Developing Bilingual Pharmacists to Break Down Barriers

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A Hispanic pharmacist fills a prescription.

Ashley Mendez’s family fled Cuba in the wake of Fidel Castro’s rise to power and settled in Miami, rebuilding their life from scratch — with little money, few possessions and no ability to speak English.

Watching her family, Ashley understood from a young age how difficult even the simplest tasks could be when you didn’t speak the same language as everyone else. That was particularly true for health care: Ashley and her family believe her grandmother’s death may have been caused in part by miscommunication over the painkiller she was taking for a pinched nerve.

So when it came time to choose a career, Ashley knew exactly what she wanted to do — and where she wanted to do it. She wanted to be a pharmacist and she wanted to work somewhere she could help people who didn’t speak English.

It was the way she could honor her grandmother.

“She was one of the most influential people in my life,” says Ashley. “If we had known more about what was going on, we could have helped her.”

There are many different barriers that prevent people from getting the health care they need: They may live in an area without the right providers, they may lack the transportation to travel to the right facility, they may not have enough money to afford the right treatment.

But one critical barrier that frequently gets overlooked is the language barrier.

According to the U.S. Census Department, the number of residents who speak Spanish at home has skyrocketed 130 percent since 1990, up to about 40 million. That increase has created an overwhelming demand for bilingual pharmacists — but the supply has not kept pace. While Hispanics comprise 18 percent of the nation’s population, they account for less than 5 percent of the pharmacist workforce.

Ashley, 27, is part of CVS Health’s effort to close the gap. She spent the summer of 2017 in an immersive internship program that seeks to help develop bilingual pharmacists. Interns spend 10 weeks shadowing pharmacists who are fluent in Spanish and participating in the care of Spanish-speaking patients. They learn medical terminology, study diseases prevalent in the Hispanic community, and become familiar with the over-the-counter products most popular among Hispanic customers.

The program is an illustration of the company’s belief that you can’t build healthy communities unless you have a workforce that reflects those communities.

“People are looking for a pharmacist they feel comfortable talking to,” says Alex Acuna, 26, another intern in the program, who attended the University of Texas at Austin.

Alex grew up in an El Paso neighborhood that was 80 percent Latino, and in a household where his mother regularly spoke Spanish. But although he could speak a fair amount of Spanish himself, communicating technical details to his Spanish-speaking customers was difficult. Nuances were being lost in translation. In normal conversation, those nuances could be insignificant. When talking about treatments and medication, they could be critical.

Alex knew he had to learn “pharmacy Spanish,” as he described it.

“When was first starting, my Spanish was a little broken,” he says.  “Saying something a certain way could mean something different to a patient.”

The internship program is one of several efforts from CVS Health to address the language gap. Last year, CVS Health gave the Roseman University College of Pharmacy $25,000 to fund Hispanic recruitment and outreach initiatives and establish a pipeline of Spanish-speaking students.

Alex, who earned his license in May, is working now back in his hometown of El Paso. He says he’s grateful to be able to give back to the community that raised him.

Ashley, who attended Florida State University as an undergraduate and studied pharmacy at Mercer University in Atlanta, says she’d love to go back to Miami, where she grew up and where she served her internship.

But she also knows that in Florida, she’ll be one among many Spanish speakers — and that she might do more for the Latino community by staying where she is now.

“There’s a need for Spanish speakers in Atlanta,” she says. “You can tell that the language barrier is a big issue.”

For more information about CVS Health’s efforts to improve care across the nation, visit our News & Insights page and the CVS Health Impact Dashboard. To stay informed about the latest updates and innovations from CVS Health, register for content alerts and our Leaders in Care newsletter.

A Hispanic pharmacist fills a prescription.
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Aetna’s New Cancer Support Center Connects Members to Personalized Information

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“Take a deep breath.”

That’s how the section of Aetna’s digital oncology hub regarding “navigating treatment” begins – no medical terms or insurance jargon, just a simple reminder.

Dealing with cancer can be an overwhelming experience for patients, families and caregivers. The lack of centralized information about the disease and effective treatments can pose a real challenge both for patients, who must cope with their own personal cancer diagnosis and journey, and their families.

While there is information available online for those dealing with cancer, it can be confusing, contradictory or even downright dangerous when patients rely solely on “Dr. Google” for information.

Aetna is stepping into that information gap by providing members with a comprehensive, user-friendly resource for cancer treatment education and support. A digital oncology hub called the Cancer Support Center is now part of Aetna’s library of online-based member resources.

“Cancer diagnosis and treatment is often the most difficult and physically, mentally and financially stressful time in a person’s life,” said Dr. Roger Brito, senior medical director on the Aetna oncology solutions team. “We made it our mission to try to make that journey a little easier.”

The project was developed as an enterprise-wide initiative, involving medical and content experts from across Aetna who worked together to create easy-to-understand materials that are location-specific and catered to a member’s diagnosis. The information on the hub is structured in a way that reflects a holistic view of the cancer patient journey – from screening and prevention, to diagnosis, to treatment, recovery and beyond.

One of the key benefits of making this kind of information available online is that it can be easily updated to reflect new treatments, standards and best practices. As Dr. Brito points out, many medications used today weren’t even available just a few years ago, so the oncology hub can be continually revised to reflect the latest medical guidance.

“It’s just a constantly changing and evolving state,” he said. “The treatments in two to three years will likely be very different from those we use today.”

The Aetna team identified breast cancer as the type of cancer that affected the most members across all ages and backgrounds (with more than 120,000 claims per year) and chose to launch the hub around this topic. However, the Cancer Support Center will continue to evolve and grow as more information is added for different cancers, including ovarian and prostate cancers.

The support center has been an early success in terms of member and caregiver engagement, according to Dr. Brito, with many visitors coming back to the site repeatedly.

“The goal is to continue to expand the hub so that we can provide the right mix of resources and education,” said Dr. Brito. “We will continue to look for opportunities to support our members and their caregivers to help ease the challenges of this difficult journey.”

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Certified Peer Support Specialists: Transforming Traditional Recovery for Members

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Following treatment for a behavioral health condition, ranging from inpatient levels to outpatient care, members often need encouragement in their recovery or assistance adjusting to a “new normal.” Having someone by their side who has lived that journey themselves – and can help promote a positive recovery – can help members understand the process, what to expect, and how to avoid and manage setbacks.

Traditionally found in Medicaid, Aetna is one of the first commercial insurers to cover peer support for members, an evidence-based behavioral health service that assists people with achieving long-term recovery from a psychiatric disorder or addiction. Over 70 percent of Aetna members that have been referred to peer support as part of Aetna Behavioral Health’s ongoing transformation initiatives have engaged with a specialist.

“Certified peer support specialists have first-hand knowledge of our members’ experience,” said Karen McBride, director, Network Management, Aetna Behavioral Health. “Their shared experience allows them to engage and connect with members, as well as their caregivers, to serve as an integral component of the treatment team.”

Aetna has also partnered with MAP Care Solutions (a provider of peer support services) to provide telephonic and video peer support to members for up to 12 months after they are discharged from treatment.

“Virtual peer support has enabled access for more members in addition to in-person specialists. Peer support has transformed the traditional process of recovery for members by ensuring treatment doesn’t stop the moment members transition to a new level of care,” said Malaika Vasiliadis, LMHC, implementation director, Behavioral Health Transformation, Aetna Behavioral Health.

Peer support can include talking to members, and to their family with a member’s permission, about the recovery process, sharing their knowledge to prevent a relapse and teaching practical recovery skills. In addition, peer support specialists can connect and accompany members to community resources to support their treatment, such as support groups, or even an auto mechanic, if the situation calls for it.

Recently, an Aetna member arrived home after being discharged from treatment to find his car wouldn’t start. Ryan Schweiger, the member’s peer support specialist, was fortunately by his side and able to support him through any negative recovery outcomes due to additional stress. Ryan had accompanied the member home and partnered with him to jump the battery and get the car to a mechanic for repairs.

“Small inconveniences like a dead car battery can be a huge stressor for someone who is in recovery for substance use disorder,” said Ryan, peer support team leader, Penn Foundation, a mental health and substance abuse treatment center in Pennsylvania. “They are vulnerable, and a situation like this can serve as a trigger.”

Aetna has empowered Ryan to do whatever is necessary to support recovery, and he is always ready to step in and help members. Beyond his impromptu trips to the mechanic, his work has ranged from jumping on the phone with members to remind them they are doing great, to attending recovery conferences together, to helping them find housing when needed and even organizing a trip to the barber to help them feel better about their appearance and connect them back to the community.

“As someone who has been through this, I know how difficult this can be.”

He notes though that each member journey is unique.

“Everyone has their own pathway; I don’t have the answers for my peers in recovery,” explains Ryan. “What worked for me won’t necessarily work for someone else. But I take my experience and help show them different pathways to recovery and provide explanations. Our job is to not judge, it is to support the person’s journey.”

As of April 1, 2019, there is no cost shareFully insured plans are waived. Self-insured plan sponsors have the option to exclude, and high-deductible health plan members must pay the deductible before cost share is waived. for Aetna members who utilize peer support. Aetna is continuing to expand its network of behavioral health and addiction facilities that provide certified peer support services to improve the length and quality of members’ recovery.

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New Aetna Enhanced Medical Bundles Provides Cash Benefits to Members Following Unexpected Health Events

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Most employers know that medical plans are a benefit that they are expected to offer to their employees. That’s the easy part. The difficult aspect is that medical plans come in many shapes and sizes, don’t always cover everything and those with high deductibles can leave employees with financial stress.

“Employers and their benefits advisers often face pressure to develop packages that deliver attractive, cost-effective options to a workforce with diverse needs,” said Randy Finn, Senior Director, Voluntary Business, Aetna. “Bundling a medical plan with a supplemental plan is a helpful solution that can deliver both administrative and cost efficiencies to employers, including savings on premiums and fees, while also enriching the benefits package they can offer their employees.”

In 2019, Aetna introduced the Aetna Enhanced Medical Bundle℠, which combines an Aetna medical plan with one or more of its supplemental plans. The Aetna supplemental plans pay cash benefits directly to members, which they can use to help cover medical plan expenses, like their deductible, or even everyday costs like childcare, rent and groceries. They also help ensure members can financially weather unexpected health events.

An Aetna Enhanced Medical Bundle can include one, two or all of three of the supplemental plans, which are:

  • Aetna Accident Plan: Cash payments for common services related to an accident, like a broken ankle.

  • Aetna Critical Illness Plan: Cash payments for expenses faced during a serious illness like cancer, stroke or heart attack.

  • Aetna Hospital Indemnity Plan: Cash payments for out-of-pocket costs associated with a planned or unplanned covered inpatient stay.

On top of cash benefits, bundled plans provide additional benefits to members. They can manage their medical and supplemental benefits through a single website, and Aetna leverages the medical claim so employees don’t have to submit additional paperwork to get their supplemental claim paid.

Through one or more supplemental plans, members gain a cost-effective means to minimize out-of-pocket medical expenses and protect themselves from a potentially financially devastating medical event.

“Whether its related to a high-deductible health plan or another medical plan, the supplemental plans under the Aetna Enhanced Medical Bundle can give members confidence that they have a safety net in the event of a health care need and the ease of an all-in-one process to manage their benefits,” said Pat McGinn, National Vice President of Sales, Aetna.

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Aetna Is Ready to Help in a Natural Disaster

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Your medicines and medical records may be the last thing on your mind when a wildfire nears your home, or a hurricane approaches, or flood waters rush closer and closer. Once you are on safer ground, however, you’ll realize you need them. Your doctor’s office or local pharmacy may not be available during a natural disaster, but your insurance company may be able to help.

Aetna has a long track record of stepping up to help its members caught in a natural disaster. Aetna’s business resiliency team keeps an eye on developing hurricanes, wildfires that are threatening communities, and other disasters. The team also monitors the news for events that strike unexpectedly, such as tornadoes. Aetna’s team is ready to move immediately, so members have one less thing to worry about.

Each disaster is different, of course. Aetna changes its normal policies during a disaster depending on many factors – the disaster’s effect on our members, the severity of the disaster’s impact on the local health care system, the geography, and any local, state or federal emergency request or declaration.

Replacing prescription medicines

Letting members refill prescriptions early is the most common way to help members during a disaster. This action can replace medicines that were lost, destroyed or left behind in an evacuation. Aetna’s pharmacy customer service teams are always ready to help a member caught in one of these situations.

If prescription mail order delivery is affected, Aetna can help members get their medicines at a local pharmacy. And if a member’s prescription had run out, Aetna can help them find an urgent care clinic where they can get a new prescription if needed.

Going to the doctor

If a widespread disaster forces doctor’s offices, clinics and even hospitals to close, Aetna can help members find care. Urgent care centers and walk-in clinics can handle many such issues. In some situations members may be able to see a doctor online through a telemedicine service. Aetna also may waive normal requirements, such as precertification for some services, if doctors can’t follow normal processes during a disaster.

Caring for your emotional well-being

Members can always access the behavioral health services that are part of their plan to help them cope with a disaster. In some circumstances, Aetna will open the behavioral health support of its Employee Assistance Program to everyone in the area affected by the disaster, whether or not they are members.

Extending deadlines

Depending on the disaster, Aetna may also extend deadlines for things like filing claim appeals.

Medical records

If you have an electronic health record set up through your insurer, hospital system or an online service, share that with any doctor caring for you during a disaster. If you don’t have access to your medical history, Aetna can provide physicians with claims information that will help them treat displaced members.

How do I get help?

If you’re an Aetna member and find yourself needing medicine or care during a disaster, call us. (If you’re not an Aetna member, check with your insurer.) Our customer service representatives can tell you what policy changes are already in place to help with the current disaster. We’re happy to help.

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Aetna President Karen Lynch on the future of health care

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Speaking at the NewCo Shift Forum, Aetna President Karen Lynch talked about the opportunity to revolutionize and humanize healthcare and described an industry that is ripe for disruption.

“Healthcare now represents around 18 percent of the U.S. gross domestic product. It’s no surprise a lot of people look at the industry and see a big bullseye,” said Lynch. “There is no question that a more consumer-centric, service-oriented approach will be essential for success.”

Lynch was interviewed by Rana Foroohar, global business columnist and associate editor at the Financial Times. The 2018 forum focused on the opportunity and influence that businesses have on industry, society and culture, and how digital and technology trends are spurring new market opportunities.

“While there have been advances, healthcare has not focused on the full consumer experience. Too often, we have thought of consumers as patients, not people,” said Lynch. “If you want to know where healthcare is headed, look no further than Aetna’s own future.”

When speaking about the proposed acquisition of Aetna by CVS Health, Lynch said the opportunity will deliver a health care experience that is simpler, more affordable and more responsive to consumers’ needs.

“We will add value for people when they engage with us by going to where they are and being part of their everyday lives – in their local communities,” said Lynch.

Lynch also talked about the importance of businesses looking after its employees.

“The reality is that today companies are judged on more than just our product. They recognize that consumers and customers are expecting them to take a stand, to be trustworthy, positive contributors to society,” said Lynch.  “We have to hold ourselves accountable to a higher standard as well.”

Aetna launched its “Social Compact” in 2015, which includes improved wages, enhanced benefits and innovative wellness programs.

In January 2015, Aetna increased the minimum hourly wage for U.S. employees to $16 per hour. The company also launched an enhanced benefits program, which lowered out-of-pocket health care expenses for thousands of eligible U.S. employees.

In August 2016, the health company announced a student loan repayment program. The company began matching loan payments in January 2017 up to $2,000 a year with a lifetime maximum of up to $10,000 for full-time U.S. employees, who graduated on or after Dec. 1, 2013. For part-time employees, Aetna matches contributions up to $1,000 a year with a lifetime maximum of $5,000.

No Offer or Solicitation

This communication is for informational purposes only and not intended to and does not constitute an offer to subscribe for, buy or sell, the solicitation of an offer to subscribe for, buy or sell or an invitation to subscribe for, buy or sell any securities or the solicitation of any vote or approval in any jurisdiction pursuant to or in connection with the proposed transaction or otherwise, nor shall there be any sale, issuance or transfer of securities in any jurisdiction in contravention of applicable law.  No offer of securities shall be made except by means of a prospectus meeting the requirements of Section 10 of the Securities Act of 1933, as amended, and otherwise in accordance with applicable law.

Additional Information and Where to Find It

In connection with the proposed transaction between CVS Health Corporation (“CVS Health”) and Aetna Inc. (“Aetna”), on February 9, 2018, CVS Health filed with the Securities and Exchange Commission (the “SEC”) an amendment to the registration statement on Form S-4 that was originally filed on January 4, 2018.  The registration statement includes a joint proxy statement of CVS Health and Aetna that also constitutes a prospectus of CVS Health.  The registration statement was declared effective by the SEC on February 9, 2018, and CVS Health and Aetna commenced mailing the definitive joint proxy statement/prospectus to stockholders of CVS Health and shareholders of Aetna on or about February 12, 2018.  INVESTORS AND SECURITY HOLDERS OF CVS HEALTH AND AETNA ARE URGED TO READ THE DEFINITIVE JOINT PROXY STATEMENT/PROSPECTUS AND OTHER DOCUMENTS FILED OR THAT WILL BE FILED WITH THE SEC CAREFULLY AND IN THEIR ENTIRETY BECAUSE THEY CONTAIN OR WILL CONTAIN IMPORTANT INFORMATION.  Investors and security holders may obtain free copies of the registration statement and the definitive joint proxy statement/prospectus and other documents filed with the SEC by CVS Health or Aetna through the website maintained by the SEC at http://www.sec.gov.  Copies of the documents filed with the SEC by CVS Health are available free of charge within the Investors section of CVS Health’s Web site at http://www.cvshealth.com/investors or by contacting CVS Health’s Investor Relations Department at 800-201-0938.  Copies of the documents filed with the SEC by Aetna are available free of charge on Aetna’s internet website at http://www.Aetna.com or by contacting Aetna’s Investor Relations Department at 860-273-0896.

Participants in the Solicitation

CVS Health, Aetna, their respective directors and certain of their respective executive officers may be considered participants in the solicitation of proxies in connection with the proposed transaction.  Information about the directors and executive officers of CVS Health is set forth in its Annual Report on Form 10-K for the year ended December 31, 2017, which was filed with the SEC on February 14, 2018, its proxy statement for its 2017 annual meeting of stockholders, which was filed with the SEC on March 31, 2017, and certain of its Current Reports on Form 8-K.  Information about the directors and executive officers of Aetna is set forth in its Annual Report on Form 10-K for the year ended December 31, 2017, which was filed with the SEC on February 23, 2018, its proxy statement for its 2017 annual meeting of shareholders, which was filed with the SEC on April 7, 2017, and certain of its Current Reports on Form 8-K.  Other information regarding the participants in the proxy solicitations and a description of their direct and indirect interests, by security holdings or otherwise, are contained in the definitive joint proxy statement/prospectus filed with the SEC and other relevant materials to be filed with the SEC when they become available.

Cautionary Statement Regarding Forward-Looking Statements

The Private Securities Litigation Reform Act of 1995 (the “Reform Act”) provides a safe harbor for forward-looking statements made by or on behalf of CVS Health or Aetna.  This communication may contain forward-looking statements within the meaning of the Reform Act.  You can generally identify forward-looking statements by the use of forward-looking terminology such as “anticipate,” “believe,” “can,” “continue,” “could,” “estimate,” “evaluate,” “expect,” “explore,” “forecast,” “guidance,” “intend,” “likely,” “may,” “might,” “outlook,” “plan,” “potential,” “predict,” “probable,” “project,” “seek,” “should,” “view,” or “will,” or the negative thereof or other variations thereon or comparable terminology.  These forward-looking statements are only predictions and involve known and unknown risks and uncertainties, many of which are beyond CVS Health’s and Aetna’s control.

Statements in this communication regarding CVS Health and Aetna that are forward-looking, including CVS Health’s and Aetna’s projections as to the closing date for the pending acquisition of Aetna (the “transaction”), the extent of, and the time necessary to obtain, the regulatory approvals required for the transaction, the anticipated benefits of the transaction, the impact of the transaction on CVS Health’s and Aetna’s businesses, the expected terms and scope of the expected financing for the transaction, the ownership percentages of CVS Health’s common stock of CVS Health stockholders and Aetna shareholders at closing, the aggregate amount of indebtedness of CVS Health following the closing of the transaction, CVS Health’s expectations regarding debt repayment and its debt to capital ratio following the closing of the transaction, CVS Health’s and Aetna’s respective share repurchase programs and ability and intent to declare future dividend payments, the number of prescriptions used by people served by the combined companies’ pharmacy benefit business, the synergies from the transaction, and CVS Health’s, Aetna’s and/or the combined company’s future operating results, are based on CVS Health’s and Aetna’s managements’ estimates, assumptions and projections, and are subject to significant uncertainties and other factors, many of which are beyond their control.  In particular, projected financial information for the combined businesses of CVS Health and Aetna is based on estimates, assumptions and projections and has not been prepared in conformance with the applicable accounting requirements of Regulation S-X relating to pro forma financial information, and the required pro forma adjustments have not been applied and are not reflected therein.  None of this information should be considered in isolation from, or as a substitute for, the historical financial statements of CVS Health and Aetna.  Important risk factors related to the transaction could cause actual future results and other future events to differ materially from those currently estimated by management, including, but not limited to:  the timing to consummate the proposed transaction; the risk that a regulatory approval that may be required for the proposed transaction is delayed, is not obtained or is obtained subject to conditions that are not anticipated; the risk that a condition to the closing of the proposed transaction may not be satisfied; the outcome of litigation related to the transaction; the ability to achieve the synergies and value creation contemplated; CVS Health’s ability to promptly and effectively integrate Aetna’s businesses; and the diversion of and attention of management of both CVS Health and Aetna on transaction-related issues.

In addition, this communication may contain forward-looking statements regarding CVS Health’s or Aetna’s respective businesses, financial condition and results of operations.  These forward-looking statements also involve risks, uncertainties and assumptions, some of which may not be presently known to CVS Health or Aetna or that they currently believe to be immaterial also may cause CVS Health’s or Aetna’s actual results to differ materially from those expressed in the forward-looking statements, adversely impact their respective businesses, CVS Health’s ability to complete the transaction and/or CVS Health’s ability to realize the expected benefits from the transaction.  Should any risks and uncertainties develop into actual events, these developments could have a material adverse effect on the transaction and/or CVS Health or Aetna, CVS Health’s ability to successfully complete the transaction and/or realize the expected benefits from the transaction.  Additional information concerning these risks, uncertainties and assumptions can be found in CVS Health’s and Aetna’s respective filings with the SEC, including the risk factors discussed in “Item 1.A. Risk Factors” in CVS Health’s and Aetna’s most recent Annual Reports on Form 10-K, as updated by their Quarterly Reports on Form 10-Q and future filings with the SEC.

You are cautioned not to place undue reliance on CVS Health’s and Aetna’s forward-looking statements.  These forward-looking statements are and will be based upon management’s then-current views and assumptions regarding future events and operating performance, and are applicable only as of the dates of such statements.  Neither CVS Health nor Aetna assumes any duty to update or revise forward-looking statements, whether as a result of new information, future events or otherwise, as of any future date.

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Pay Flex CEO Shines Light on Opportunity for Payers, Providers to Collaborate on Revenue Cycle

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When it comes to health care costs, many consumers feel left in the dark. In fact, the No. 1 reason people do not pay their health care bills is due to confusion over the often antiquated and clunky payment process.

At the HIMSS Annual Conference & Exhibition in Las Vegas this week, PayFlex CEO and President Erin Hatzikostas hosted a session, “Equipping Consumers To Be The Chief Financial Officer Of Their Own Health Care,” to discuss how providers and health plans can work together to engage consumers to better understand and manage their health care expenses. PayFlex is a part of the Aetna family.

With the rise of consumer directed health plans turning patients into larger financial stakeholders in their care, “Consumers are left woefully behind in getting the information they need,” said Hatzikostas.

Consumers cannot make informed choices about their elective health care if they do not know what it costs. Furthermore, even after patients receive care, they are often left in a thicket of mail from providers and their insurer, including Explanations of Benefits (EOBs) which may look like bills, bills from providers that look like EOBs, etc.

While this is confusing for the patient, it also negatively affects doctors who performed services with the promise of getting compensated quickly. Collections typically take 3-5 months to process and only 17 percent of bills are collected. This delay is not linked to an unwillingness or inability by the patient to pay – three-fourths of people are willing and/or able to pay for their health care costs – but a lack of understanding of the payment system and process. “The No. 1 reason is that people were confused,” said Hatzikostas.

As a complex issue, the health care payment crisis requires a complex solution. Convenience and consumerism are hard to balance and simple solutions will not work.

In 2014, PayFlex launched Money Square for Health to help equip consumers to be better financial stewards of their health care. After just three years, the service earned over 200,000 users, with many repeat users. Beta testing confirmed the huge opportunity in the ecosystem to engage consumers and, with the learnings from Money Square for Health, Aetna launched AetnaPay to further empower consumers to become the CFO of their health care finances.

There is still much work to be done in supporting consumers to own their health care finances, but progress is being made. As we continue to shine a light on the payment black box, it will be imperative for providers to collaborate with health plans on solutions and work together to share quality data and advance work flows.

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Ben Wanamaker at HLTH conference: Don’t forget about providing value to the patient

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Too often, digital health tools are created with one party trying to hoard all of the value created, according to Ben Wanamaker, head of consumer technology and services at Aetna during a panel at the inaugural HLTH conference last week in Las Vegas.

The value must be distributed to the entire health ecosystem – especially patients – if they are to be successful, suggested Wanamaker.

“We need to figure out how to share the value [of Digital Health tools] with the technology purveyor, the payer, plan sponsor and deliver enough value to the patient for participating,” he said. “They deserve value.”

Wanamaker appeared on a panel titled “Who Will Rescue Healthcare?” with Lloyd Minor, dean of the Stanford School of medicine. The moderator of the panel was Annie Lamont, managing partner of Oak HC/FT.

Wanamaker also shared his vision for the role that digital health tools could fill in the current health care system.

“There’s a really huge gap we have to close, which is understanding what you want and what you need in health care. That’s where digital health becomes really important for us,” said Wanamaker.

“The points in time that show up in a payers’ dataset are too sporadic, too sparse to really understand what you want. The average American sees a provider approximately three times a year…although you’re spending 17 or 18 percent of your money on healthcare. That’s very imbalanced. That doesn’t work.”

With the recent Cambridge Analytica privacy scandal, moderator Lamont bluntly brought up one of the elephants in the room for digital health. What will health systems and insurers do with all this data?

We “believe users deserve a lot of say in how their data is used and shared and for what purpose,” said Wanamaker. “One of the principles we use to guide our work as we work with technology partners is your data is only used for good.

“A lot of people ask me questions like, ‘Well, Ben. If you use my health care data, wouldn’t you just use it to underwrite?’ The answer is an unequivocal no, because why would you ever share your data in any form or allow me to use the data you already shared if you had fear of me using it against you?”

The panel concluded by trying to imagine where the industry should be in one and five years.

“A one year view is that we need to increase the fidelity of vision in what’s going on in people’s lives,” said Wanamaker. “I think the five year vision would be to re-architect delivery around much more personalized entry points for patients… that are closer to home or in the home.”

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AetnaCare’s Personalized Approach Making a Difference for Members

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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.”

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The School Employee Guidance Program: Meeting teachers where they are

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As one suburban school teacher put it: “The stress never ends.”

She was responding to a 2017 Aetna survey that proved she wasn’t alone. The findings showed school employees with a higher prevalence of depression, anxiety and turnover compared to other professions due to a variety of factors such as classroom behavioral issues, increased class sizes and the focus on standardized testing scores.

With more than 1 million public school employees as members, Aetna is addressing the unique needs of this group by launching The School Employee Guidance program, the latest in the company’s ongoing commitment to improve its members’ emotional, physical and mental health.

“A teacher’s workday doesn’t end when the last bell rings. With the School Employee Guidance Program, teachers can connect to support when and how they need us, so that when the first bell rings the next day, they have all the tools in their back pocket to do the job they were inspired to do,” said Brooke Wilson, head of Worklife Services, Aetna Resources for Living.

Many existing school programs have been created in response to a tragic event or crisis, but The School Employee Guidance Program is different because it uses a combination of proactive individual and onsite group training and counseling for student behavior-based conflicts. The program also includes workshops on relevant topics including:

  • Preventing burnout
  • Coping with anxiety
  • Managing challenging interactions
  • Handling stress
  • Addressing autism spectrum disorder (ASD) and ADHD

Additionally, school employees enrolled in the program have access to a 24/7 help line for clinician support, confidential self-assessments, online webinars and videos on stress management and ADHD, and more.

The program is the result of a 2017 research study  that Aetna conducted. The survey included teachers, professional staff and administrators nationwide from a cross-section of large and small districts in high and low communities to determine the top challenges in their industry. The research findings concluded that:

  • 80 percent of survey participants said managing class behavior for ADD and ADHD caused significant stress

  • 24 percent of survey participants expressed the need for an on-staff counselor, social worker or therapist

  • The average class size has almost doubled from 15.1 to 27.1 students over time

To learn more about the program, visit the Aetna Public Sector website or contact your Aetna representative.

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