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	Provider Compensation


	The primary care doctors who care for you and your family as Aetna HMO or QPOS^® members are family practitioners, general practitioners, internists, and pediatricians. They care for you and also manage your care when they send or "refer" you to a specialist. When a doctor asks to join our network, we do a review of the physician's licenses, education and work history. Before the doctor may begin caring for Aetna members, information about the doctor and the office is reviewed by a committee of doctors who also care for Aetna members. Doctors who are in our network do not work for Aetna. They provide care in their own private offices. Participating providers in our network have agreed to be compensated in various ways. For example, many participating primary care physicians are compensated in accordance with our Quality Enhancement (QE)Model* described below. Also, specialists, hospitals, some primary care physicians and other providers in the Aetna network are paid in the following ways: Per individual service (fee-for-service at contracted rates) Per hospital day Under other capitation methods (a certain amount per member, per month) By Integrated Delivery Systems, independent practice associations (IPAs), physician hospital organizations and similar provider organizations that are compensated by us on a capitated or other basis. * The extent of implementation of the Quality Enhancement Model varies by service area. Under the Quality Enhancement Model, doctors are paid by "capitation" or fee for service. Capitation means the doctor is paid a fixed amount once a month for every member who chose that doctor. Payment is made every month, even for patients who do not go to the doctor that month. The Quality Enhancement (QE) program is one of several components that make up Aetna's new Primary Care Compensation Program. It is a quality-based program to reward PCPs for providing quality health care services to Aetna's membership. The QE is a more simplified and flexible approach to linking quality-based measures to a financial compensation structure. The QE payment is a monthly per-member, per-month (PMPM) amount that is based on scores from quality-oriented measures. These measures will give the primary care physician's office the opportunity to enhance their compensation through the provision of specific services that improve the quality of care and service provided to our members. You are encouraged to ask your doctors and other providers how they are compensated for their services, including whether their arrangements include any financial incentives for managing costs.