CVS Health Expands Nurse-Led Program to Cut Medicare Readmissions

CVS Health, through its Aetna insurance division, is expanding a program designed to reduce hospital readmissions among Medicare Advantage members aged 65 and older. This initiative assigns Aetna-employed nurses to patients transitioning from hospitals to home or nursing facilities to coordinate in-home care and manage follow-up appointments, aiming to improve patient outcomes and reduce costly readmissions. The program supports patients with disabilities and complex care needs by providing personalized nursing support starting at hospital discharge.

This expansion aligns with recent regulatory changes by the Centers for Medicare & Medicaid Services (CMS), which now include Medicare Advantage members in hospital readmission penalty calculations starting fiscal year 2027. Hospitals with higher-than-expected readmission rates can face payment reductions up to 3%, incentivizing improved care coordination post-discharge. However, some hospital groups, including the American Hospital Association, have raised concerns about potential unfair penalties linked to coverage delays.

By the end of 2025, CVS Health plans to implement this nurse-led care transition program in 10 hospitals across key markets including Kansas City, Houston, and Raleigh. The approach aims to leverage the health plan's vested interest in patient health to provide more effective discharge instructions and care management compared to traditional hospital-based efforts.

Industry experts highlight that such programs can enhance coordination between payers and providers, helping to address readmissions which account for significant healthcare costs. The personalized nurse engagement model could serve as a blueprint for other insurers seeking to improve quality metrics and patient satisfaction while adapting to evolving CMS regulations. CVS Health intends to advocate for broader adoption of similar models.

Overall, this expansion represents a strategic effort by a major payer-provider entity to align care delivery with regulatory incentives designed to reduce readmissions, enhance post-acute care, and ultimately optimize health outcomes for the growing Medicare Advantage population.