Managing a chronic condition like diabetes or high blood pressure can be a difficult, confusing and complex process. For members of AetnaCare, however, a personalized care approach is simplifying their health journeys and helping them to feel better quicker.
Launched in New Jersey in 2017, AetnaCare uses analytics to identify members who need the most help and connects them with local health and wellness services. Nurse case managers provide members with an integrated care plan as well as the knowledge, motivation and confidence to manage their own health.
“This is really a first-of-its-kind initiative centered on personalized health,” said Dr. Hal Paz, Aetna executive vice president and chief medical officer. “In the 14 months since we launched the program, we’ve curated a unique health ecosystem around medically complex members with both traditional and nontraditional care approaches.”
Getting the Right Help at the Right Time
By helping to coordinate care that members may receive via retail clinics, healthcare devices, pharmacy services, behavioral health and social services, AetnaCare nurse case managers help to simplify and clarify the best care path for each member.
“As the program has evolved, we’ve identified four key health events—inpatient admission, use of the emergency room, a new diagnosis or new medications added to a member’s regimen—that trigger our outreach to members in the program,” said Dr. Sunny Ramchandani, Aetna deputy chief medical officer. “By engaging with members at these critical health points, we provide help to our members right when they need it.”
The program has fostered collaborative relationships with the treating physicians, most of whom help with member outreach, according to Ramchandani, which helps to boost engagement rates. “We found that if a nurse case manager reaches out by phone, members don’t always respond,” he said. “But if a personal physician reaches out, it’s a different scenario completely.” This targeted scenario has improved member engagement rates to more than 70 percent.
Mapping a Member’s Health Care Journey
Divided into key health events, care maps reinforce the most up-to-date clinical, social and wellness practices. Each care map has various objectives, such as ensuring that members stick to their treatment plans and medication regimens, ensuring that members who have critical health needs receive the support they need and reinforcing healthy behaviors.
AetnaCare nurses, who meet with members at their homes, local coffee shops, by phone or wherever the member is most comfortable, use the care maps to educate members about their conditions. The nurses work closely with the members’ own health care team, making sure members have the resources and support to achieve their health goals. Regular check-ins to see where members are on their personalized plans are also features of the plan.
Paz noted that AetnaCare is seeing exceptionally high rates of engagement in members’ homes. “One of the unique aspects of the program is that we work directly with members’ primary care doctors,” he said, adding that AetnaCare is achieving positive outcomes. “We are seeing early evidence of reduced emergency room visits and hospital admissions as well as better medication adherence among our members.”
Ramchandani believes that patient outcomes, in large part, depend on the role of the nurse case managers.
“We injected a little bit of that doctor ethos into the nurse training… moving beyond symptom management toward actually getting the patient healthier,” he said, adding that AetnaCare nurses are now accountable for outcomes in the same ways that doctors are. “That requires nurses to learn new skills, and they are very excited to impact a member at that level… to be the lynchpin of care for a member.”
Caring Approach Helps AetnaCare Member Get Active Again
AetnaCare nurse case manager Nicole Taylor is using those new skills every day and is seeing the positive effects of the program on members’ health first-hand. Her personal, caring approach was particularly effective with Marshall Cummings, an Aetna member with diabetes, heart disease, and liver cancer.
Cummings, 67, lives alone in Elizabeth, NJ, and didn’t want to burden his family and friends as he struggled to manage his health. Nicole became his lifeline, going to doctors’ appointments and surgeries with him, educating him on the right foods to eat, improving his medication regimen, getting him active again and generally lifting his spirits. “She was the right person at the right time,” says Marshall. “Nicole helped me get my strength back.”
“I think being able to meet with Marshall in person, in his home, was a great change for him,” Taylor said. “After our time together, he is now much more health literate and feels confident asking his doctors questions now.”
Taylor also encouraged Cummings to join a gym and get involved in his community to boost his overall wellbeing. She now checks in with him on a quarterly basis to encourage him and continue reinforcing health-related messages.
“As AetnaCare nurse case managers, we’re very involved in all decisions related to our clients, and we’re given a voice in the care they receive,” Taylor said. “As case managers, we’re constantly moving, shaking and changing… looking for new opportunities to help members. It’s very cool.”