**Aetna Expands Hospital Program to Reduce Readmissions and Enhance Patient Care**

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Aetna Expands Clinical Collaboration Program to Enhance Hospital Support and Medicare Advantage Outcomes

NEW YORK, NY – Aetna, a CVS Health company, is extending its Aetna Clinical Collaboration (ACC) program to ten hospitals across teh country by year-end, bolstering support for healthcare providers and improving outcomes for Medicare Advantage members. New partnerships have been secured with AdventHealth Shawnee Mission, Houston methodist, and WakeMed Health & Hospitals.

The ACC program pairs Aetna nurses with hospital staff to optimize care for members enrolled in medicare Advantage plans. Hospital readmissions are a meaningful concern, particularly among seniors, with approximately 20% of hospitalized Medicare patients being readmitted within 30 days of discharge. This program directly addresses this issue.

The goal of the ACC program is to reduce 30-day readmission rates and emergency department visits for Aetna medicare Advantage members while alleviating administrative burden for hospitals and clinical teams. Dr. Ben Kornitzer, Senior Vice President and Medical Director of Aetna, emphasized that “the hospital discharge is one of the most critical and vulnerable moments in a patient’s care journey.”

Launched earlier this year, the program has already seen promising initial results, with roughly one in four participants actively engaged with an Aetna care manager. When fully implemented, Aetna anticipates a 5% reduction in both 30-day readmissions and hospital length of stay.

Aetna serves over 4 million members over the age of 65 and plans to further expand the ACC program throughout its provider network in 2026 and beyond. The program is also being applied to Aetna’s commercial plans.

This initiative follows a recent Centers for Medicare & Medicaid Services (CMS) rule requiring Medicare Advantage plans to include hospital readmissions in their care quality calculations beginning in 2027. While the American Hospital Association expressed concerns that these rules could unfairly penalize hospitals, Aetna views the program as a proactive way to improve patient care and outcomes.

A CVS Health spokesperson stated the program benefits both Aetna members and providers, indicating an intention to support similar initiatives in the future.

At the time of this reporting, CVS Health stock closed trading at $75.19, up 0.36%.

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Aetna, a CVS Health company, is significantly expanding its successful hospital program, focusing on proactive discharge planning, post-acute care coordination, and chronic disease management to demonstrably lower hospital readmission rates and elevate the overall quality of patient care. This initiative, building on existing partnerships, represents a significant investment in value-based care and preventative health strategies. The expansion, slated for full rollout by Q4 2025, will initially target members in key geographic areas with high rates of preventable hospital revisits.

Understanding the Core of the Program: Aetna’s Approach to Readmission Reduction

Aetna’s program isn’t simply about limiting hospital stays; it’s about ensuring patients receive the right care, at the right time, and in the right setting. The core tenets revolve around a multi-faceted approach:

* Early Identification of High-Risk Patients: Utilizing predictive analytics and risk stratification, Aetna identifies members likely to experience complications or require readmission following discharge. Factors considered include age, pre-existing chronic conditions (like heart failure, diabetes, and COPD), socioeconomic determinants of health, and prior hospitalization history.

* personalized Discharge Planning: Moving beyond standard discharge instructions, Aetna collaborates with hospitals and physicians to create individualized plans.This includes medication reconciliation, scheduling follow-up appointments, arranging for home health services, and addressing potential barriers to adherence.

* Transitional Care Management (TCM): A dedicated care team provides support during the critical transition period following discharge. This often involves phone calls, virtual check-ins, and in-home visits to monitor symptoms, answer questions, and reinforce self-management strategies. Transitional care is a key component in preventing complications.

* Post-Acute care Coordination: Seamlessly connecting patients with appropriate post-acute care services – such as skilled nursing facilities (SNFs), rehabilitation centers, and long-term acute care hospitals (LTACs) – based on their specific needs. aetna emphasizes network quality and ensures continuity of care.

* Behavioral Health Integration: Recognizing the significant impact of mental health on physical health outcomes, the program integrates behavioral health support for patients struggling with depression, anxiety, or other mental health conditions.

The Role of Technology and Data Analytics in Aetna’s Strategy

The program’s success hinges on leveraging technology and data analytics. Aetna utilizes several key tools:

* Real-Time Data Monitoring: Aetna’s platform integrates with hospital electronic health records (EHRs) to provide real-time insights into patient conditions and potential risks.

* Predictive Modeling: Sophisticated algorithms analyze patient data to identify individuals at high risk of readmission, allowing for proactive intervention. This includes identifying patients at risk for avoidable readmissions.

* Telehealth Integration: Expanding access to telehealth services allows for remote monitoring, virtual consultations, and convenient follow-up care.

* Care Management Platforms: Dedicated platforms facilitate communication and collaboration among care team members, ensuring coordinated care delivery.

* Remote Patient Monitoring (RPM): Utilizing devices to track vital signs and other health metrics remotely, enabling early detection of potential problems. RPM is becoming increasingly important in preventative care.

Benefits of Aetna’s Expanded Hospital Program

The expanded program offers a range of benefits for all stakeholders:

* For Patients: Improved health outcomes, reduced risk of complications, enhanced quality of life, and greater peace of mind. Better patient engagement is a key outcome.

* For Hospitals: reduced readmission penalties from CMS (Centers for Medicare & Medicaid Services), improved Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores, and enhanced reputation.

* For Aetna: Lower healthcare costs, improved member satisfaction, and a stronger position in the value-based care market.

* For Employers: Healthier workforce, reduced absenteeism, and lower healthcare premiums.

Real-World Examples & Case Studies

While specific patient details remain confidential, Aetna has shared anonymized data demonstrating the program’s effectiveness. A pilot program implemented in Florida with a network of participating hospitals showed a 15% reduction in 30-day readmission rates for patients with heart failure. another case study involving patients with chronic obstructive pulmonary disease (COPD) revealed a 10% decrease in emergency department visits within six months of enrollment in the program. These results highlight the potential for significant improvements in patient care and cost savings.

Addressing Common Challenges in Readmission Reduction

Aetna acknowledges the challenges inherent in reducing readmissions and has implemented strategies to address them:

* Social Determinants of Health: Recognizing that factors like housing instability, food insecurity, and transportation barriers can significantly impact health outcomes, Aetna connects patients with community resources to address these needs.

* Medication Adherence: Providing medication reminders,simplifying medication regimens,and addressing cost concerns to improve adherence.

* Patient Education: Empowering patients with the knowledge and skills they need to manage their conditions effectively.

* Caregiver Support: Engaging family members and caregivers in the care process to provide additional support and assistance.

The Future of Aetna’s Hospital Program: Focus on Preventative Care & digital Health

Looking ahead, Aetna plans to further expand the program’s reach and incorporate new technologies. Key areas of focus include:

* Increased Investment in Preventative Care: Shifting the focus from reactive treatment to proactive prevention through wellness programs and early intervention strategies.

* Expansion of Digital Health Solutions: Leveraging mobile apps, wearable devices, and other digital tools to enhance patient engagement and remote monitoring.

* Artificial Intelligence (AI) and Machine Learning (ML): Utilizing AI and ML to refine predictive models, personalize care plans, and automate administrative tasks.

* Greater Collaboration with Community-Based Organizations: Strengthening partnerships with local organizations to address social determinants of health and provide comprehensive support to patients. Community health workers will play a larger role.

This expansion underscores Aetna’s commitment to transforming healthcare and delivering value-based care that improves the health and well-being of its members. The program’s success will depend on continued collaboration with hospitals, physicians, and community partners, and also a relentless focus on innovation and patient-centered care.