BLUE BELL, PA – Medicare Advantage members in Pennsylvania who enrolled in a Health Quality Partners (HQP) care management program had 20 percent fewer inpatient hospital admissions, according to a report issued by Aetna on Nov. 16.
Results of the care program showed that 18 percent of participants had lower medical costs, compared to members with similar conditions who did not participate, according to the first-year results of the HQP program.
Aetna officials said the health plan identified participants for the voluntary care management program by looking at physician offices that treat a large number of Aetna Medicare Advantage members. The company reviewed claims data and identified 1,500 members who were most in need of care due to chronic illness. From that group, 942 members agreed to participate.
HQP developed risk profiles for those members, generated medical record reviews in primary care offices, and utilized frequent data feeds from Aetna relating to hospital and facility admissions, lab values and claims data. It used this information to prioritize outreach efforts to members with the highest risk, according to Aetna.
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In the first year, a group of 97 high-risk members agreed to participate in the advanced care management program and received more individually focused assessment and interventions, said Aetna officials. All told, HQP reported 2,285 participant contacts and more than 12,000 total interventions over the first year, including assessments, monitoring, education and counseling, and coordinating additional community health and social services.
“We’re very encouraged by the first-year results,” said Mike Ungvary, senior vice president of Medicare operations for Aetna’s Northeast Region. “HQP has had a major positive impact on Medicare beneficiaries for several years, improving outcomes, addressing the root causes of high cost and poor quality. Its approach is a valuable tool for members.”
HQP contracted with Aetna in December 2009 after participating for several years in a Medicare Coordinated Care Demonstration (MCCD). according to Aetna. Working directly with members and in collaboration with their primary care providers, HQP nurses provide ongoing assessments and monitoring; support for medication adherence; patient education; self-management coaching; and close follow-up during transitions from hospital to home or nursing facilities.
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The nurses also promote physical activity, weight management, healthy eating, vaccinations, social engagement, and home safety, all of which are found to be beneficial for older adults, according to Aetna officials. The nurses use proactive outreach to identify members who would benefit from those services, and deliver them in a reliable, affordable, easy-to-access way.
“Thanks to the effective collaboration and professionalism of the Aetna team and the support of primary care providers, things have gotten off to a good start,” said Sherry Marcantonio, senior vice president for Health Quality Partners. “The early evidence of the program’s effectiveness among Aetna Medicare Advantage members is consistent with the results we’ve seen with traditional fee-for-service Medicare beneficiaries participating in the MCCD. We look forward to working with more Aetna members in the coming years and building on this initial success.”
Aetna provides health benefits to more than 1 million members in Pennsylvania. Its members have access to a network that includes more than 200 hospitals and more than 31,000 primary care and specialist physicians.
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