Aetna's Supposed Healthcare IT Prowess: The Bar is Set Awfully Low

A few weeks ago, I noted that Aetna (AET) is showing interesting — if still nascent — signs of transforming its business, in part due to its seemingly aggressive embrace of healthcare information technology. My BNET colleague Ken Terry echoed this theme when he recently pointed out Aetna’s sizable lead over its larger rival, UnitedHealth Group, in terms of offering personal-health records and mining medical and claims data to help its members search for useful health information.

All that may well be correct so far as it goes. But I’m a longtime Aetna member myself, and some of my recent experiences with the company demonstrate just how low a bar an IT “leader” in the health-insurance industry has to clear. Let’s just say that it isn’t exactly pretty.

Start with Aetna’s much-vaunted personal-health record. I’ve been on an Aetna plan for almost a decade, so I figured they’d have plenty of data to play with even though I’ve been pretty healthy over that period. Not exactly. My Aetna PHR doesn’t know my phone number, marital status (despite having held family coverage for most of the last decade), height, weight, blood type or blood pressure. Now, maybe not all of this information is available in the insurer’s claims data — but that says a lot about the weakness of that particular approach, IT commitment or no.

The PHR does have a list of every doctor I’ve seen in the past ten years, which is nice, and it seems to have tracked various travel and seasonal vaccinations pretty well. But its prescription record is pathetic — it lists two medications I took briefly four years ago, but there’s no mention of the half-dozen-odd times I’ve taken a course of antibiotics or some other prescription. Best of all, the PHR knows exactly what blood tests I got at my last physical — but it has no idea what any of the readings were, and in fact doesn’t even seem to know the “normal” range for the various tests.

Absent my taking time to fill in a lot of data for the PHR, in fact, it’s as close to useless as just about anything I’ve seen. (So there’s no way I’m about to experiment with exporting this sad collection of data to Microsoft’s (MSFT) HealthVault or Aetna’s own internal data-sharing network.) Sure, some information may be missing because my primary-care doctor only recently started keeping computerized medical records, but Aetna is supposed to be able to plumb pharmacy and laboratory records for this data as well. If my experience is any indication, they’ve vastly exaggerated their capabilities in that respect.

The second issue may seem trivial by comparison, although I think it’s also telling. I recently changed from a group to an individual Aetna plan, and for various reasons found it easiest to pay my premium via credit card. Doing so has entailed a monthly call to Aetna, each taking five to 10 minutes to navigated voice menus and then read my credit-card number to someone in the billing department.

So I figured I’d ask about having my card billed directly. Could I arrange that online? Heck, no — Aetna apparently has no ability to process online transactions by individuals. Could I arrange it by phone? Heck, no — although the billing person was kind enough to offer to send me the appropriate forms. By mail. In, as it turned out, a hand-addressed envelope (click for a slightly larger image — and yes, I’ve blurred my address):

The forms themselves appear to be blurry xeroxes of an Aetna application pamphlet of some sort. Why, exactly, it made sense for this unfortunate Aetna staffer to make copies, stuff them in an envelope and then address it by hand still kind of boggles the mind. But it speaks volumes as to how much progress Aetna has made applying modern IT to operations that directly affect its members.

Comments

[Chemist29:]

Haha, sometimes I forget how efficient the private sector is. Experiences like this (which are not difficult to find, everyone i've talked to has them!) really underscore the fact that health insurers might be the one of the worst run businesses. Cable companies give them a run for their money.

2008 Dec 24 12:02 PM

[Chris B:]

How long ago did they start the program? Could it be that they are in the process of migrating data from various sources?

Nonetheless, I appreciate articles like this one that talk about the most important business concept that is almost always overlooked by stock investors - quality.

I also share the Chemist's observation about how inefficient the US healthcare system is. Well, actually it's not an observation. The fact is we spend twice as much money on healthcare than other developed nations and get similar if not worse results. A friend of mine went in for a follow-up appointment and the doctor walked in, told him he was being referred to a specialist, and billed his insurance $300 for the 2 minute visit because he couldn't just do the referral without a visit! It also takes weeks to get into a doctor's office. Then there's all the middlemen at every layer from employer to insurer to contractors to the doctor.

2008 Dec 24 12:58 PM

[User 308330:]

Aaamen, aaaamen, aaaaaamen!

2008 Dec 24 01:10 PM

[User 326348:]

It is an unfortunate myth that has been developed by health insurance companies/ managed care that they represent a high quality, more efficient medicine. The only reason they use I.T is to cut their cost . They have no regard to the patients' health . Health insurance companies/ managed care were created due to the need to improve health care quality and access while keeping costs down . They have failed miserably and created ,instead, monster administrations which actually drove the cost of healthcare up. They have raised the cost of health insurance up , decreased access to healthcare and at the same time they have decreased physician and hospital compensation over the last 10 years by more than one half. Where do you think went all the money that they have made with this technique ? The answer is simple: to bloat further their own administrations and increase exponentially the direct and indirect income of their top executives. The US healthcare costs are still going up BECAUSE of these
healthcare insurance companies . Managed care has become a total failure that serves only the managed care companies and their executives while abusing everybody else. Any attempts to correct this problem need to start by removing healthcare insurance companies from the business of healthcare. The government should not even consider using them to help deliver Universal healthcare. Managed care organizations/health insurance companies have now a proven record of being more inefficient and definitely more costly to the health care system even than Medicare,while raising and not decreasing health costs. By cutting compensation to hospitals and doctors and raising their charges , Managed care organizations/health insurance companies have decreased health quality and access while increasing their top executives' compensation.
Getting rid of these healthcare system parasites will be a great positive step in the right direction of fixing the american healthcare system. The challange is now in the hands of the new team in Washington.

A 30 year veteran of the American healthcare system.

2008 Dec 26 07:15 PM

[Tatort:]

The US spends - annually - $700 per capita more than Canada in healthcare admin costs. The US also experiences around $350 per capita in annual costs associated with fraud (and I doubt this figure accurately accounts for the tremendous level of upcoding that occurs in the system, which if not fraud is at the very least abuse). The average general practitioner in the US nets 4X what his counterpart in France makes (2.7 vs. Italy, 2X vs. Australia, 1.6X vs. Japan, 1.3 vs. the UK); the salary differentials for specialists are even higher. Hospitals in the US are probably the most inefficient organizations in the entire country (yes, even more inefficient than insurance companies!). Medical errors cost the system tens of billions of dollars annually, and the funny thing is that they actually hurt patients but under our fee-for-service reimbusement system actually inflate revenues for those who cause the errors to begin with!

There's a lot of blame to be spread around when evaluating our overly high-costing healthcare system.

Jan 02 01:07 PM

[User 411535:]

good job thank

healthinsurance-provid.../

May 11 07:57 AM

[User 411535:]

good job thank

healthinsurance-provid.../

May 11 07:58 AM