Aetna – Reshaping Healthcare

I just attended the Aetna National Broker Advisory Council Meeting. This is a very inspiring meeting to me, one in which I learn of the ways Aetna is helping to tackle the biggest issue in healthcare today: COST!

While the CVS-Aetna merger is awaiting approval, it’s nice to hear that Aetna is moving forward with their care management improvements. Bringing care from the waiting room to the living room is an exciting prospect. Aetna is piloting this program in South Florida – and soon to roll out in Texas, they are putting clinical care teams on the street which are actually visiting at-risk Aetna members in their homes. The objective is to improve compliance with post-hospital care regimens and reduce the need for readmissions and other complications. It seems obvious and like low-hanging fruit, but pulling it off is a monumental task. Aetna is also building out a medical concierge program which will supercharge each interaction with a member; so for example, if an individual is overdue for a mammogram or needs another screening and happens to call in for a new ID card, the member will be counseled by the care concierge to take action on their health. This program, which they hope to expand to 1.2 million members within 18 months, is similar to one established by Cigna – but no doubt it will effectively reduce costs.

Aetna is also building out its digital capabilities to increase awareness of health issues and make costs and alternatives more transparent. It’s improving its smart phone app to put more information in a member’s hand and make that information easier to access. It’s also expanding its claims experience reporting for plan sponsors and putting alternative plan design modeling at the brokers’ and plan sponsors’ fingertips. Alerts can be set up to raise awareness of cost spikes that arise and can be customized by the user. 

Aetna is also lowering costs by moving the care delivery site to be as cost-efficient as possible. In one instance, home infusions saved $2 million per year as compared with hospital-based infusions. 

And one can only imagine what will be possible with the CVS integration. Consider the possibility of expanding integrated care counseling to include pharmacists whenever medications are sought. Think about the CVS MinuteClinic as an improved front door which can then triage care to the appropriate setting. Aetna will soon be releasing its version 2.0 of the Aetna-Apple partnership – it might be possible for example, to alert a member that they should get a flu shot as they are about to pass a CVS pharmacy and share how long the wait time would be

Aetna is focused on lowering costs, but most importantly improving the customer experience. I like what I hear. Hopefully they can pull it off.

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