HARTFORD, Conn. – During the past six years, Aetna (NYSE: AET) has “embedded” many of its nurse case managers in the offices of health care providers who support Aetna’s Medicare Advantage members. This collaborative approach has been shown to help improve the quality of care for Aetna Medicare Advantage members and also lower health care costs for these members. Aetna’s early success in Medicare Provider Collaborations helped lay the foundation for the company’s broader work to advance value-based, accountable care models.
The Aetna Medicare Advantage Provider Collaboration Embedded Case Management Program was recognized recently for these positive results with a 2013 Case in Point Platinum award. Case In Point is a unique awards program presented by Dorland Health that recognizes the most successful and innovative care management programs working to improve health care.
“We are honored to receive the Case in Point award, and even more pleased that our collaborative work with health care providers continues to help our Medicare Advantage members live healthier lives,” said Randall Krakauer, MD, FACP, FACR, Aetna’s national Medicare medical director. “Our success with this program is led by our talented and dedicated nurse case managers who become trusted members of the clinical teams they support. By combining our capabilities and resources with the collaborating provider groups, we can create better health outcomes for our members and patients than either of us can do alone.”
Through the Provider Collaboration program, Aetna has helped participating health care providers improve in a number of clinical quality metrics, such as:
- Increasing the percentage of Aetna Medicare Advantage members who have an office visit each calendar year;
- Encouraging office visits every six months for members with chronic heart failure (CHF), chronic obstructive pulmonary disease (COPD) or diabetes;
- Encouraging HbA1C (blood glucose) tests each calendar year for members with diabetes; and
- Confirming that members schedule follow-up visits within 30 days of being discharged from an inpatient stay.
Aetna’s Provider Collaboration program was previously featured in the September 2012 issue of Health Affairs. The Health Affairs article included results from Aetna’s first Provider Collaboration arrangement with NovaHealth, the independent physician association founded by InterMed, based in Portland, Maine. The results showed that:
- Patients in the program had 50 percent fewer inpatient hospital days, 45 percent fewer hospital admissions, and 56 percent fewer readmissions than unmanaged Medicare populations statewide.
- The total per member, per month costs for Aetna Medicare Advantage members in the program were 16.5 to 33 percent lower across all medical cost categories than for other Aetna Medicare Advantage members not cared for through this program.
Aetna now has Medicare Provider Collaboration arrangements with more than 70 health care facilities across the country, with plans to expand the program in the future. These arrangements currently support the care of more than 50,000 Aetna Medicare Advantage members.
Aetna is one of the nation’s leading diversified health care benefits companies, serving an estimated 44 million people with information and resources to help them make better informed decisions about their health care. Aetna offers a broad range of traditional, voluntary and consumer-directed health insurance products and related services, including medical, pharmacy, dental, behavioral health, group life and disability plans, and medical management capabilities, Medicaid health care management services, workers’ compensation administrative services and health information technology services. Aetna’s customers include employer groups, individuals, college students, part-time and hourly workers, health plans, health care providers, governmental units, government-sponsored plans, labor groups and expatriates. For more information, see www.aetna.com.