Aetna Behavioral Health Overview of Clinical Services by ubs20614

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									  Aetna
Behavioral   Aetna Behavioral Health : Overview
 Health
              of Clinical Services & Programs



               Suzanne Hemp, LCSW, ACSW

                   Clinical Services Head
  Aetna
Behavioral
  Health
                 Agenda

             Vision & Values

             Clinical Services

             Specialty Programs

             Outpatient Care Management

             Q&A

                                          2
  Aetna
Behavioral    Our Philosophy -Treating the Whole
 Aetna
 Health
 Behavioral   Person
 Health




                          We will fully leverage the value
                          of integration by improving
                          member engagement through
                          holistic treatment that stresses
                          recovery and resiliency,
                          enabling members to become
                          more productive and achieve
                          their optimal health




                                                             3
  Aetna
Behavioral
 Health       The Aetna Way

 We put the people who use our services at the center of everything we do,
 and we live by a core set of values:




                                                                             4
  Aetna
Behavioral
 Health
             Clinical Services
             Core Components

       Member centric / Member Engagement
       Integration with Aetna Medical
       Collaboration / Consultation
       PCP Communication
       Clinical Excellence
       Transition from UM to CM Model
       Outcome Focused
       Leverage Community Resources
                                            5
  Aetna
Behavioral
  Health     Medical Necessity Criteria

       LOCAT
       ASAM
       TCADA
       CPGs




                                          6
  Aetna
Behavioral
 Health
              Clinical Services Teams

      Pre-Certification – Higher Levels of Care
      Concurrent Review – Higher Levels of Care
        – UM to CM
        – Daily Rounds with Medical Directors
      Intensive Outpatient Program
      Outpatient Care Management Program
      Care Associate Support
        – Linkages
        – Ambulatory Follow Up
        – Ad-Hoc Providers

                                                  7
  Aetna
Behavioral
 Health          Specialty Programs


         Med / Psych Case Management
         Intensive Case Management (ICM)
         Disease Management
             • Alcohol
             • Anxiety
             • Depression
             • Bi-Polar
             • Healthy Nutrition (planned for late 2007)

                                                           8
  Aetna
Behavioral
 Health
                   Med / Psych Program
                   Results

                        Medical/BH Cost Outcomes
             ER Utilization – 17% Reduction
             Inpatient LOS – 64% Reduction
             Outpatient Visits – No change
             Total Pharmacy Cost – 16% increase
              – Antidepressant accounted for 28% of increase
             Antidepressant Cost – 23% increase
             Net Medical Cost – 12% Reduction
             ROI: 2:1
             Med / Psych SF 12 (N=1571)
             8.9% Physical Health Improvement
             44.9% Mental Health Improvement
             3.95 Average work days gained per month
                                                               9
  Aetna
Behavioral
                     Depression Disease
 Health              Management Program
                     Results

                         Medical/BH Cost Outcomes
             BH inpatient costs decreased 23%
             Medical inpatient costs decreased 17%
             Medical ER visits decreased 10%
             Depression Disease Management SF 12
             Level II:
             29.6% Mental Health Improvement
             Members gain average of 2.00 days worked, per month
             Level III
             49.0% Mental Health Improvement
             Members gain average of 1.80 days worked, per month




                                                                   10
  Aetna
Behavioral
 Health      Clinical Program Improvements

       Implemented 1st phase of new clinical model –
       care planner – predictive modeling
       Achieved significant increase in Specialty
       Program enrollment
       Implemented Medical Director rounds
       Significant expansion of Streamlined UM
       Program
       Launched new outpatient program
       Implemented national roll-out of PCP
       Depression Program
                                                       11
  Aetna
Behavioral
 Health      Aetna BHA Member Site

      URL http://www.aetnabhra.com/ - link is posted
      on Navigator and external ABH website
      Member receives tailored feedback on a
      personal progress page
      Based upon member answers follow up
      assessments are suggested
      Member is shown a graphical representation of
      their progress
      If email address is available member receives
      regular email reminders to return to the site    12
  Aetna
Behavioral
 Health
             Aetna BHA Member Log on
             Page – Nov. 06 example




                                       13
  Aetna
Behavioral   Aetna BHA Member Tailored
 Health
             Feedback - Nov. 06 example




                                          14
  Aetna
Behavioral   Example of Member Personal
 Health
             Page to track progress




                                          15
  Aetna
Behavioral
 Health
             Example of Email Reminder
             Content




                                         16
  Aetna
Behavioral
 Health      Aetna BHA Provider Site

      URL https://www.aetnabhra.com/ - link is posted
      on Navigator and external website
      Providers may register and log on to the site
      Providers whose patients have entered the
      provider’s pin # on the page asking if they would
      like their results to be sent to their provider will
      be able to see the member survey results on the
      site.
      Providers who would like to send members to
      the site may print a direction page for the
      member which will include their pin #.
                                                         17
  Aetna
Behavioral
 Health
             Outpatient Care Management –
             Current Program

       Identify outpatient treatments at risk
       Outreach to providers when risk is identified
       BH assessment and progress tracking tool
       online for members to complete – provide
       feedback to member, provider and care
       management staff
       Primary care initiative
       Referrals into Specialty Programs

                                                       18
  Aetna
Behavioral
 Health
             Outpatient Care Management –
             Next Steps

       Rollout out March “Behavioral Health Insights”
       newsletter
       Increase use of predictive models and web
       based tools to identify at-risk members or those
       in ineffective care
       Ongoing development of the “Chairman’s
       Initiative” focusing on treatment of depression in
       the primary care setting


                                                          19
  Aetna
Behavioral
 Health       Closing

       Key contact info:
             Lois Vecchione : 603-330-7603 or
                              vecchionel@aetna.com
             Suzanne Hemp : 610-783-4006 or
                              hemps@aetna.com


       Q&A


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