Coram, a CVS specialty business, provides high-quality infusion and tube-feeding care to patients where they live, work and travel. So when 17-year-old Andrew had an opportunity to go on a six-week cycling, cross-country adventure this past summer, his parents knew the Coram nursing team could help.
Andrew has Gaucher disease and receives enzyme replacement home infusions every 2 to 3 weeks. His trip would leave from Massachusetts in June and not return until early August, so he would require infusions along the route. His parents and medical team mapped out the trip and planned for infusions in Oklahoma City and Santa Monica, CA.
Coram nurses worked with Andrew’s primary care team at Boston’s Children’s Hospital to secure connections in the other states who would be willing to help. He needed an in-state physician to write the nursing orders, and a Coram nurse to meet him at a hotel for the infusion. The Coram Oklahoma City and Los Angeles branches ensured Andrew received the specialized care he needed.
Gaucher disease is a rare genetic enzyme deficiency disorder that affects 10,000 to 20,000 Americans, and can largely be controlled with enzyme replacement. Patients experience anemia, low platelet counts, severely enlarged liver and spleen, and bone disease.
Coram’s Vast Nurse Network
“The benefit of working with Coram is that we have more than 38 years of experience providing infusion services to patients,” said Julie Scaramuzzi, Nurse Manager, Infusion. “We meet patients where they are, and Coram has 73 ambulatory infusion suites across the country. Our team helps patients prepare the paperwork to bring liquids through airport security, and secure a nurse and location for the treatment,” she said. Coram has more than 2,000 clinicians who provide care to nearly 200,000 patients annually for a range of complex conditions including immune deficiencies, neurological disorders, digestive diseases and serious infections.
Andrew’s mom, Heidi, connected with Coram to pick up the medication near her home, and with the paperwork in order, boarded planes to Oklahoma and California. She met Andrew and the nurses in the hotels, and Andrew successfully received his treatments on the road. He was able to stay with his biking group for the entire trip.
Julie said “Andrew proves that patients who home-infuse are no longer home-bound. Our team works with many patients who travel for business or even just to see family for the holidays. Our network of nurses is vast and we are able to meet patients where they are, when they need their treatment.”
The Accordant Team Approach for Gaucher Patients
In addition to care from Coram clinicians and nurses, Accordant offers support for members with rare conditions, such as Gaucher disease, through targeted interventions designed to meet each patient’s unique needs.
“The specialized care team is composed of registered nurses, pharmacists, social workers, and a medical director – all backed by a medical advisory board,” Ahmed F. Hassan, Vice President and General Manager, Accordant. “These skilled practitioners set mutually agreed-upon health goals with the patient, discuss symptom management, explain proper use of medications, and even deal with resource issues such as lack of transportation to doctors’ appointments or cost of care.”
The more than 30 physicians on Accordant’s medical advisory board are available to the Accordant team to discuss complex situations and offer insights into care approaches that the nurse may use in supporting the patient. And, all of the team’s care is grounded in the latest evidence-based medicine and clinical guidelines.
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As health care costs continue to rise, payers, providers and patients are looking for new ways to help improve quality of patient care and their experience while lowering overall costs. One promising area is in home infusion care.
In fact, published research has shown that the home infusion services, like those provided by Coram CVS Specialty Services, can be safe and beneficial for those patients requiring infused therapies and in some cases can be a lower cost alternative to receiving the same services in a hospital or inpatient setting. In addition, the research has also shown that patients overwhelmingly prefer receiving their infusion therapies at home.
Read more about the benefits and value of home infusion care from Tricia Lacavich, Vice President for CVS Specialty Coram Infusion Services, in her recent article in Fierce Healthcare.
As CVS Health looks to transform health care and contribute to a better, more efficient system, we are looking at ways to leverage and improve the use of technology to improve quality of care and patient outcomes.
This is especially important in specialty pharmacy and why we’ve introduced Specialty Expedite.
Getting patients the medications they need quickly and efficiently
For patients with complex medical conditions requiring specialty medications, getting started on their prescriptions quickly and efficiently is crucial to their care. But the process has not always been that simple, with patients sometimes having to wait as long as several weeks to complete the manual onboarding and prior authorization process.
Specifically, the process to get started on a specialty medication often requires physician’s offices and insurers to fax appropriate patient records and/or required approvals before a prescription can be filled, which can be time consuming but is a critical step to ensure that patients are receiving the most appropriate medication.
In addition, across the health care system, the Federal government is looking at ways to help enable and improve health information technology (IT) systems and as part of that, officials have even called for health care to be a “fax free zone by 2020.”
How it works
Specialty Expedite works by securely gathering appropriate patient information, including insurance, lab work and diagnosis codes via a doctor’s electronic health record (EHR) system instead of sharing through fax. The process also cuts down on paperwork and phone calls, resulting in fewer errors and more efficiencies.
In addition, patients also now have the option of receiving real-time status updates via email or text, so that they can stay informed on the status of their prescriptions and any prior authorization requirements. Patients are also able to choose how they want to get their specialty medications — at their local CVS Pharmacy or though specialty mail service
Helping patients with complex medical conditions get the specialty medication they need more quickly and efficiently through technology and solutions such as Specialty Expedite is one more way we are helping people on their path to better health.
Coram, a CVS specialty business, provides high-quality infusion and tube-feeding care to patients where they live, work and travel. For younger patients, that list now includes where they play.
As part of enhancing the consumer experience, Coram pediatric patients who receive home parenteral (intravenous) nutrition (HPN) and enteral (tube-feeding) nutrition can carry their pump and nutrition in a backpack that’s sized just for them.
Coram Pediatric Pump Pals backpacks enable children and teens to carry their portable pump and nutrition while they participate in normal activities while infusing.
About 1,200 pediatric patients use the parenteral backpacks, while nearly 1,600 utilize the enteral packs for school and other activities.
“The entire system fits nicely into these small backpacks for little ones,” said Karen Hamilton, Director of Clinical Nutrition for CVS Health. “They can be worn by the patient or hung nearby throughout the infusion.” As with all home infusion therapies, the intent is for the patient to be as mobile as possible.
“Our backpacks give young patients the freedom to leave the house and live their lives,” said Hamilton. “Gone are the days of being homebound and having to miss out on activities, birthday parties and other events. The backpacks are designed to be fun and not look medical.”
Providing quality infusion care at home and on the go
Coram CVS Specialty Infusion Services delivers high-quality infusion therapy services in home-based and outpatient settings to more than 183,000 patients per year. Services are provided at more than 90 locations nationwide, as well as through the largest home infusion network in the country.
Coram’s home-based care includes nutrition, delivered either intravenously when the digestive tract is not functional and necessary for patients to maintain adequate nutrition, as well as through tube-feeding. Patients may receive parenteral or enteral nutrition for weeks or months until their issues resolve, or may even need care for their lifetime.
The Coram Pediatric Pump Pals backpacks connect to a portable infusion pump that has been pre-programmed by the Coram pharmacy team to deliver the nutrition over a specified amount of time with each pump customized to the unique patient’s needs.
“I remember the days with the challenges when we had pediatric patients and no backpacks. Then we progressed to an initial mini- adult pack for these little patients,” said Wanda Rogers, Director of Pharmacy Infusion. “This is a wonderful advancement to have these young patients ambulate with color and fit into the typical daily activities.”
“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.”
“I’d like to talk to you about decisions you might have to make in the future if you become very sick.”
Thus begins a video designed to make end-of-life care planning easier. It is one of nearly 300 decision aids now available for Aetna members and their families as part of a new pilot program to help bridge these difficult discussions.
“This is a very personal conversation,” said Vinnette Perry, director of Clinical Health Services for Aetna. “There’s fear of the unknown. We don’t always talk about how we want to die, and we don’t necessarily want to talk about a loved one dying.”
The pilot program, in collaboration with the nonprofit organization Advanced Care Planning Decisions (ACP Decisions), leverages their comprehensive video library to help patients and their families make the most informed medical choices possible.
Meeting members where they are
Aetna Medicare nurse case managers, who routinely work with members about end-of-life decision making, know that there is no one-size-fits-all approach. Each member faces unique challenges and has unique needs. For example, Perry shared a recent example involving a 77-year-old member with advanced heart failure who was overcome with emotion upon connecting with his case manager; not because of a fear of death, but because he was moved that someone cared. The conversation that began that day resulted in his decision to move across the country to be closer to family.
It’s estimated that less than 30 percent of individuals discuss end-of-life care with their loved ones, despite over 90 percent recognizing the value of such conversations.
For nearly 15 years, Aetna’s Compassionate Care program has helped seriously ill members and their families face the end-of-life on their own terms, without unnecessary stress or discomfort. The program features a proprietary algorithm that identifies members approximately 9-12 months before the end-of-life and provides them with comprehensive care management and caregiver support.
An opportunity to stop and think
Aetna’s multi-state pilot with ACP Decisions aims to enhance the Compassionate Care program by connecting Aetna’s vulnerable members and their families with evidence-based decision-making tools. It also encourages case managers to discuss end-of-life decisions with members who are still in good health.
“The videos empower patients and engage them in a way that simply having a conversation, or talking about advanced care planning in the abstract, doesn’t,” said Dr. Angelo Volandes, president and co-founder of ACP Decisions. “Our hope in partnering with Aetna is to make this routine and part of normal patient care.”
A series of interactive trainings for local case managers kicked-off in December 2018, demonstrating how to leverage these tools and past experiences in sensitive conversations. Since launching, case managers have seen the impact of these videos first-hand.
Sarah Fischer, an Aetna field case manager, believes the videos help members take control and draw the whole family into the discussion – even for those who feel they already have a handle on end-of-life decisions.
“The videos really make you stop and think,” Fischer says. “This program is giving us an opportunity as well as invaluable tools and confidence to talk with members about these difficult issues.”
The program is currently underway in Pennsylvania, Maine and Illinois, and will continue through the first half of 2020. The teams are monitoring success through a variety of measures, including hospice utilization, inpatient admissions and the completion of advanced care directives. In addition to arming case managers, the program is working to educate and train local providers to use these powerful video tools in their interactions with patients.
“These conversations result in better patient and family satisfaction and reduced unnecessary low-value care,” said Dr. Daniel Knecht, vice president of Health Strategy and Innovation for Aetna, adding that the discussions can even increase life expectancy.
Jaimie Marvin, a field case manager with a background in hospice care, points out that both members and their families appreciate the ability to understand and speak up about end-of-life.
“Although we don’t always know when we’ll have to say goodbye, it’s comforting to know that you’re protecting someone’s dignity through the final moments of their life.”
Prioritizing members’ overall needs – including the time and resources needed to get and stay healthy – Aetna has launched Aetna 360™ Behavioral Health. Through this approach, which launched May 1, 2019, Aetna partners with behavioral health and substance use disorder treatment facilities to coordinate care for members, collaborate on holistic discharge planning and provide support for members and their families during treatment and upon discharge.
“Our focus is on how we can help, rather than limiting members to a number of days or conducting traditional reviews,” said MaryEllen Schuman, Director, Clinical Health Services, Aetna Behavioral Health. “This new approach incorporates both a member’s physical and behavioral health, along with any social determinants of health, to ensure we develop a comprehensive, long-term plan that helps them attain and maintain their optimal health.”
Aetna 360 Behavioral Health combines and builds on a pair of recent programs, Member Care Coordination (MCC) and Utilization Management Transformation (UMT). Both programs, which began in late 2017, led to lower readmission rates, higher ambulatory follow-up rates for mental health visits and high engagement and satisfaction rates among members, caregivers and providers.
Under Aetna 360 Behavioral Health, partnering facilities, as well as members and their caregivers, have a single point of contact with Aetna Behavioral Health. The assigned 360 Care Advocate collaborates with the facility to understand the member, family and caregiver’s needs, and then directly with members and caregivers when needed, both during and after discharge. The 360 Care Advocate is supported by a team at Aetna which includes medical, pharmacy, Resources for Living® and others.
“The 360 Care Advocates work behind the scenes to collaborate with providers to ensure members have the resources they need, and then directly with members, family and caregivers to ensure they have access to everything from a primary care provider and transportation to an appointment, to a support group or daycare if they are a caregiver,” said Lynn Watson, Manager, Clinical Health Services, Aetna Behavioral Health. “They also link members to peer support services, several digital resources and community support services to enhance their care and service.”
The 360 Care Advocates collaborate with members’ medical and behavioral health outpatient providers as needed and provide specific resources to caregivers to ensure they can help members navigate the health care system.
At launch, 304 facilities are partnering with Aetna to implement Aetna 360 Behavioral Health. These partnerships extend the successful work that began under the previous pilots.
“We deal with a sick population, but Aetna has been right there with us,” explained Peter Schorr, President and CEO, Retreat Behavioral Health, which operates several substance use disorder and mental health treatment centers, about MCC. “Aetna ensures patients are provided with the stays that they need. It feels good to be trusted and not fight over reviews.”
Facility staff have also benefited from Aetna’s behavioral health initiatives.
“Both our patients and staff view Aetna as an ally that is helping us to tear down barriers to treatment and recovery,” notes Jay Crosson, CEO, Cumberland Heights Foundation, an alcohol and drug treatment center in Tennessee. “The Member Care Coordination program was a real positive mindset change for everyone.”
Aetna will continue to expand the number of partnering facilities implementing Aetna 360 Behavioral Health. Aetna 360 Behavioral Health is currently for Aetna Commercial members of all ages and Aetna Federal Employee Plans.
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 share
New Aetna Enhanced Medical Bundles Provides Cash Benefits to Members Following Unexpected Health Events
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.
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.
Depending on the disaster, Aetna may also extend deadlines for things like filing claim appeals.
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.