Aetna led the way on ‘concurrent care’

WASHINGTON–When it came to writing end-of-life care provisions into the health reform bill, members of Congress turned in part to Aetna Inc., the Hartford-based insurance giant.

Aetna is one of the few private insurers that already allows patients to seek both aggressive treatments for life-threatening illnesses and hospice care at the same time.

Dr. Randall Krakauer, who oversees Aetna’s so-called “concurrent-care” program, said the company’s experience has been so good it’s seeking to expand the initiative to patients covered by its Medicare Advantage plan, a federal program that uses private insurers to deliver Medicare services.

After Aetna began its concurrent care program in 2004, the number of patients who decided to use hospice services nearly tripled, Krakauer said, while their use of acute-care services, such as trips to a hospital ER, dropped significantly. The company’s costs went down, and patients felt better served.

Five years later, some lawmakers in Washington began to ask company officials about the program, as Congress was drafting the health care overhaul.

“We had input at various levels,” Krakauer said, “and these contacts are continuing.”

He said Aetna’s experience has shown that with aggressive case management of terminally ill patients, offering this new benefit can spur significant change. “It creates almost an imperative that we do this on a larger scale,” he said.

Asked if the health care reform was too timid, he demurred. “That’s a political judgment. I’m a rheumatologist,” he said.

But then he outlined a list of more far-reaching steps he thinks Congress should take:

“I would like to see the Medicare hospice benefit liberalized for everyone; case management provided in some form; palliative care consultation for everyone with advanced illness … I think there’s a great deal to be accomplished here,” he said.

The health reform bill, he said, offers “some small steps that could be very helpful, at least as examples if nothing else.”