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

BLUE BELL, Pa.--(BUSINESS WIRE)--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.

“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”

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.

“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.