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Going forward, we advocate continued work in several key areas to help make health care reform more effective:

  • Addressing the true drivers of medical costs, which are responsible for rising health care premiums

  • Reforming the medical payment system

  • Harnessing the power of health information technology

  • Improving the quality of health care outcomes

Nationally and in states across the country, we strongly advocate a public-private coordination and collaboration. It is imperative that government and the private sector work together to make the goals of health care reform a reality.

Getting health care reform implementation right

Since the adoption of the Patient Protection and Affordable Care Act in March 2010, we are focusing on helping our constituents understand the operational impact of the new law and on achieving compliance to help fully realize the goals of reform. At Aetna, compliance is a core competency.

We are well positioned to meet the needs of the new health care marketplace, with our diverse array of health care products and services. Our Health Care Reform Project Management Office is working to translate the many provisions of the new health care law into workable business practices across the enterprise. We also continue to offer the benefit of our experience to the rule-making phase of reform implementation, to help ensure that the new law is implemented in a workable fashion.

While the adoption of health care reform was truly historic in helping to widen access to health care coverage, we know that much more can be done to help improve the quality of health care outcomes and help restrain the escalating cost of health care services. We will continue to lead the way in advocating solutions that fill this gap.

Payment focused on value, rather than volume

Improving health care delivery must include reforming our payment system to focus on quality and value. We support transforming the payment system into one that aligns provider reimbursement incentives with achieving high-quality outcomes for patients.

We must work together to test and identify new payment models and pay-for-performance programs that create incentives for improvements in performance, outcomes and quality of care. We have developed our own new payment structures to help promote a team approach to medicine and improve outcomes. To help focus greater attention system-wide on quality and costs, we committed resources in 2009 to develop and promote a special edition of Health Affairs focused on “Bending the Cost Curve,” and we brought together economists, researchers and public policy experts at a special kick-off event to promote real-world solutions.

The health information technology advantage

It is clear that any comprehensive approach to health care reform must include encouraging the widespread adoption of health information technology (HIT) tools. We need to enhance the delivery of health care by using HIT tools that enable providers and patients to make better use of the right data at the right time to make quality care decisions. HIT can facilitate vast improvements in individuals’ health care experiences by offering them a clearer picture of their own health, a more coordinated interaction with multiple health care providers, and better, safer health outcomes.

We believe the key to unleashing the power of HIT is to make data actionable. Making patient data more visible to physicians helps them make better decisions for their patients. It’s what has driven much of the $1.8 billion we have invested in HIT since 2005. For example, our CareEngine® clinical decision support system sent 16.9 million care alerts (identifying gaps in care, medical errors and quality concerns) to physicians in 2009.

Promoting health and wellness

Making the health care system work better also requires a renewed focus on wellness and preventive care. Investments should be made in programs that help consumers become more engaged in their health and adopt sustained behavior changes. Helping people get and stay healthy is an Aetna priority.

  • In early 2010, we launched a team-based fitness and nutrition program for employers nationwide that uses online social networking to encourage people of all health and fitness levels to work together to achieve their optimal health. Later in 2010, we added a Healthy Lifestyle Coaching program to our offerings.

  • Since 2008, we have partnered with Earvin “Magic” Johnson to promote health literacy, wellness and healthy behaviors in major urban markets across the country.

  • Approximately 2.5 million members are in disease management or case management programs that are helping people with chronic conditions and other needs get the treatment and preventive care they need by taking a wider, holistic view on health.

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