer groups that the data mining has/will save them money. It is because of this lack of proof that large national accounts have switched from Aetna back to Blue Cross and Blue Shield Plans because of their superior provider discounts. These discounts produce discernable savings immediately versus ones that will or may occur in two years or more.