Aetna Institutes

Aetna Institutes™ facilities are publicly recognized, high-quality, high-value health care facilities. Aetna's goals are to:

• Recognize facilities with distinguished performance for health services that are critical to members.
• Engage consumers by providing them with information to help make informed choices about facilities with distinguished performance.
• Provide access for our members to high-quality, cost-effective care.

The two major components of Aetna Institutes™ facilities are:

• Institutes of Excellence™ (IOE) facilities - A designation for health care facilities that offer highly specialized clinical services to members with complex or rare conditions; a member's clinical care in these cases is coordinated nationally by Aetna (for example, transplant care).
• Institutes of Quality® (IOQ) facilities - A designation for health care providers who offer clinical services for prevalent health conditions to our Aetna members, served through integrated clinical management at the regional level (for example, bariatric surgery).
  

Institutes of Excellence™ Transplant Facilities

Aetna's National Medical Excellence Program coordinates care and provides access to covered transplant treatment through the national Institutes of Excellence™ network. Hospitals that have met extensive quality, as well as cost-effectiveness criteria have been selected by Aetna to participate in our Institutes of Excellence™ Transplant Facilities for solid organ transplants and bone marrow transplants. These facilities have been contracted on a transplant-specific basis and are considered participating only for the transplant type listed in our network directory.

To learn more about the requirements for Institutes of Excellence™ Transplant Facilities, please refer to our Program Criteria  (PDF, 83 KB).

Institutes of Excellence™ Transplant Facilities are identified in DocFind.

Learn more about transplant support and coverage for complex care.

Institutes of Quality® Bariatric Surgery Facilities 

Institutes of Quality® Bariatric Surgery Facilities are a national network of health care facilities that are designated based on measures of clinical performance, access and efficiency for bariatric surgery. Bariatric surgery, also known as weight loss surgery, refers to various surgical procedures to treat people living with morbid, or extreme, obesity.

Facilities selected for the network met the following criteria:

• Have significant experience in bariatric surgery. Inpatient facilities must perform a minimum of 125 procedures in the most recent calendar year. Ambulatory surgery centers must perform a minimum of 75 procedures in the most recent calendar year. 
• Have evidence-based and recognized standards for clinical outcomes, processes of care and patient safety.
• Provide ongoing follow-up programs and support for their bariatric surgery patients.
• Adhere to Aetna's standards for member access to the facility and Aetna participating providers.
• Demonstrate efficiency in providing care based on overall cost of care, readmission rates and comprehensiveness of program.
• Ambulatory surgery centers must be accredited by one of the following: American Association of Ambulatory Healthcare, American Association of Ambulatory Surgery Centers, American Osteopathic Associations' Healthcare Facilities Accreditation Program, or Joint Commission on Accreditation of Healthcare Organizations.

To learn more about the requirements for Institutes of Quality® Bariatric Surgery Facilities, please refer to our Program Criteria  (PDF, 62 KB).

Bariatric surgery and benefit coverage
Bariatric surgery is not a covered benefit under all plans, and the Bariatric Network is not available for all plans. Some Aetna plans entirely exclude coverage of surgical treatment for obesity. Refer to benefit plan descriptions and Clinical Policy Bulletin #157--Obesity Surgery for more information.

Institutes of Quality® Bariatric Surgery Facilities are identified in DocFind.

Institutes of Quality® Cardiac Care Facilities 

We designate cardiac care facilities as Institutes of Quality (IOQ) based on measures of clinical performance, access and efficiency for cardiac care. IOQ Cardiac Care facilities include comprehensive heart and vascular treatment centers that provide both inpatient and outpatient procedures. They also offer medical care for cardiac conditions that do not involve surgery or procedures.

Aetna’s IOQ Cardiac Care program designations include:

• Cardiac medical interventions
• Cardiac rhythm disorders
• Cardiac surgery

We may designate a facility for one or more IOQ Cardiac Care program designations. Selected facilities meet the following criteria:

• Show evidence of significant experience in cardiac care, including a minimum of 125 open heart procedures, 400 angioplasty or stent procedures, and 50 permanent pacemaker implantation procedures in the most recent 12 calendar months
• Use evidence-based and recognized standards for clinical outcomes, processes of care and patient safety
• Provide ongoing follow-up programs and support for their cardiac patients
• Adhere to Aetna's standards for member access to the facility and Aetna participating providers
• Demonstrate efficiency in providing care based on overall cost of care, readmission rates and comprehensiveness of program

To learn more about the requirements for IOQ Cardiac Care facilities, please refer to our Program Criteria  (PDF, 48 KB)

IOQ Cardiac Care facilities are identified in DocFind.

Institutes of Quality® Orthopedic Care Facilities 

Institutes of Quality (IOQ) Orthopedic Care facilities are health care facilities that are designated based on measures of clinical performance, access and efficiency for orthopedic care. In reviewing these facilities, we seek to identify comprehensive orthopedic treatment centers that can provide both inpatient and outpatient procedures.

Facilities selected for the network have met the following criteria:

• Significant experience in orthopedic care, including annual volumes at a minimum of 200 knee replacement procedures annually 100 hip replacement procedures, and 100 spine procedures.
• Significant physician experience in orthopedic care, with at least one physician achieving minimum annual volumes of 50 knee replacement procedures, 50 hip replacement procedures, and 50 spine procedures.
• Evidence-based and recognized standards for clinical outcomes, processes of care and patient safety.
• Provide ongoing follow-up programs and support for their orthopedic patients.
• Adhere to Aetna's standards for member access to the facility and Aetna participating providers.
• Demonstrate efficiency in providing care based on overall cost of care, readmission rates and comprehensiveness of program.

To learn more about the requirements for IOQ Orthopedic Care facilities, please refer to our Program Criteria   (PDF, 53 KB)

IOQ Orthopedic Care facilities are identified in DocFind upon designation.