“We are certainly delighted, but not surprised, by the continuing benefit our program offers Aetna members with complex, chronic medical conditions. This is consistent with our long-running success in the CMS Medicare Coordinated Care Demonstration,” said Sherry Marcantonio, HQP’s senior vice president and chief program architect. “We are very impressed with Aetna’s evidence-based, action-oriented commitment to innovation, and their willingness to complement their already impressive suite of case management and quality improvement initiatives with HQP’s program.“It is the kind of leadership our ailing health care system needs if we are to transform it into one that puts people and prevention at the heart of care. We look forward to our continued work with Aetna to develop and broadly implement preventive services that improve the health and quality of life of vulnerable populations and reduce health care costs,” Marcantonio said. Aetna identified participants for the voluntary care management program by looking at 53 area physician offices that treat a large number of Aetna Medicare Advantage members. The company reviewed claims data and identified members who were most in need of care management due to chronic illness. HQP developed risk profiles for those members, generated medical record reviews in primary care offices, and utilized frequent data feeds from Aetna relating to hospital and facility admissions, lab values and claims data. It used this information to customize outreach efforts to members with the highest risk. During the program’s first two years, 170 high-risk members agreed to participate in the advanced care management program and received more individually focused assessment and interventions. All told, HQP reported more than 4,700 participant contacts, with greater than 60 percent of contacts being in-person. More than 28,700 total interventions were delivered, including assessments; monitoring; self-management; education and counseling; medication management; care transition support; and coordination of additional community health and social services.
Aetna provides health benefits to more than 1 million members in Pennsylvania. Its members have access to a network that includes more than 200 hospitals and more than 32,000 primary care and specialist physicians.About Health Quality Partners Health Quality Partners (HQP) is a not-for-profit health care quality research and development organization dedicated to improving population health outcomes through health system redesign and advanced care coordination. HQP has developed an effective community-based model of advanced care management that improves health outcomes, longevity, and costs for chronically ill Medicare beneficiaries and that works in collaboration with primary care offices of all sizes and types. For more information, see www.hqp.org. About Aetna Aetna is one of the nation's leading diversified health care benefits companies, serving approximately 37.3 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 and health information technology services. Our 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.