Quality measurement

At Aetna, we work constantly to improve the quality of health care for our members. We seek out and recognize clinical quality and efficiency among health care providers. We promote quality care at all levels. And we work with health care providers to measure and improve care quality and safety. We receive feedback from physicians through our Physician Advisory Board and quality committees. Their input also helps us to improve quality.

Care for complicated conditions

Through the Aetna Institutes™ program, we recognize facilities that offer high-quality, cost-effective health care. Aetna staff also coordinate care for members. This program has two parts:

• Institutes of Excellence™ (IOE)  These facilities provide care for highly specialized needs (for example, transplants).
• Institutes of Quality® (IOQ)  These facilities offer clinical services for more common health conditions (for example, bariatric surgery).

Our Institutes of Excellence™ care and claims management is part of our National Medical Excellence® program.

Aexcel®
Aetna's Aexcel network is also part of our National Medical Excellence program. Aexcel includes health care specialists  (PDF) in 12 areas. These specialists: 

• Are part of Aetna's network
• Meet industry-accepted practices for clinical performance
• Meet Aetna's efficiency standards

We choose specialists based on national standards that are consistent with leading associations.

The National Committee for Quality Assurance (NCQA) is an independent, not-for-profit organization that accredits health care organizations. It also recognizes physicians in key clinical areas.

The NCQA serves as an independent ratings examiner for Aetna. It reviews how Aetna’s Aexcel program meets criteria required by the State of New York. View the NCQA’s latest report on our compliance with New York’s requirements.

• Find out more about how we choose specialists.  (PDF)
• Learn the details in our "Physician Guide to Aexcel."  (PDF)

 Read our report cards; compare our quality

Quality Report Cards rate the quality of health plans' care and service in different states. These reports use a standard set of measures called the Healthcare Effectiveness Data and Information Set (HEDIS®). You and your patients can compare the experiences of Aetna members and those enrolled in other health plans.

Cooperation with doctors  

We work with the medical community to improve the quality of health care. Our Physician Advisory Board provides us with advice on issues important to doctors.