Over the summer, Aetna made a commitment to ease friction for both patients and providers.
Now, the company is offering a look at the progress it's made toward that goal. The insurer, a subsidiary of healthcare giant CVS Health, said in an announcement that it is leaning on technology to make bundled prior authorization determinations.
Previously, authorization requests for medical claims and pharmacy claims needed to be submitted separately. For instance, a patient seeking in vitro fertilization treatment would need to have a request sent for the procedure itself, followed by a second request for the necessary medications, Aetna said.
Beginning in November, however, providers could submit medical prior authorization requests to Aetna, and if approved, the associated medications under the pharmacy benefit are also approved automatically.
In addition, in the same month, Aetna rolled out a bundled prior authorization offering in the musculoskeletal space, according to the announcement. That offering includes key x-rays, knee arthroplasty procedures, non-opioid pain medications, durable medical equipment and inpatient admissions if needed.
The insurer launched similar prior auth bundles for lung, breast and prostate cancer earlier this year, Aetna said.
“Aetna committed to several bold actions earlier this year that were intended to improve the American healthcare industry and I’m proud of the progress we’ve made against these commitments,” said Aetna president Steve Nelson in the announcement.
“Working in partnership with stakeholders across the industry, I am optimistic that we can achieve our shared purpose of simplifying the healthcare system to make it easier for consumers to navigate and access affordable, personalized solutions," Nelson said.
Aetna also highlighted its Clinical Collaboration Program, which pairs Aetna nurses with hospital staff to support care for Medicare Advantage members. The company estimates that this initiative will reduce the length of stay and year-over-year 30-day readmissions by 5% for its members once it's fully rolled out.
Aetna is currently implementing the program in 17 hospitals and medical facilities, and intends to continue expanding MA as well as the commercial market, according to the announcement.
The company is also leaning on artificial intelligence as part of its push to ease friction for members and providers. This includes its new member app that the team is building out with new tools and experiences. Last month, the insurer unveiled its conversational AI assistant, which is embedded throughout the app and web experience for members.