about aetna better health
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About Aetna Better Health. Medicaid business unit owned by Aetna, Inc. Twenty-three (23) years of experience as a Medicaid Managed Care leader nationally Serving Families and Children, Aged, Blind and Disabled, Long Term Care, Medicare/Medicaid Enrollees - PowerPoint PPT PresentationTRANSCRIPT
Aetna Inc.AETNA BETTER HEALTH
AETNA BETTER HEALTH®Doing the right thing for the right reason
Aetna Inc.AETNA BETTER HEALTH
About Aetna Better Health• Medicaid business unit owned by Aetna, Inc.• Twenty-three (23) years of experience as a Medicaid
Managed Care leader nationally• Serving Families and Children, Aged, Blind and Disabled,
Long Term Care, Medicare/Medicaid Enrollees• Manage services for more than 1.3 million Beneficiaries in
twelve (12) states
Aetna Inc.AETNA BETTER HEALTH
Aetna Inc.AETNA BETTER HEALTH
What is the Illinois Integrated Care Program (ICP)?• A Medicaid program designed to link primary, specialty,
institutional and community services focused on improving quality through coordination, pay for performance and creation of health homes
• Members choose or are automatically assigned a health plan with either Aetna Better Health or IlliniCare Health Plan and receive Medicaid services through those health plans
• Persons who are aged, blind and disabled (ABD) in suburban Cook (non-606 zip codes), Will, Dupage, Kane, Kankakee and Lake counties
Aetna Inc.AETNA BETTER HEALTH
Integrated Care Service PackagesResponsibilities of Aetna Better Health will include all covered services currently funded by Medicaid through the State Plan or waivers, and will be phased in as follows:
• Service Package I: All medical, pharmacy, dental and behavioral health services for the member. This includes all non-long term care services, mental health services, alcohol and substance abuse services and short term post-acute rehabilitation stays in nursing facilities.
• Service Package II: Nursing facility services and services provided through the Home and Community Based Services waivers, except those waivers serving individuals with developmental disabilities.
• Service Package III: Home and Community Base Services Waiver services for individuals with developmental disabilities and ICF/DD services
Aetna Inc.AETNA BETTER HEALTH
Integrated Care Management Guiding Principles• Focus on each individual member
• Work with members and providers to address medical, behavioral, social, and long-term care needs
• Partner with the member and/or caregiver to maximize the member’s self management ability
• Enhance quality of care outcomes
• Support member’s choice of community living
Aetna Inc.AETNA BETTER HEALTH
Aetna Better Health of Illinois OverviewCycle of Care
Recovery
ResiliencyAutonomy
Working Relationship
Cycle of Care Management
Aetna Inc.AETNA BETTER HEALTH
Community-Based Integrated Care Team• 35 out of 85 employees are responsible for direct care
coordination• 21 Care Coordinators - licensed clinicians; clinical social
worker or RNs• 14 Care Management Associates - individuals with medical or
behavioral health experience; know the community• 11 Provider Representatives – education and support for
providers relative to all service issues• 1 Community Liaison Manager – interact with advocates,
community and supportive agencies
Aetna Inc.AETNA BETTER HEALTH
Pay for Performance and Quality MeasuresIllinois Department of Healthcare and Family Services (HFS) will hold Aetna accountable for thirty (30) distinct quality measures including:• Behavioral health assessment within 60 days of enrollment and 30 day
follow up for patients with a finding• 7 day follow up after hospitalization for mental illness• Annual Influenza Immunization• Increased use of Diabetes care therapies• Increased use of Congestive Heart Failure therapies• Increased use of Coronary Artery Disease therapies• ER visits per 1,000 patients• Hospital in-patient visits per 1,000 patients• In-patient Hospital re-admission
Aetna Inc.AETNA BETTER HEALTH
ICP Status as of April 2012Aetna Better Health Members: 18,447• Total ICP enrollment: 35,518
Aetna Better Health Network Providers• 56 Hospital and Specialty Hospitals• 1,982 Primary Care Providers• 3,569 Specialists• 45 Community Mental Health Centers (CMHC)
Aetna Inc.AETNA BETTER HEALTH
Provider Payment• Direct Patient Care: $.88 per ICP dollar must be spent on
patient care. • Timely Payment: 90% of all clean claims for covered
services will be paid in 30 days; 99% of all clean claims for covered services to be paid within 90 days
• Reimbursement: no less than State Medicaid fee schedule
Aetna Inc.AETNA BETTER HEALTH
Phase 2: Aetna’s Long-Term Care Principles• Assist members and their families with the resources they
need to live in the least restrictive setting
• Provide members their choice of settings and allow them to direct their own care to the greatest extent possible
• Create a long-term support program that offers access to community-based options
• Creates a long-term care system that is financially sustainable and better aligns incentives across the system
Aetna Inc.AETNA BETTER HEALTH
The Member’s Voice in the Health Plan: Member Advisory Council• Participants include members, family members, advocates
and providers• Quarterly meetings scheduled with three held on October
26, 2011, January 25, 2012 and April 18, 2012• Agenda: Council members draft agenda items; discuss and
provide Aetna feedback on issues ranging from network adequacy to customer service
Aetna Inc.AETNA BETTER HEALTH
Contact Information
Robert MendonsaChief Executive OfficerAetna Better Health of Illinois312.821.0502 office312.235.9909 [email protected]
Jacqleen MusarraCommunity Liaison ManagerAetna Better Health of [email protected]