Aetna to open medical offices in state Insurer is getting into direct care

July 17, 1993|By Patricia Meisol | Patricia Meisol,Staff Writer

In a bid to cut costs and cater to its growing customer base, Aetna Health Plans of the Mid-Atlantic Inc. will open two medical offices in Maryland this fall and up to 15 more in the Baltimore-Washington region by year-end.

The first two offices, to be staffed by two to four primary care physicians, will be opened in Montgomery and Prince George's counties and will serve 4,000 to 8,000 patients each, depending on the number of doctors.

Aetna also plans to open similar medical offices in Atlanta this fall and around the country next year.

The insurance company's executives say Aetna is getting into the direct delivery of care as it moves aggressively to expand in Maryland, where its managed-care membership has more than doubled in six months, to 14,000.

Overall, Aetna insures 300,000 people in the region, mostly in northern Virginia, with about half enrolled in managed-care programs. These range from plans that allow members to use their own doctors for extra fees to the most restrictive form of managed care -- health maintenance organizations -- which typically require members to use pre-selected doctors, hospitals and other medical services for all needs. Increasingly employers have turned to managed-care plans as a way to hold down spiraling health care costs.

"We believe more and more of our customers are looking at managed-care plans as an alternative to offer their employees, and the major reason is the cost of traditional insurance plans," said Doug Meyer, company spokesman. "The alternatives they are looking at are network-based primary care," he said.

In attempting to deliver care directly, Aetna is seeking to cut costs by stressing prevention and making greater use of primary care physicians. Aetna already has a regional network of 3,500 doctors it approves for patients enrolled in many of its managed-care programs. About 40 percent of these are primary care physicians.

Many studies show that increased use of primary care doctors for medical problems now treated by specialists would result in the same quality at reduced costs. Managed-care plans often require patients to first visit a primary care physician who gives basic care and "manages" other medical needs.

The Baltimore-Washington area is a prime market for managed-care companies for a number of reasons, primarily the density of the population and the high number of retired government workers who form a huge pool of potential customers.

In the past 18 months, a multitude of companies, including U.S. Healthcare, Mid Atlantic Medical, Kaiser Permanente, and last week, Humana Inc., entered the area or revamped operations to capture more of the expanding market.

In the past six months alone, membership in Aetna's regional "point of service" program doubled to 30,000. It requires members to select a primary care physician to receive full benefits, but allows them to opt for other doctors if they are willing to pay more of the bill themselves.

Maryland-based McCormick and Co. Inc., whose employees nationwide total about 7,000, switched to the point-of-service plan and another Aetna managed-care program earlier this month. McCormick selected Aetna because of the insurance company's networks in many parts of the country where McCormick has plants, said Barbara Zavadny, manager of benefits, planning and administration for McCormick.

She said the company and employees are paying less and getting more benefits under the new contract.

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