After more than eight months of negotiation, Emory
Healthcare (EHC) will terminate its participation as a provider
of health services for Aetna Health Inc., effective Dec. 31.
Although Aetna manages EmoryChoice, the decision should not be cause
for concern for those Emory employees who use EmoryChoice as their
healthcare insurance. Alice Miller, vice president for Human Resources
(HR) for the University, and Peg Bloomquist, senior director of
HR for EHC, are now sending letters to all Emory employees with
EmoryChoice, assuring them that no employee or family member who
has health insurance as part of their Emory benefits plan will experience
any interruption in insurance coverage. The decision does not affect
the other Emory plans.
Emory is in the process of choosing another insurance company to
manage EmoryChoice, and a new arrangement will be in place before
the termination with Aetna. Because EHC postponed the effective
date of termination until Dec. 31, Emory employees will continue
their coverage as is, with no need to do anything until the regularly
scheduled Open Enrollment period this fall.
Patrick Hammond, EHC senior director of managed care and employer
support services, said the decision to terminate participation for
Aetna was a difficult one.
“We recognize,” Hammond said, “that more than
300,000 people in greater Atlanta who are now covered by Aetna will
be affected by this decision. For those [non-Emory] patients, Emory
Healthcare will no longer be considered an in-network participating
provider on Jan. 1, 2004.
“Emory Healthcare and Aetna Health Inc. were unable to reach
an agreement on reimbursement rates that we believe is fair to our
patients, to Emory Healthcare providers and to the other 90-plus
health care plans in which we participate at rates similar to those
we offered Aetna,” Hammond continued. “Emory’s
policy is simple: We offer fair and appropriate reimbursement rates
that reflect the cost of providing care. We also believe payors
with whom we participate should allow all their members—not
simply PPO network members—access to Emory’s world-class
As health care costs continue to rise, Aetna’s average annual
rate increase of payment to EHC over the past three years has been
less than 2.5 percent. At the same time, according to Aetna’s
public premium filings, the company has increased its premiums and
administrative allocation an average of 14.5 percent per year.
During this same period, the average hospital consumer price index
(considered the national industry trend of expenditures hospital
incur to deliver care) has increased more than 7 percent annually
due to nursing and other skilled health care professional labor
shortages and the increasing cost of technology and drugs.
As an academic health center, Emory treats a high proportion of
patients with severe and complex illnesses, or who need state-of-the-art
treatments not easily available elsewhere, all the while keeping
its costs in line with industry trends, especially in comparison
with comparable health centers.
“Emory already has taken many steps to reduce costs,”
Hammond said. “Had we accepted Aetna’s proposal, Emory
would have lost more than $1.5 million on hospital services alone.
We would have been forced to make further cuts that we believe would
affect the type of services and quality of care for which we are
known throughout the region. We are unable to continue to work with
an insurance company that is not willing to provide adequate reimbursement
to cover the increased costs of providing care.”
“We are glad we will be able to ensure continuing coverage
and full access to Emory Healthcare services to our own employees,”
said John Fox, EHC president and CEO. “We wish we could do
something similar for the rest of our patients who are in other
employer plans administered by Aetna. There are many excellent health
care providers in the Atlanta community, but because of our highly
specialized services and experience, we believe access to our care
is an important dimension of being covered. We regret anyone may
be denied that access.”