Alan Weber, M.B.A. and John Kelly, M.D.
Alan Weber, M.B.A., of Aetna and John Kelly, M.D., of Aetna-U.S. Healthcare addressed a lively standing-room-only crowd at the Colonial Penn Center on December 17, 1999 in the final LDI Health Policy seminar of 1999. Entitled "The Power of Information and Technology to Improve Outcomes," the discussion centered on Aetna’s advances in information technology. Aetna-U.S. Healthcare is the largest health insurance and managed Care Company in the United States, with 21 million members in its health care plans and 15 million members in its dental plans.
Mr. Weber then outlined Aetna's current and future use of information technology to improve quality of care and the administrative processes that support care. “At its most basic level, the Internet can decrease costs for physicians and hospitals, speed up claims and referrals, and allow providers to quickly determine what benefits a patient has.” He also pointed to web-based resources as a way to streamline the entire administrative process and reduce the “hassle factor” for physicians. For example, Aetna is currently implementing an Internet-based “E-Pay System” that can process payments to physicians in as little as three days. He stressed the importance of linking all physician offices to the Internet and cited a recent study that showed that less than fifty percent of physicians actually use the Internet at work. However, Mr. Weber was careful to point out that information technology can only add value to the process of providing members with health care, and will not solve all the problems with the health care system.
Dr. Kelly, Director of Physician Relations at Aetna, spoke about the potential impact of information technology on quality of care. Geographic variations in utilization of procedures such as coronary artery bypass grafts and hysterectomies could be reduced, he said, by developing an on-line system where physicians could quickly and easily see how their utilization rates compare with their peers.
Dr. Kelly also mentioned Aetna's U.S. Quality Algorithm membership database, which allows Aetna to track its members based on sixty-five disease categories. Aetna uses this database to enroll patients with certain chronic diseases in disease management programs that have reduced use of resource-intensive services. He noted that, “when we put [disease management] programs in place, patients with congestive heart failure and asthma go to the hospital less [often].” In the future, Aetna hopes to use the database to develop a real-time program that would track prescriptions as they are filled. Although these are all steps that might lead to an electronic medical record, Mr. Weber mentioned a few significant stumbling blocks, such as privacy issues and the lack of uniform documentation standards by physicians and health plans.
Mr. Weber noted that Aetna members are also benefiting from on-line information. On the Aetna web site, "Doc Find" is a provider database that helps members find a participating physician in their area, and can also provide them with a map to the physicians' office. Members and non-members alike can visit the Intelihealth web site sponsored by Aetna and Johns Hopkins University that contains over 3 million pages of health-related content. The popular site (it receives over one million hits a month) provides health information that is verified by experts at Hopkins. Although Intelihealth is only one of many health information sites on the web, Mr. Weber stressed that the amount of information on the Intelihealth site far exceeds that of its competitors.
The speakers fielded a wide range of questions from the audience, from the role of government in regulating the managed care industry, to the nature of financial incentives to physicians. A former Executive Vice President at Citibank, Mr. Weber pointed to the success of the banking industry in self-regulating and argued that the managed care industry should be allowed to do the same. In response to whether the major players in the managed care industry would be able to work together as successfully as those in the banking industry, Mr. Weber contended that they would, because they share key objectives, such as the need to reduce administrative costs.
The speakers also addressed questions about Aetna’s incentives for primary care physicians and specialists. According to Dr. Kelly, specialists’ services are an area they try to handle delicately. Specifically, Dr. Kelly discussed the difficulty of implementing effective cost control measures that would not micromanage specialists' decisions. On the primary care side, Dr. Kelly briefly explained that certain cutoff points are used to evaluate physician performance in target areas (such as percentage of children immunized) and primary care physicians receive bonuses for reaching desired levels.
Questioners from the audience brought up two common criticisms of the managed care industry, namely that it is simply about “making a buck,” and that it tries to avoid enrolling the chronically ill. To the first criticism, Mr. Weber explained that managed care companies are in the middle of competing interests: physicians who want to get paid more, employers who want to pay less, and consumers who want more services regardless of the cost. Mr. Weber noted that as a shareholder owned company, Aetna does have an interest in making a profit. However, he pointed to the recent forty-five percent drop in the company's stock to illustrate that health care is a tough industry in which to make money.
the second criticism of adverse selection, Dr. Kelly stated, “There is
so much misinformation about our industry.” Mr. Weber stressed that Aetna
deals mainly with employers, and that the company bases coverage decisions
on employee groups, not individuals. The speakers emphasized that
Aetna has a commitment to take care of its members when they are sick.
Alan J. Weber is Vice Chairman of Strategy and Finance at Aetna. Mr. Weber oversees Aetna’s financial and operational strategy, as well as corporate planning and capital management, investor relations, information technology strategy and Year 2000 programs management. He also serves as the company's Chief Financial Officer.
Mr. Weber spent 27 years at Citibank, which he joined in 1971 straight from obtaining his M.B.A. at he Kellogg School, Northwestern University and B.S. in Economics at the Wharton School, University of Pennsylvania (1970). The first four years at the Bank were spent in Financial Control and Operations management positions in New York. Weber was appointed as the Operations Group Financial Controller in 1975 and a year later he was named a Division Head in the Operations Group responsible for operational/technology support of the Corporate Banking business in the United States. In 1978, Weber was appointed a Senior Vice President and given responsibilities for developing the Financial Institutions market in the United States. In 1982, Weber changed career paths from the Institutional Banking sector to the Consumer Banking sector and was given responsibility for building the Bank’s consumer business in Italy and Greece. In 1984, Weber was given responsibility for all Consumer Banking in twelve Asia/ Pacific countries; encompassing branches, finance companies, credit card companies and subsidiaries. In 1988, Alan Weber returned to New York and was elected a member of the Corporation ‘s Policy Committee, and promoted to Executive Vice President. His responsibilities encompassed Citibank’s business with Financial Institutions around the world, including banks, central banks, insurance companies brokers/dealers and other financial intermediaries. In 1994, Mr. Weber was put in charge of the Latin America Consumer Bank Group. In 1997, the Asia/ Pacific region was added to his existing responsibilities in Latin America. This area was responsible for developing the Consumer business proposition in the emerging markets of the world. In August 1998 Alan Weber joined Aetna.