Aetna launches Institutes of Quality Program

by | Blog

Aetna recently announced their Institutes of Quality (bariatric surgery, cardiac care, orthopedic care) and Institutes of Excellent Programs (transplant surgery & infertility clinics).

These Institute programs are the first of many that we are likely to see from private payers, where providers are required to meet a set of quality and operational requirements in return for preferential positioning within networks.

For example, with the Orthopedic Program, Aetna have a number of important requirements including:

  • Accreditation (at least one from a selection of chosen bodies)
  • Reporting of orthopedic case information to external registries
  • A documented continuous quality improvement program with initiatives focused on continuously monitoring and improving orthopedic care

There are also a number of mandatory procedure based requirements, for example that a facility must have performed at least 200 knee replacement surgeries in the past 12 months and at least one physician who performed at least 50 knee replacements in the same period.

In order to succeed in this kind of environment, it’s important to be proactive about quality measurement and improvement. While programs like these are in their early days you can expect to see them crop up in more specialties with a greater focus on quality improvement and patient-centered outcomes.

Read more about Aetna’s programs here.

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