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CVS Health company Aetna announced plans to scale the Aetna Clinical Collaboration (ACC) program to 10 hospitals by the end of the year, with some implementations already underway.
The program has already begun at AdventHealth Shawnee Mission, Houston Methodist, and WakeMed Health and Hospitals, Aetna said.
The ACC program brings Aetna nurses together with hospital staff, working side-by-side to help Medicare Advantage members get the care and support they need to remain healthy when they return home from the hospital, or make the transition into a skilled nursing facility.
According to data published in Patient Safety Network, hospital admissions occur more often among older populations, with about 20% of Medicare-insured patients who are hospitalized being readmitted within 30 days of being discharged.
The ACC program, said Aetna, aims to improve care outcomes for Aetna Medicare Advantage members, reducing their 30-day readmission rates and emergency room visits while also easing the administrative load on hospitals and clinical personnel.
WHAT'S THE IMPACT
Dr. Ben Kornitzer, senior vice president and Aetna chief medical officer, said that hospital discharge is one of the most important, and vulnerable, moments in a patient's journey.
“Patients may be managing new diagnoses, complex medications, and follow-up needs, all while coping with the stress of transitioning back home or to a new facility,” he said. “By embedding Aetna nurses within hospitals, we’re partnering with care teams to ensure that members are supported every step of the way and have the right services to stay well and avoid complications that could lead to readmission.”
The first ACC program was implemented earlier this year, with about one in four program members already actively engaged with an Aetna care manager.
Once fully implemented at scale, the ACC program is projected to reduce year-over-year 30-day readmissions and hospital length of stay by 5%, said Aetna.
THE LARGER TREND
Aetna announced earlier this year that it will be exiting the Affordable Care Act's individual markets in 2026.
President and CEO David Joyner said during an earnings call in May that the company was disappointed by “continued underperformance” from its individual exchange products and saw no path to improve its position.
Aetna has exited the ACA market before, in 2018, when it joined other insurers in leaving or downsizing its footprint, as premiums rose and insurers lost money.
In 2021, Aetna re-entered the market, with former CEO Karen Lynch saying at the time that the market had stabilized and resolved earlier "structural issues."
Yet Aetna has struggled since its reintroduction into the ACA exchange and posted an adjusted operating income loss of $924 million in 2024.
Jeff Lagasse is editor of Healthcare Finance News.
Email: jlagasse@himss.org
Healthcare Finance News is a HIMSS Media publication.