CVS Health aims to cut hospital readmissions
By: Amina Niasse
Reuters
NEW YORK - CVS Health's Aetna insurance are, 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.
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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 transpiration to follow-up appointments.
..... "Our goal is to literally have a nurse at the bedside with that member, with that family beginning to think though what their care journey should look like," said Dr. Ben Kornitzer, chief medical officer at Aetna.
..... CVS' mover comes after the Centers for Medicare & Medicaid Services in July [2025] finalized a rule that includes Medicare Advantage members in calculations for readmission penalties applied to hospitals, effective in fiscal year 2027.
..... The American Hospital Association has protested that this inclusion would wrongfully penalize hospitals for negative outcomes associates 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.
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A spokesperson for CVS Health, said the program is meant to improve patient helaht, which would benefit Aetna and provides, adding the company will push for similar programs moving forward.