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Features and Capa bilities of Truly Integrated PlanssReal-time data integration to predict medical eventsand employee disabilities and facilitate coordinatedcare managem ent within HIPAA guidelines.sCombined disability management and patientmanagement expertise to coordinate services formem bers, and manage costs and resources.sA holistic view of an individuals situation to createadministrative efficiencies and opportunities for earlyintervention and physician involvement.sCoordinated consistent disability, medical andrehabilitation services to provide assessm ents and

address each individuals medical cond ition andfunctional requirements at w ork.

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etna IntegratedHealth and DisabilityAetna stands alone inintegrating medical anddisability data in real-timand im plementing h olisticare managem ent toimprove outcomes foremployers and theiremployees.

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Through rea l-time data integration, predictivm odeling of m edical and disability events,and p rospective early intervention, Aetnagives members the advantage of the earliestpossible clinical support and case managem en

In todays business environment,controlling benefits costs and m aximizingemployee health and productivity arecrucial issues. Aetna can make adifference with our new model forlinking medical, short term disabilityand long term disability plans.Under our Integrated Health andDisability (IHD) approach, Aetnaintegrates medical and disabilityprograms two ways:1.With the employees consent, we

integrate medical and disability casemanagem ent to coordinate care.By looking at an employees medicalneeds and ability to work, we canidentify opportunities to help anemployee prevent a disability altogether,or return to the workplace sooner andavoid an ex tended disability claim.

2.We integrate medical and disability datathrough Aetna Integrated InformaticsS M ,our data integration and analysisexperts. B y analyzing historical claimsdata, we have developed medical anddisability predictive models that identifymembers at risk for adverse health anddisability events. This allow s us toimplement early intervention programsdesigned to avo id or lessen disabilitiesand time away from work.

IHD is our way of doing business,and there is no ad ditional cost forthese value-added services.

Linking medical and disabilityclaims information, claimsprocesses and case managementoffers you several advantages:s roviding a consistent medical

case manager for the employees upporting complete, efficient

interactions between youremployees and Aetna staff oncomplex clinical issuess ssuring seamless coordination of

health, disability and behavioralhealth services, thereby reducingmultiple phone calls from Aetna toyour employees and benefits staffsmproving plan administrationsncreasing employee satisfactionsntegrated data analysis and reportsAll disabilities involve medicaltreatment as a k ey component ofrestoring functionality. Aetna is anexpert in both health and disability,so w e are able to apply a ho listicapproach to disabilities that focuseson employee health needs.Aetna is a leading benefits companyintegrating health and disability datain real time: W e have the ability topredict both medical and disabilityevents, and take prospective action,giving us a distinct advantage in beingmore timely in our interventions.

This means we can offer improvemein productivity and absenteeism bsdentifying employees at risk

for adverse medical and relateddisability events within HIP AAguidelines, and helping individuand their doctors take steps toimprove health.s oordinating Aetna resources

that can offer early interventionservices designed to assistemployees in their efforts tosuccessfully address these eventss ssisting you in identifying

issues that adversely impact thehealth and productivity of thework force, and offering solutioto foster increased wellness andproductivity.s implifying utilization and

improv ing access to health anddisability benefits.s elping decrease days out of wo

Ultimately, by integratinghealth and disabilityplans with Aetna, youcan build a healthier, morproductive work force.

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A Look at How IHD Works

between the two specialists workinon her care. Mary did not sufferany interruption in her disabilitybenefits, her physician and emploer were not contacted multipletimes for information, and she haa high degree of satisfaction w iththe process. By following her caremanagement plan, Mary was ableto avoid further short-termhospitalizations and absencesfrom work.

Em ployees who have coverage under anetna health plan and an Aetna disability

plan, as well as a diagnosis that triggers casemanagem ent, will benefit from this model.IHD coordinates the activities of AetnasMedical Case M anagement program,etna Disability, Aetnas Behavioral Healthprogram services, and Aetna IntegratedInformatics (AetInfo), our data integrationand analysis experts.IHD is fully HIPAA-compliant. If Aetnadetermines that the employee may benefitfrom integrated case management, theemployee will be asked if he or she w ishesto have Aetna medical and Aetna disabilitystaff share data and coordinate activities.W hen the employee agrees, and signsand returns a Release of Informationform (R O I) available online or by mail,the medical and disability staffs can shareclinical information and jointly work withthe employee to help him or her addressmedical and disability issues.Located together, medical and behavioralhealth case managers act as the clinicalconsultants to disability claim analysts forthe disability event as long as the caseremains in case management. Disabilityanalysts make disability claim decisions.Contact your broker or local Aetnarepresentative today !Find out more about how we can worktogether to make a difference in theoutcomes of employee illnesses and injuries.

A C ase in Point: Marys StoryMary is a 47-year-old in a sedentaryoffice job. She underw ent elect ivesurgery for a gastrointestinal cond itiona few years ago, but continued tohave problems.During this time, she saw her regulardoctor and som e specialists, andrequired a number of prescriptions,home health care and special medicalsupplies. Her frequent short-termhospitalizations triggered our casemanagement process and she wasreferred to a more form al health caremanagement program.Another surgical procedure wouldrequire Mary to be out of work and,whe n she inquired about her disabilitybenefits, she learned about Aetnasintegrated approach to health anddisability and g ave permission to shareinformation. Our disability and healthcare managers w ere then able to usedata integrated in real-time in Aetnascomm on system platform to developa course of action.Mary suffered more setbacks followingher surgery and she was readmitted tothe hospital without being able tocontact her disability specialist to updateher disability status. How ever, withcomb ined disabili ty managem ent andpatient managemen t services, thedisability staff was able to review theinformation gathered previously by themedical nurse case manager and extendMarys disability benefits appropriately.There was n o lapse in M arys disabilitycertification, and no need for her tore-start the benefits process afterdischarge from the hospital.Taking a holistic view of Maryssituation as she continued to recover,the nurse case man ager and disabilityspecialist worked together on a plan tomonitor M arys progress.The result: Because Marys health anddisability benefits were coordinatedin a consistent , seamless m anner,a valuable connection w as created

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wDATA INTEGRATION, REPORTING AND ANALYSIS w

THE WELLNESS-DISABILITY CONTINUUMPeople experience health along a continuum of care

WELL BEING/'INDEPENDENCE CHRONIC'CONDITION ACUTE OR'CATASTROPHIC(illness/injury) DISABILITY'OUTCOMESGOALS sKeep healthy s dentify risks &behaviors early sEffective decisionmaking sMinimize duration sRecoverysAvoid migration to sSupport return to sResidual functiounhealthy condition sTarget interventions sProvider, case manager,patient interaction health sChronic conditiosManage condition sAppropriate treatment sFacilitate return towork s ermanent disabisAvoid migrationto acute conditionor disability sAvoid migrationto disability sAvoid migration topermanent disabilityTOOLS & s nformed Health s nformed Health s nformed Health s nformed Health sAetna Long TermSTRATEGIES Line (Self care) Line (Self care) Line (Self care) Line (Self care) DisabilitysAetna InteliHealthSM sAetna InteliHealthSM sAetna InteliHealthS M sAetna InteliHealthS M sAetna Long TermsSimple Steps sDiseasemanagement s ntegration s ntegration Care InsurancesBenefit design > Case management > Case managementsAetna PharmacysCoverage bulletins > Disability management > Disability managementsAetna BehavioralHealth > Behavioral healthmanagement > Behavioral healthmanagementsNational Medical sClinical duration toolsExcellence Program sVocational rehabilitationsSpecialist network sSpecialist networksAetna Pharmacy sAetna PharmacysAetna BehavioralHealthDisability stems from health deterioration/health needs.A consumer-oriented philosophy of medical care offers the opportunity to integrate care, including disability.

Aetna is the brand name used for products and services provided by one or more ofthe Aetna group of subsidiary companies.HMO, Quality Point-of-Service , Aetna OpenAccess , Aetna Choice POS and USAccess plans are provided or administered by AetnaHealth Inc., Aetna Health of California Inc., Aetna Health of the Carolinas Inc., AetnaHealth of Illinois Inc., Corporate Health Insurance Company, Aetna Health InsuranceCompany of Connecticut, Aetna Health Insurance Company of New York and/or AetnaHealth Insurance Company; and in Arizona Aetna Health Inc. and/or Corporate HealthInsurance Company. Elect Choice, Managed Choice POS, Open Choice PPO, AetnaChoice POS II, Aetna Open Access Managed Choice , Aetna Open Access Elect Choice,Traditional Choice and Aetna HealthFund medical plans are provided or administered byAetna Life Insurance Company.Group Disability products are provided or administered by Aetna Life Insurance Company.26.02.106.1 (2/04) 2004 Aetna Inc.