Presentation is loading. Please wait.

Presentation is loading. Please wait.

Quality health plans & benefits Healthier living Financial well-being Intelligent solutions Aetna Open Access® Managed Choice® POS for.

Similar presentations


Presentation on theme: "Quality health plans & benefits Healthier living Financial well-being Intelligent solutions Aetna Open Access® Managed Choice® POS for."— Presentation transcript:

1 Quality health plans & benefits Healthier living Financial well-being Intelligent solutions Aetna Open Access® Managed Choice® POS for

2 2 Our healthy: Health care built around people Our commitment to the employees and family members of Great Lakes Behavioral Health is more access, more choice and more information concerning their health care benefits. USA Networks  >Over 1 million health care professionals  >580K primary care doctors & specialists  >5400 hospitals Membership  22.7 Million medical members  14.5 Million dental members  14.1 Million Pharmacy Members International Presence  Over 71K health care professionals worldwide  More than 445,000 international members  Operations in Europe, Asia, Africa & the Middle East Medical Management  Wellness Programs  Disease Management Programs Health Information Technology  Aetna Navigator ℠  Aetna Mobile  Medquery Powered by the CareEngine ®

3 Benefit Plan Offerings

4 4 Network Provider collaboration and network contracting Nationally and in Western Pennsylvania 4

5 5 Our network strategy offers choice, while driving the outcomes you need. SavingsQualityEfficiency Complete Western PA network Broad national network Network

6 6 Inpatient Transforming the market – complete provider access with more choice for Aetna members Allegheny Health Network UPMC Health System Professional Inpatient Outpatient Professional UPMC  Available in-network July 1, 2011  Contract through December 31, 2017 Allegheny Health Network  Ongoing long term contract until Oct 1,2017

7 7 Information is Power Consumer Tools and Member Experience 7

8 8 Aetna Navigator ®  Claims, Balances, and eligibility information  Find a Doctor with DocFind ®  Personal Health Record and Health History Report  Health Assessments through Simple Steps To A Healthier Life ®**  Doctors’ Rates, Medical Procedure by Facility Cost Tool, Estimate the Cost of Care  Hospital Comparison Tool  Price-A-Drug***  Health information with SmartSource** and Aetna InteliHealth ® With Aetna’s secure member website*, members can better manage their health and benefits with easy online access to: *Available to members with Aetna benefits. An Aetna medical or Aetna dental plan is not required. **Availability varies by plan ***Aetna pharmacy required

9 9  We provide your employees with the online tools they need to shop around, make informed decisions and become smarter consumers  Our transparency tools are the first in the industry to:  calculate personalized cost estimates based on claim adjudication logic (Member Payment Estimator)  provide physician price, clinical quality and efficiency information  offer site-specific cost information for hospitals and other facilities Innovative online tools Meet your employees at teachable moments Ask Ann SmartSource PHR DocFind Aetna Navigator Price A Drug MPE 10

10 Estimate the Cost of Care tool Available to all Aetna Navigator ® registered subscribers Provides average costs for approximately 200 medical and dental procedures, tests, office visits, diseases and conditions Access to Price-A-Drug SM with costs for approximately 9,000 prescription drugs Illustrates potential cost advantage of using in-network providers Uses data sourced directly from Aetna’s systems Available at no additional cost to members or plan sponsors

11 11 Net cost is really what matters Pittsburgh market examples Allowed charges Facility Example: MRI of the lower back 11 Facility B $699 Freestanding site C $336 Freestanding site D $425 Facility A $896

12 12 Putting employees in the driver’s seat of their health journey Assessing symptoms to make better care choices with iTriage® An easy-to-use secure tool that provides members with access to valuable tools and information about their health with Aetna Navigator℠ Aetna Mobile

13 13 Online programs* to help you reach your health goals Manage your weight: Reach your goal weight, and boost how active you are with HealthMedia® BALANCE™. Deal with stress: Find out where your tension comes from, and get proven strategies to stay calm under pressure with HealthMedia® RELAX™. Eat healthier: Learn better eating habits for life with HealthMedia® NOURISH™. Sleep better: Beat sleepless nights with strategies from HealthMedia® OVERCOMING™ Insomnia. Quit smoking: Get a quit plan that uses your strengths to help you get past old roadblocks with HealthMedia® BREATHE™. Be happier: Everyone gets the blues at one time or another. Sometimes it’s more serious. Get the confidential support you need with HealthMedia® OVERCOMING ™ Depression. Simple Steps To A Healthier Life Program

14 14 Aetna Health Connections SM Disease Management Focus on 35 Chronic Conditions Vascular  Heart failure  Diabetes – adult & pediatric  Coronary artery disease (CAD)  Peripheral artery disease (PAD)  Hypertension – adult & pediatric (high blood pressure)  Cerebrovascular disease/stroke (CVA)  Hyperlipidemia (high cholesterol) Pulmonary  Asthma – adult & pediatric  Chronic obstructive pulmonary disease (COPD) Orthopedic / Rheumatologic  Osteopenia*  Osteoporosis  Osteoarthritis* (OA)  Rheumatoid arthritis (RA)  Chronic lower back pain Gastrointestinal  Gastro esophageal reflux disease (GERD)  Peptic ulcer disease  Inflammatory bowel disease (IBD) (Crohn’s disease)  Chronic hepatitis Neuro-Geriatric  Geriatrics  Migraines  Seizures  Parkinsonism Cancer  General cancer*  Breast cancer  Lung cancer  Lymphoma/ leukemia  Prostate cancer  Colorectal cancer Renal  Chronic kidney disease  End stage renal failure Other  Weight management – adult & pediatric  Cystic Fibrosis – adult & pediatric  HIV  Hypercoagulable state  Sickle cell disease – adult & pediatric  Depression* *Addressed as a comorbid condition

15 15 Questions?

16 16 Sources 1 “Kaiser/HRET Survey of Employer-Sponsored Health Benefits, ,” The Kaiser Family Foundation and the Health Research & Educational Trust, November ”Roundtable on Value & Science-Driven Health Care,” Institute of Medicine of the National Academies, September “Employer Survey on Purchasing Value in Health Care,” Towers Watson/National Business Group on Health, March Troost JP, Rafferty AP, Luo Z, Reeves MJ. Temporal and regional trends in the prevalence of healthy lifestyle characteristics: United States, Am J Pub Health. 2012; 102(7): Sharon Begley, “As America’s Waistline Expands, Costs Soar,” Reuters, April Based on the 2013 national average annual premiums for covered workers ($5,884, single; $16,361, family). 7 Sherman BW, Lynch WD. Connecting the dots: Examining the link between workforce health and business performance. Am J Man Care (in press). 8 “Accountable Care Payers: Partners in a Changing Paradigm,” KLAS, June Claffey TF, Agostini JV, Collet EN, Reisman L, Krakauer R. Payer-provider collaboration in accountable care reduced use and improved quality in Maine Medicare Advantage plan. Health Aff. 2012; 31(9): Medical results are generated by the Pioneer Medicare population from Banner Health Network. 11 Results are from Aetna’s generic prescription program with Optimus. 12 Aetna One℠ Premier Health Concierge reports. 13 Results based on Aetna In Touch Care report findings, “Metabolic Syndrome and Employer Sponsored Medical Benefits: An Actuarial Analysis,” Milliman, March Aetna disease management program dashboards (initial engagement vs. step-downs), February Based on historical data from July 1, 2011, to June 30, 2012, comparing the cost of cases performed at Institutes of Quality® (IOQ) facilities with that of cases performed at non-IOQ facilities (specific customer savings will vary). 17 Health economic savings model, Aetna book of business, Aexcel book of business study, “Health Information Exchanges: Rapid Growth in an Evolving Market,” performance report, KLAS, June “Metabolic Syndrome and Employer Sponsored Medical Benefits: An Actuarial Analysis,” Milliman, March “What Is Metabolic Syndrome,” American Heart Association, May Aetna committed to a 25 percent metabolic syndrome reduction. Guarantee population defined as individuals who complete a baseline metabolic syndrome screening in year one and a follow-up screening in year two (minimum 12 months apart). Receive the guarantee by achieving at least 50 percent participation in both year one and year two screenings. Available to groups with a minimum of 300 eligible employees. Not available on a fully insured basis in all states. Please contact your broker or Aetna representative for additional details on state availability. 23 Sherman BW, Lynch WD. Connecting the dots: Examining the link between workforce health and business performance. Am J Man Care (in press). 24 Wei HG, Rosenberg S, Shnaiden T, Jacques J, Steinberg G, Reisman L. Clinical validity of alerts generated by the CareEngine claims-driven decision support engine. AMIA Annu Symp Proc Nov 6: “Accountable Care Payers: Partners in a Changing Paradigm,” KLAS, June 2013.

17 17 Thank you Aetna is the brand name used for products and services provided by one or more of the Aetna group of subsidiary companies, including Aetna Life Insurance Company and its affiliates (Aetna). This material is for information only. Health benefits and insurance plans contain exclusions and limitations. Health information programs provide general health information and are not a substitute for diagnosis or treatment by a physician or other health care professional. The CareEngine is a proprietary technology platform developed by ActiveHealth Management, an Aetna company. In conjunction with clinicians, the CareEngine continuously analyzes claims and other data against evidenced-based best practices and alerts the members and their physicians about possible care gaps and other inconsistencies. Information is not a substitute for diagnosis or treatment by a physician or other health care professional. The Aetna Personal Health Record should not be used as the sole source of information about the member’s medical history. Information is believed to be accurate as of the production date; however, it is subject to change. For more information about Aetna plans, refer to We are located at 151 Farmington Ave., Hartford, Connecticut The Aetna name and logo are registered trademarks. Apple and the Apple logo are trademarks of Apple Inc., registered in the U.S. and other countries. App Store is a service mark of Apple Inc. ©2013 Aetna Inc (11/13)


Download ppt "Quality health plans & benefits Healthier living Financial well-being Intelligent solutions Aetna Open Access® Managed Choice® POS for."

Similar presentations


Ads by Google