25 things to know about Aetna

Aetna's roots go back to the 1850s, when Aetna Insurance Company organized an annuity fund to sell life insurance. Since then, Hartford, Conn.-based Aetna has become one of the nation's largest insurance companies, providing insurance to roughly 46 million people.

Here are 25 things to know about Aetna.

The basics

1. Aetna's company name is inspired by Mt.Etna — an 11,000-foot volcano on the eastern shores of Sicily, Italy, which is the most active volcano in Europe.

2. Aetna was founded in 1853, and Eliphalet A. Bulkeley was the company's first president. The insurer introduced major medical coverage in 1951, when a labor shortage paired with wage freezes made employee benefits all the more critical for worker retention. Aetna paid its first Medicare claim in 1966 and created an HMO subsidiary in 1973.

3. As of March 2015, Aetna had 23.7 million medical members, approximately 15.5 million dental members and approximately 15.4 million pharmacy benefit management services members.

4. Major Aetna players include:

  • Mark T. Bertolini, chairman and CEO of Aetna, who serves as the company's executive sponsor for diversity, participates in several Aetna employee resource groups, and maintains a blog to communicate with employees.
  • Karen S. Rohan, president of Aetna, who is responsible for the company's core institutional businesses.
  • Shawn M. Guertin, executive vice president, CFO and chief enterprise risk officer of Aetna, who is responsible for leading all of the corporation's financial activities
  • Harold Paz, MD, executive vice president and CMO of Aetna, who leads clinical strategy and policy at the intersection of all of Aetna’s domestic and global businesses.

5. As of March 2015, Aetna's network, which stretches across the U.S. and much of the world, consisted of more than 1.1 million healthcare professionals, more than 674,000 primary care physicians and specialists, and 5,589 hospitals.

6. Aetna participates in Patient Protection and Affordable Care Act health insurance marketplaces. In May 2014, Aetna reported it had more than 600,000 exchange enrollees. 

7 Aetna has roughly 49,350 employees.

8. In January, Aetna set its wage floor to $16 an hour for its lowest paid employees, boosting the employees' incomes by as much as 33 percent.

9. The wage increase was expected to cost Aetna $26 million annually, but Mr. Bertolini predicted the higher wages will allow Aetna to offset some costs by reducing the $120 million spent each year on employee turnover-related costs.

Merger talks and finances

10. Aetna is among the major payers involved in the merger frenzy talks that are going on in the health insurance sector. Within the last two weeks Anthem has made two takeover bids for Cigna, and Cigna has rejected both of them. Additionally, The Wall Street Journal reports Aetna has demonstrated interest in taking over Humana.

11. Most recently, UnitedHealth Group approached Aetna about a takeover deal that would likely be valued at more than $40 billion.

12. Aetna's 2014 revenue was approximately $58 billion.

13. Aetna reported net income of $777.5 million on $15.1 billion in revenue for the first quarter of fiscal 2015, up from net income of $665.5 million on $14 billion in revenue a year earlier.

14. Aetna's operating revenue was up 8 percent in the first quarter of fiscal year 2015, growing to $15.1 billion.  

15. The company's financial growth was partially attributable to an increase in medical membership, which totaled approximately 23.7 million as of March 31 — a sequential increase of 122,000 members.

16. Based on its Q1 financials, Aetna projects operating earnings per share for the full year 2015 in the range of $7.20 to $7.40, up from its original guidance of at least $7.00.

Accountable care agreements

17. Approximately 3.2 million Aetna members receive care through accountable care agreements, and 30 percent of Aetna's claims payments go to providers practicing value-based care. Aetna plans to increase the number of such claims payments to 50 percent by 2018 and 75 percent by 2020.

18. Here are a few accountable care agreements the payer recently struck with providers: In April, Atlanta-based Emory Healthcare and Aetna announced plans to form a new accountable care organization. In May, Cigna and Hackensack, N.J.-based Regional Cancer Care Associates announced the launch of a value-based initiative to improve care for patients receiving chemotherapy. That same month, Aetna and Omaha, Neb.-based CHI Health announced the launch of an ACO for employers.

19. A 2012 case study including 750 Medicare Advantage members receiving services from the accountable care agreement between Aetna and Portland, Maine-based NovaHealth found patients had 50 percent fewer hospital days, 45 percent fewer admissions and 56 percent fewer readmissions than the rest of Maine's Medicaid population. Additionally, healthcare costs for patients in the pilot program were 16.5 to 33 percent lower than costs for members not in the program. The case study was published in Health Affairs.

20. Aetna has also formed patient-centered medical homes. Aetna and Purchase, N.Y.-based WESTMED Medical Group were able to reduce hospital admissions among their patients by 35 percent in the first year after forming their patient-centered medical home. WESTMED physicians also reportedly met or exceeded 90 percent of their targeted goals for diabetes management and screenings, cancer screenings and heart disease.

Legal disputes, rankings and other issues

21. Aetna was named No. 32. in Diversity publication DiversityInc's ranking of Top 50 Companies for Diversity, an annual list now in its 16th year. More than 1,600 companies participated in DiversityInc's survey in 2015.

22. In the 2015 edition of athenahealth's PayerView report, Aetna ranked second overall among commercial and major payers. Payers were ranked based on metrics such as days in accounts receivable, claim resolution rate, denial rate and more.

23. Aetna is among the key players in the healthcare industry that joined the Clear Choices Campaign, a healthcare coalition which will advocate for more transparent, accountable and consumer-friendly health markets.

24. This year has not been free from controversy for Aetna. Earlier this month, East Texas Medical Center Tyler filed a lawsuit in excess of $1 million against three of the largest health insurance companies in the state — Blue Cross Blue Shield of Texas, Aetna and Cigna — claiming exclusion from their preferred provider networks has created "serious and negative consumer impact."

25. In February, Aetna filed a lawsuit alleging that North Cypress (Texas) Medical Center and its CEO engaged in an illegal kickback scheme and used deceptive billing practices that led Aetna Life Insurance to overpay the physician-owned community hospital by as much as $120 million.

 

More articles on payers:

25 things to know about Cigna
Cigna rejects 2 takeover bids from Anthem
25 things to know about Humana

 

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