Transforming health care with providers and members

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Darleen Boone
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1 Quality health plans & benefits Healthier living Financial well- being Intelligent solu;ons Transforming health care with providers and members Ramzy ElGomayel May 8, (9/13)

2 ACOs are expanding our value- based network Over 250 achve ACO negohahons covering 60% of U.S. populahon CT DE DC MA MD NJ Key Contracted ACOs Primary Care Medical Homes (PCMH) Medicare Collabora;ons ACOs in Nego;a;on Other Aetna Value- based contracts (InsHtutes of Excellence and Quality, Hospital/ Specialty P4P, Bundled Payments, Aetna Performance Network, Aexcel & Savings Plus) 2

3 The Affordable Care Act did not solve the health costs crisis ACOs can help An Accountable Care Organiza;on (ACO) is a provider- based organiza;on willing to take responsibility for managing the health of a defined popula;on Improve Efficiency Improve Sa1sfac1on External ACO Goals Improve Quality Aetna Accountable Care Network Broker Seminar 3

4 Accountable care changes the provider focus from volume to value to drive sustainability Today s business model Tomorrow s business model Payment reform Care management Provider Patient Health plan services Integrated care plan Health informa;on technology Focus on volume Impersonal transachons care visits Onus on member to share health informahon Lots of duplicahve tests TreaHng symptoms Focus on value Personal care plan Efficient use of member s Hme Improving outcomes Aetna Accountable Care Network Broker Seminar 4

5 Aetna Whole Health plans that make use of a whole new model of health care delivery Three transforma;onal goals make the difference: Improve pa;ent health at a lower cost strategic financial incenhves drive the Aetna and Accountable Care Network collaborahon to improve quality while controlling costs. Doctors use technology to help pa;ents make informed health care decisions technology that provides the right informahon at the right Hme to make the best possible decisions. Exceed expecta;ons healthcare is coordinated, measured and constantly working to improve health outcomes and deliver an excephonal member experience. Aetna Accountable Care Network Broker Seminar 5

6 How we ve achieved savings Nova Health ACO results 45% fewer hospital admissions 56% fewer readmissions Banner ACO Pioneer results 3.5% - 4.5% reduchon in lab uhlizahon 5.3% - 6.0% reduchon in radiology uhlizahon Op;mus ACO results Increased generic prescribing from 60% to 68% Sources: 1. Payer- Provider CollaboraHon in Accountable Care Reduced Use and Improved Quality in Maine Medicare Advantage Plan, Aetna and NovaHealth, Health Affairs, Volume 31, Number 9, September 2012; 2. Medical results above are generated by the Pioneer Medicare populahon from Banner Health Network, 3. Results from Aetna s Value- Ready Generic Prescribing Program with OpHmus. 6

7 We are already seeing a payoff in quality and cost of care $ BeWer health 0.9% 1.6% reduchon in hospital admissions 28% 64% pahents reaching goals for blood pressure and cholesterol levels 1 BeWer care 0.5% 1.2% increase in PCP visits 2% 5% reduchon in hospital readmissions BeWer cost 3.9% 4.5% clinical efficiencies 3.5 % 6.0% reduchon in in lab and radiology uhlizahon 8% 15% expected medical cost savings* Medical results above are generated by the Pioneer Medicare populahon from Banner Health Network. 1 Payer- Provider CollaboraHon in Accountable Care Reduced Use and Improved Quality in Maine Medicare Advantage Plan, Aetna and NovaHealth, Health Affairs, Volume 31, Number 9, September *Actual costs will vary. 7

8 How it works Level 1 benefits/designated services Accountable Care Network providers comprise the majority of providers in the Designated provider level 1 network. Addi.onal providers from the Aetna PPO network are included in level 1 as Designated providers and services to assure that all services are available in level 1 at maximum savings.* Emergency services are always covered at level 1 benefits regardless of the provider. PCP selechon is not required, however highly encouraged so members can receive the highest level of coordinated care. Referrals are not needed to access specialty care *refer to specialty list anachment Accountable Care Network Broker Seminar 8

9 Our diverse suite of tools and services enable the ACO model and make Aetna a partner of choice HEALTH PLAN PRODUCTS AND SERVICES HEALTH INFORMATION EXCHANGE CONSUMER ENGAGEMENT DISTRIBUTED APPLICATONS MOBILE CONNECTIVITY CLINICAL DECISION SUPPORT & WORKFLOW MANAGEMENT 9

10 Privately or Publicly Sponsored Medicity HIE SoluHon Connects Systems to Transform Data Into AcHon Analytics, Clinical Decision Support, Risk-stratified Populations & Quality Measures Data Aggregation Community Health Record Identity Management Bio Surveillance Registries Patient Consent Framework Patient Portal Medicity Proprietary & ConfidenHal 10

11 One pa;ent. One record. Fully integrated health care delivery system Primary Care Physician Pa;ent Inpa;ent Specialist Physician Outpa;ent Lab Work Home Health Pharmacy Electronic Health Record Aetna Accountable Care Network Broker Seminar 11

12 How well do you know your population?? CONFIDENTIAL May not be copied, reprinted or redistributed without prior written approval 12

13 Enabling actionable population-based care 2012 CONFIDENTIAL Aetna Inc. May not be copied, reprinted or redistributed without prior written approval 13

14 What is an accountable care organiza;on (ACO)? Empowered doctors Engaged pahents + = BeWer health outcomes Electronic Medical Record Health Information Exchange Care Management Solutions Real Time Claims Analysis Aetna Technology Support Aetna Care Management Support Aetna Accountable Care Network Broker Seminar 14

15 Personal Health Record Aetna SmartSource SM Mobile Web Apps for iphone, BlackBerry, Android TM Member Get Ac;ve! Mindbloom TM Life Game Click on image to see website or video Emerging Technology 15

16 Aetna Navigator Easy registra;on and login Accessible anyhme, anywhere Secure registrahon process Ann, virtual assistant, to assist with login or registrahon queshons Easy access to informahon from menus, quick links, related shortcuts and Site Map Accountable Care Network Broker Seminar 16

17 View claim details and balances Navigator provides claim search, claim lists, and claim details for 24 months aser date of service Easy access to fund balances and details Go green! Get online access to EOBs for 24 months aser date of service Have a queshon about a claim? Send a Message includes the details of your claim. Accountable Care Network Broker Seminar 17

18 Tools to manage your health SmartSource SM * Personal Health Record* Health History Report Simple Steps to a Healthier Life * Aetna InteliHealth Tools that provide cost informahon for medical and dental procedures and prescriphon drugs *Not available with all Aetna plans. Accountable Care Network Broker Seminar 18

19 Aetna s mobile suite Aetna Mobile International (Shanghai / Middle East) itriage PayFlex iphone is a trademark of Apple Inc., registered in the U.S. and other countries. Emerging Technology 19

20 Aetna Mobile func;onality Available via mobile web, ios and Android Search for doctors in Aetna's network by name, locahon or specialty Easily locate urgent Care Centers and Walk- In Clinics near you See the status of your recent claims View your coverage and benefits informahon Stay up- to- date with your PHR View ID card info Get a drug cost eshmate before you fill a prescriphon Emerging Technology 20

21 itriage connec;ng consumers to informa;on and care on the go One of health care s leading mobile playorms to empower people to make bener health care decisions, and improve health care delivery The itriage app provides a Symptom- to- Provider pathway, connechng pahents who are achvely looking for health care with providers who have the capability and capacity to deliver that care itriage can even help a consumer book an appointment with a physician or pre- register with an Emergency Department itriage is a top 5 free health care and fitness app with a 4+ (out of 5) user star rahng in the Google Play TM media store and the App Store Emerging Technology 21

ACO s as Private Label Insurance Products

ACO s as Private Label Insurance Products Creating Value for Plan Sponsors Continuing Education: November 19, 2013 Clarence Williams Vice President Client Strategy Accountable Care Solutions Today s discussion