Key Highlights :
CVS Health's Aetna business will implement its nurse-support program for Medicare Advantage members to reduce readmissions.
The program will roll out in ten hospitals by the end of 2025, providing follow-up, home care, and transportation assistance.
The move comes ahead of new CMS rules in 2027 that will include Medicare Advantage members in readmission penalty assessments.
Key Background :
Hospital readmissions are a chronic problem in American healthcare, reflecting failures in post-discharge care planning, follow-up care, and patient support. Not only are these repeat hospitalizations costly, but they are often countertherapeutic for the patient, particularly for older, disabled, or chronically ill Medicare Advantage members.
Medicare Advantage plans, operated by private insurers on contract with the federal program, now cover more than half of Medicare beneficiaries. Yet many of those covered have barriers to overcome in transitioning from hospital to home, such as limited use of transportation, delayed follow-up appointments to be scheduled, or nonexistent in-home care assistance. Such barriers most frequently result in preventable readmissions.
Regulators have heightened the spotlight on the topic. In July 2025, CMS issued a final rule that will expand its hospital readmission penalty program to Medicare Advantage members starting in fiscal year 2027. Under this proposal, hospitals with 30-day readmission rates above certain benchmarks for targeted conditions will face up to 3 percent payment reductions. The rule dramatically raises the stakes for providers with Medicare Advantage populations.
At the forefront, CVS Health's Aetna division has piloted innovative care models to improve discharge planning. The nurse-assignment initiative is one such example, with the goal of bringing continuity of care by placing clinical professionals into the patient's transition stream directly. Nurses will assist with medication adherence, link patients to home-based services, and provide logistical assistance to minimize risk of relapse or complications.
By December 2025, CVS expects to operate the program in ten US hospitals, including Houston Methodist in Texas, AdventHealth Shawnee Mission in Kansas City, and WakeMed Health & Hospitals in North Carolina. The company believes that this targeted approach will reduce unnecessary hospitalization, improve patient outcomes, and relieve economic burden on the health system.
Industry reactions are mixed. Insurers consider the program an encouraging move toward better care management, but hospital executives fear that CMS's penalty framework places too much blame on providers for issues caused by insurance coverage. Still, efforts like Aetna's can be pivotal in balancing regulatory mandates with quality of care improvements.
About the Author
Kevin Smith
Kevin Smith is a Managing Editor at World Care Magazine.