Physical Therapist

Sentara Aetna partnership expands Virginia coverage. The Sentara Aetna partnership will expand Medicare Advantage and Medicaid members' access to hospitals, physicians and other healthcare services across Virginia beginning Jan. 1, 2027. Sentara Health and Aetna announced the expanded provider network agreement Oct. 29, extending their existing commercial insurance relationship to additional government-sponsored health plans. Financial terms and the number of newly affected members were not disclosed. The agreement has implications for health insurers, hospitals and Medicaid managed care organizations seeking to maintain provider access across Virginia. Aetna members in several regions will gain in-network access to Sentara's full system of hospitals and care sites. The expansion comes as provider network contracting remains an important consideration for beneficiaries selecting Medicare Advantage coverage for 2027. Sentara Aetna partnership expands provider access. According to the official Sentara announcement, the agreement covers members enrolled in Aetna Medicare Advantage and Aetna Better Health of Virginia Medicaid plans. The expanded network will include Sentara hospitals, physicians and other care locations across the health system. The organizations identified Hampton Roads, Southwest Virginia and Northern Virginia as the primary regions benefiting from the arrangement. Sentara already participates in Aetna's commercial insurance network. The new agreement extends that relationship to Medicare Advantage and Medicaid coverage, allowing eligible members to use additional Sentara facilities as in-network providers. The organizations did not disclose specific reimbursement rates, contract duration or projected financial effects. Rachelle Capps, vice president for managed care contracting at Sentara, said the expanded agreement reflects the importance of collaboration between healthcare providers and insurers. According to the Oct. 29 announcement, the organizations intend to address gaps in network access while supporting healthcare services for eligible members. The Sentara Aetna partnership takes effect at the beginning of the 2027 coverage year. Both organizations will need to coordinate provider directory information, member communications and administrative arrangements before the new network provisions become active. Sentara did not announce changes to its existing arrangements with Aetna commercial members. Medicare Advantage members gain hospital options. The agreement extends Sentara's hospital and provider network to Aetna Medicare Advantage members in the specified Virginia regions. Medicare Advantage plans operate through private insurers under contracts with the federal Medicare program. Participating providers and network arrangements can influence where members receive covered nonemergency services and the amount they pay. According to Sentara, the expanded agreement provides eligible Aetna Medicare Advantage members access to its full network rather than only selected participating facilities. The arrangement could give members additional choices when selecting hospitals, specialists and outpatient services. However, neither company provided estimates of how many beneficiaries would gain access to previously unavailable providers. The timing is relevant to Medicare's annual enrollment period, which runs from Oct. 15 through Dec. 7. Beneficiaries reviewing coverage for 2027 can compare participating provider networks alongside premiums, prescription drug coverage and other plan benefits. Specific provider participation and benefit details should be confirmed through applicable Aetna plan materials. The Sentara Aetna partnership also follows a separate contracting dispute between Sentara and Anthem Blue Cross and Blue Shield of Virginia. On Oct. 5, Sentara announced that negotiations over Medicare Advantage, Medicaid and Affordable Care Act Marketplace contracts had ended without an agreement. The health system said affected Anthem members could face out-of-network transitions beginning in January 2027, subject to applicable coverage protections. Medicaid expansion strengthens network availability. Aetna Better Health of Virginia members will also gain access to additional Sentara healthcare facilities under the agreement. The Medicaid managed care plan serves eligible beneficiaries through Virginia's state-administered Medicaid program. Its provider network includes healthcare professionals and facilities responsible for delivering covered services under applicable plan arrangements. Corey Pleasants, CEO of Aetna Better Health of Virginia, said the agreement would increase provider choice for members. In the company announcement, Pleasants said the organizations were focused on delivering a more connected healthcare experience for communities across Virginia. Sentara operates more than 100 care sites across Virginia and North Carolina, according to its public website. The new agreement specifically addresses Aetna government-sponsored plan members in Virginia. The companies did not provide a facility-by-facility list identifying newly participating locations or separate membership figures for the three regions. For Medicaid managed care organizations, provider network agreements influence access to primary care, specialty services and hospital treatment. The Sentara Aetna partnership expands the provider options available to eligible members, but the announcement does not establish whether the arrangement will reduce appointment delays, emergency department utilization or healthcare spending. Those potential effects would require subsequent evaluation. What comes next. The expanded network agreement is scheduled to take effect Jan. 1, 2027. Sentara and Aetna will need to implement the new contracting arrangements and ensure that affected members can identify participating hospitals, physicians and other providers. The companies have not announced additional implementation milestones or a separate enrollment target. Members selecting Medicare Advantage plans for 2027 will have an opportunity to review available provider networks during the annual enrollment period. Medicaid members can confirm their provider options through Aetna Better Health of Virginia and applicable state enrollment resources. The agreement does not automatically change a beneficiary's insurance enrollment or guarantee coverage for services outside the terms of their plan. For Sentara, the expansion adds government-sponsored insurance participation to an established commercial relationship with Aetna. The arrangement also provides a new network access option as the health system prepares for potential changes involving Anthem members. However, the companies have not described the Aetna agreement as a replacement for any existing payer contract. For healthcare executives, the Sentara Aetna partnership highlights the role of payer-provider contracting in determining access to hospital services. Its immediate effect will be broader in-network participation for eligible Medicare Advantage and Medicaid members beginning in 2027. Longer-term implications for patient utilization, provider reimbursement and healthcare costs will depend on actual enrollment and service delivery after implementation.

Sentara hospitals are using AI to help monitor patients, determine discharge timelines. The Virginia-based health system joins more than 150 hospitals nationwide using Regard technology as state lawmakers consider how to regulate AI's growing presence in healthcare. Virginia-based nonprofit health system Sentara announced last week that it has started using artificial intelligence technology to assist with patient monitoring and discharges. Regard is an AI system that integrates with electronic health records. Co-founder and president Nate Wilson said it's used by more than 150 hospitals across the country. Dr. Rollin Reeder, chief health information officer at Sentara, said that all 12 of the health system's hospitals now use Regard. The tool helps physicians and case managers more easily parse through patients' hospital admission charts, monitoring notes during their stay and their medical histories, both men said. The goal is to help diagnose new or worsening symptoms sooner and think proactively about patients' discharge times and follow-up care. "If a patient is going to need rehab or help at home, you want that on the table at admission, not the afternoon they're medically cleared to leave," Reeder said. "Catching it early gives the case manager time to find a bed, arrange services and walk the family through it." Discharge planning begins as soon as a person is admitted for inpatient care. Case managers analyze health data about the patient to help determine when it may be safe for them to go home or whether they may need to transfer to a rehabilitation facility first. Case managers also begin the work of determining what services are covered by patients' insurance. But the information is scattered, Reeder explained. "Most of those answers are buried" in patients' charts, medical history, screenings and doctor's notes, he said. "The hard part has always been that it's spread out everywhere, so case managers spend a lot of their day clicking around just to get the basics before they could start planning," Reeder explained. Regard helps scan and filter information, Reeder said, and case managers appreciate a feature that allows them to pull up rundowns of what may have changed with the patient since the previous day. Sentara emphasizes AI is a tool, not human replacement. A press release announcing the adoption of Regard implied that it's estimated to save "nearly 90,000 hours of staff time - the equivalent of hiring 40+ full-time employees." When asked if use of the technology may lead to reduced case manager staff, Reeder said "no one is losing their job over this." Staffing levels and certain services have been in flux for some hospitals and clinics over the past year following H.R. 1, a reconciliation bill Congress passed last summer that entails changes to hospital funding mechanisms and puts roughly 300,000 Virginians at risk of losing Medicaid insurance. Citing the bill as a contributing factor, Valley Health changed staffing contracts and trimmed services this past spring. Last winter, Centra closed its labor and delivery unit at a hospital in Farmville. Last fall, Shenandoah Valley's Augusta Health closed three clinics. Thirteen rural hospitals - including a Sentara hospital in Halifax - have also been identified as vulnerable to service cuts or closure over time, a state report indicated. Reeder said the estimate of 90,000 hours Regard saves being equivalent to hiring more than 40 full-time staff was meant to reflect how case managers can spend less time glued to a computer screen and more interfacing with patients. "The 90,000 hours is a forecast of time our case managers can redirect to patient care, based on pilot data we haven't confirmed yet," he said. "Our goal is for every case manager to reach more patients, catch problems earlier and spend more time with the people they're caring for." 'There's just so much going on' Wilson, Regard's president and co-founder, shared how the technology can also help identify sudden, deadly health conditions like sepsis, an infection that can be triggered by underlying health conditions or that manifests post-surgery in some patients. "There's just so much going on with the scale of data on every single patient that humans can't keep up anymore," he said. "There's 50,000 data points in every patient. Imagine a 100-page book, and we have time to flip through the first three pages. When we were able to catch things earlier, we've seen it move (the) length of stay." A case study compiled by Regard amid Sentara's pilot use of the program revealed how a doctor in their Norfolk location used the technology to solve a patient's condition. Dr. Colin Findlay had suspected lack of adherence to prescribed medications was the root cause of an admitted patient's uncontrolled heart failure, but Regard's comb-through of the person's records revealed a separate condition. It turned out that doctors had previously paused the patient's use of hypothyroidism medication for other reasons. When left untreated for too long, hypothyroidism can cause rapid heart rates. Regard helped Findlay confirm that it was time for the patients' prescription to be resumed. While AI use has been growing across multiple industries in recent years, it has presented a series of pros and cons. Theresa McDonnell, chief nurse executive at Duke University Health System, has emphasized that AI tools can reduce staff burnout, but cautioned about the technology's potential to depersonalize care or weaken patient trust. Likewise, a National Institutes of Health study labeled AI "the opportunity for health care revolution," but said that it also presents ethical, regulatory and safety challenges to address when integrating it. Regulating the tech. In Virginia's legislative session earlier this year, Del. Irene Shin, D-Fairfax, and Sen. Jeremy McPike, D-Prince William successfully carried legislation to prohibit downcoding insurance claims without a healthcare provider providing reasons for the decision. The new law is meant to ensure human decisions factored into insurance claims rather than allowing AI technology to carry out the action on its own. "Applications where it's an assistive tool and not deciding is what's appropriate," McPike said. "We have licensed practitioners, and that's why we hire them. That's why we folks go to school in very sophisticated and specialized areas." Further action is expected in the state's 2027 legislative session, Virginia's Joint Committee on Technology and Science director Jodi Kuhn said. The committee outlined a series of recommendations for lawmakers to explore. One suggestion is to establish an enforcement agency that can receive complaints from the public, investigate potential noncompliance with regulations and impose penalties. Other ideas include requiring disclosure of AI use in healthcare or human-involvement bills, like the ones McPike and Shin have already explored. Del. Rodney Willett, D-Henrico, who chairs the House of Delegates' Health and Human Services Committee, said he will be introducing the public disclosure bill soon. "It's one of those guardrail things, but it's not prohibiting AI use," he said.