Aetna Business Plan

Organizational Background

In order to create the best strategic plan all of the information available about the organizations current structure must be gathered. This strategic plan is for Aetna. Aetna provides Medicare Advantage and Medicare Part D plans for various states throughout the country. Medicare Advantage is supplemental coverage that senior members can elect to help offset the costs of healthcare not covered by traditional Medicare. The federal government requires that subscribers already carry traditional Medicare coverage before electing additional coverage with a private organization. Medicare Advantage is comprehensive and most plans include prescription drug coverage. Medicare Advantage is heavily regulated by the federal government through the Centers for Medicare & Medicaid Services (CMS). Aetna currently offers Medicare Advantage plans in Alabama, Arizona, Florida, Georgia, Illinois, Maryland, North Carolina, Pennsylvania, South Carolina, Tennessee, and Texas. Aetna covers approximately 1.5 million lives across the country Medicare Advantage makes up just under 450,000 of those lives. Part D plans are offered as supplemental coverage for prescription drugs, since there is little variation throughout the industry Part D will not be the focus of this strategic plan. There are approximately 15 million Medicare Advantage subscribers across the country, making Aetna the 7th largest provider based on the official enrollment numbers from November of 2014. The Medicare Advantage industry is highly competitive, one large source of income for providers is the Quality Bonus Payments released every year by the government. CMS grades health plans on several criteria pertaining to healthcare provided along with customer feedback on providers. CMS looks to make sure certain medical tests/screenings were completed, prescriptions were written, customer satisfaction, and provider operations meet the standard. All of these areas of focus are graded individually and rolled up to create an overall STAR rating. STAR ratings are given in half star increments up to 5 stars. Plans that receive a 4 star or higher rating for the year are given a percentage of their healthcare cost bid back in the form of a bonus payment. These amounts are based on several factors such as the number of lives covered, the amount of money spent on healthcare, and other health related expenses. The amounts paid out are substantial some contracts see amounts well into the 10s of millions. STARS is the focus of this researcher’s job responsibilities.

Organizational Foundations

Mission

Aetna has a very simple mission statement that speaks to who they are and what they do. Aetna’s mission statement is “Our work is rooted in our mission to improve the health, well being and sense of security of those we serve.” (Aetna, 2014) This type of statement is lacking in any real depth “…it can’t be denied that most mission statements have neither inspired people to change the world nor provided them with an accurate description of what an organization actually does for a living.” (Lencioni, 2012) As with most organizations, Aetna keeps its mission statement vague and general. By doing this is does not leave room to be disputed by competitors, but also does not set a course for the company.

Aetna does create value for the members that it serves, but the mission statement does not reflect that. The mission statement should be more reflective of an organizations value. Aetna does a good job of creating shared and public value “…companies can create financial profits and social benefits at the same time.” (Manus, 2015) As a healthcare organization Aetna brings benefits to the elderly population by increasing their healthcare knowledge as well as different initiatives that force members to take a more active approach to their healthcare.

Vision

Aetna starts to dig a little deeper into their business when speaking of their vision. The vision statement says “We understand our customers’ needs and work together to help them achieve healthier, more secure lives.” (Aetna, 2014) In contrast to the mission the company’s vision does start to deliver depth. It continues the methodology of being general and vague, but it does show a little of how the company adds value.

The areas that both the mission and vision statements fail is in answering the six critical questions outlined by Lencioni. “These are the six questions: Why do we exist?, How do we behave?, What do we do?, How will we succeed?, What is most important, right now?, and Who must do what?” (Lencioni, 2012) These questions should not be outlined in the mission or vision statements, but without answering them Aetna has failed to set a clear vision or mission. As part of the strategic plan these questions will be answered to set clearer strategy for the future of the company.

Values

Aetna falls into the same trap that a lot of organizations do when stating their core values. “An organization knows that it has identified its core values correctly when it will allow itself to be punished for living those values and when it accepts the fact that employees will sometimes take those values too far.” (Lencioni, 2012) Aetna has not communicated clear values to the outside world. Most of the organizations values are permission to play or aspirational.

• Customer Centricity

• Inclusive

• Collaboration

• Innovation

• Integrity

The values listed above are the values communicated by Aetna. Integrity and Inclusive are standards of any ethical business in the United States. Customer Centricity is aspirational in that the organization wants to improve the customer’s experience, but based on surveys completed by CMS they are not achieving this as a core competency or value. These are the same issues facing every organization that communicates their values, but Aetna must break this standard in order to grow strategically.

Leadership

Vision

As outlined earlier the corporate vision for Aetna is lacking in detail and direction. The leadership within STARS Analytics is slightly different. Leadership has a vision for the future that involves more automation of standard processes to allow for creative thinking within the department to maximize yearly ratings. There is not a clearly defined vision for the department due to recent changes in leadership, but the internal leadership within the department is moving processes to a more streamlined and efficient way of working.

Values

Aetna corporate values have been discussed above. The values of leadership within STARS Analytics are not directly aligned with the corporate values, but offer a unique view point. Leadership have some similar values to the organization such as integrity through the leadership value of data integrity. There are various values within leadership that do not precisely align such as hard work, dedication, and good attitude. These values boost morale within the department and will propel the department to the next level.

Value

Adding value to the organization is of vital importance to all levels of an organization. Leadership within the STARS Analytics department adds value by supporting the analysts, providing unique industry perspective, understanding temporary staffing constraints, and setting direction for the department. “Management involves planning and budgeting. Leadership involves setting direction.” (Kotter, 2011, pg.39) The leadership structure within STARS Analytics has been volatile and uncertain, but good leadership has begun to emerge within the department. The added value from leadership will help the department grow and exceed expectations in the near future.

Value Propositions for Stakeholders

Aetna has several stakeholders, to be more precise the stakeholders of the STARS Analytics department will be reviewed. Stakeholders are either primary or secondary. Primary stakeholders as defined by business dictionary are people directly benefiting from a particular business activity, such as service agreement changes. Secondary stakeholders would then be people indirectly affected by business activities. The primary stakeholder for the STARS Analytics department is the Medicare Advantage subscriber. The secondary stakeholders are the market directors and the other STARS analysts within the department.

Subscribers benefit most from Medicare Advantage plans. Subscribers are provided with healthcare coverage above the Medicare plans available to seniors. This healthcare coverage offers greater benefits to the subscriber by covering more of the costs associated with healthcare management. Members also receive better overall health by health plans focusing on preventive screenings and healthcare such as yearly mammograms for women to help prevent breast cancer. All of these benefits require supporting data to make the most of the benefits. Aetna struggles where data is concerned. The data is not readily available to everyone and has gaps in data historically. According to an article on data-driven healthcare companies, “Companies that have embraced a data-driven culture--rating themselves substantially ahead of their peers in their use of data--are three times more likely to rate themselves as substantially