By Amina Niasse
NEW YORK (Reuters) -CVS Health’s Aetna insurance arm will expand a nascent program pairing members in its privately run Medicare plans with nurses – an effort the company says will reduce hospital readmissions, which are costly and can be detrimental to patient health.
For patients on the Medicare Advantage plans for people 65 and older, the program might assign Aetna-employed nurses to those who are released from hospitals or transitioning into a nursing facility or who have disabilities to navigate additional needs. Services provided range from coordinating in-home care to ensuring transportation to follow-up appointments.
“Our goal is to literally have a nurse at the bedside with that member, with that family, beginning to think through what their care journey should look like,” said Dr. Ben Kornitzer, chief medical officer at Aetna.
CVS’s move comes after the Centers for Medicare & Medicaid Services in July finalized a rule that includes Medicare Advantage members in calculations for readmission penalties applied to hospitals, effective in the fiscal year 2027.
The American Hospital Association has protested that this inclusion would wrongfully penalize hospitals for negative outcomes associated with coverage delays and denials.
The government insurance agency recalculates performance each year and flags hospitals with higher-than-expected readmissions over 30 days for some conditions, before reducing payments by up to 3% of discharge fees paid.
For the fiscal year 2023, 75% of hospitals subject to the rule faced penalties, according to an analysis of government data by research firm the Advisory Board.
A spokesperson for CVS Health said the program is meant to improve patient health, which would benefit Aetna and providers, adding the company will push for similar programs moving forward.
CVS said it will implement the program in 10 hospitals by the end of the year, including hospitals AdventHealth Shawnee Mission in Kansas City, Kan., Houston Methodist in Texas, and WakeMed Health & Hospitals, in Raleigh, N.C.
“Sometimes the health plan is more helpful in giving discharge instructions, because they have a vested interest in keeping the patient better,” said Sadhna Paralkar, a senior vice president at health consultancy Segal.
(Reporting by Amina Niasse; editing by Caroline Humer and Edwina Gibbs)
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