What's Up with Aetna's Work Comp Unit?

Thursday, January 13, 2011 | 0

By Joe Paduda
CompPharma and Health Strategy Associates

Last week several of the folks responsible for managing new business and existing clients for Aetna's Work Comp unit were laid off. Not exactly a great way to start 2011.

This came after a year plus in which AWCA's network customers were increasingly plagued by problems associated with poor provider data quality and provider relations issues, complicated by a lack of responsiveness from Aetna.

With that background, it's not exactly surprising that AWCA cut its work force; without much to say to clients it didn't make much sense to have a staff that was supposed to be doing the talking. I would note that the customer-facing staff were in the rather uncomfortable rock-and-a-hard-place position, stuck between Aetna's networks ops staff and policies, and their work comp payer customers who weren't getting the answers they wanted or, quite frankly, deserved.

Originally, AWCA was set up as an individual business unit led by Pat Scullion. AWCA's individual functions were separated out several years ago, and now reside in different operating units within mother Aetna. Furthermore, there is no one leader or advocate for the entire AWCA 'program' - provider relations, compliance, customer service, account management, IT - so the folks doing the work have other things to do, other things that may, or may not, be higher on the priority list.

Aetna's work comp "network" has been plagued with lousy provider data quality in several states for as long as I can recall; Pennsylvania among the most problematic. The problem manifests itself when employers post panels, or lists, of providers accepting workers comp, only to find some/many of the docs don't take comp patients, aren't at that address, don't answer that phone number, and/or claim they aren't in the AWCA network. The employer then complains to the insurer, who then calls the network and in the case of AWCA, often to no avail.

What makes this interesting are the downstream implications for payers, other network vendors, and providers. Aetna is the defacto network - or a major part of the network - for Coventry in a couple dozen states. Many large payers - Liberty, AIG, Travelers, Sedgwick, Hartford - work with Aetna directly or through Coventry. It remains to be seen if the layoff is limited to customer-facing staff or there will be further changes at AWCA.

UPDATE two sources called to let me know that AWCA has told some of their direct clients that they will no longer service them directly, as they are not large enough to merit a direct relationship with AWCA. Instead, these clients will have to access AWCA through another entity - usually Coventry.

That said, the termination of these professionals hasn't been good news for AWCA's clients. Some see this as the latest in the de-evolution of what had been a promising network alternative.

On a personal note, there's some talent now on the street; companies looking for network ops and sales personnel may want to reach out to the (now former) AWCA people.

<i>Joe Paduda is co-owner of CompPharma, a consortium of pharmacy benefit managers, and owner of Health Strategy Associates, an employer consulting firm in Connecticut. This column was reprinted with his permission from his Managed Care Matters blog, at http://www.joepaduda.com</i>