Aetna, Health Quality Partners See Fewer Admissions, Lower Costs From Care Management Program

For the second year in a row, Aetna (NYSE: AET) Medicare Advantage members in Pennsylvania who enrolled in a Health Quality Partners (HQP) care management program continued to have fewer hospital admissions and lower medical costs than members with similar conditions who did not participate.

According to the second-year results of the HQP effort, members eligible for the program had 15 percent fewer inpatient hospital admissions. They also had 17 percent fewer outpatient hospital services and a 16 percent reduction in total hospital-associated expenditures.

The HQP care management program is designed to help Aetna Medicare Advantage members improve their health and quality of life and live more independently. Some 1,200 members from Bucks, Montgomery, Northampton and Lehigh counties participated in the program, which revolves around HQP’s community-based nurse care management of preventable complications from chronic illness. Of that group, 14 percent of members took part in HQP’s Advanced Care Management program, which includes intensive, individualized nurse involvement.

“Aetna is very excited about the continued success of this program,” said Patrick Young, president of Aetna’s Pennsylvania and Delaware operations. “By addressing cost and quality issues at their roots, HQP has improved the lives of Medicare beneficiaries for many years. It’s gratifying to see continued improvement in the program’s second year after our initial year of success.”

HQP contracted with Aetna in December 2009 after participating for several years in a Medicare Coordinated Care Demonstration (MCCD). Working directly with members and in collaboration with affiliated primary care providers, HQP nurses provide ongoing assessments and monitoring; support for medication adherence; patient education; self-management coaching; and close follow-up during transitions from hospital to home or nursing facilities.

The nurses also promote physical activity, weight management, healthy eating, vaccinations, social engagement and home safety. All of those factors are found to be beneficial for older adults. The HQP program uses proactive methods to identify and outreach to members who would benefit from this comprehensive set of preventive services. They are delivered in a reliable, affordable, easy-to-access way.

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