Managed Care - Aetna

Report
AETNA BETTER HEALTH®
Doing the right thing for the
right reason
AETNA BETTER HEALTH
Aetna Inc.
1
Aetna Better Health®
Disability Rights
Consortium Meeting
Jacqleen Musarra
Community Liaison Manager
June 27, 2012
AETNA BETTER HEALTH
Aetna Inc.
About Aetna Better Health
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Medicaid business unit owned by Aetna, Inc.
Twenty-three (23) years of experience as a Medicaid
Managed Care leader nationally
Serving Families and Children, Aged, Blind and Disabled,
Long Term Care, Medicare/Medicaid Enrollees
Manage services for more than 1.3 million Beneficiaries in
twelve (12) states
AETNA BETTER HEALTH
Aetna Inc.
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AETNA BETTER HEALTH
Aetna Inc.
What is the Illinois Integrated Care Program
(ICP)?
•
A Medicaid program designed to link primary, specialty,
institutional and community services focused on improving
quality through coordination, pay for performance and
creation of health homes
•
Members choose or are automatically assigned a health
plan with either Aetna Better Health or IlliniCare Health Plan
and receive Medicaid services through those health plans
•
Persons who are aged, blind and disabled (ABD) in suburban
Cook (non-606 zip codes), Will, Dupage, Kane, Kankakee and
Lake counties
AETNA BETTER HEALTH
Aetna Inc.
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Integrated Care Service Packages
Responsibilities of Aetna Better Health will include all covered
services currently funded by Medicaid through the State Plan or
waivers, and will be phased in as follows:
•
Service Package I: All medical, pharmacy, dental and behavioral health
services for the member. This includes all non-long term care services,
mental health services, alcohol and substance abuse services and short
term post-acute rehabilitation stays in nursing facilities.
•
Service Package II: Nursing facility services and services provided through
the Home and Community Based Services waivers, except those waivers
serving individuals with developmental disabilities.
•
Service Package III: Home and Community Base Services Waiver services
for individuals with developmental disabilities and ICF/DD services
AETNA BETTER HEALTH
Aetna Inc.
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Integrated Care Management Guiding
Principles
•
Focus on each individual member (consumer directed)
•
Work with members and providers to address medical,
behavioral, social, and long-term care needs
•
Partner with the member and/or caregiver to maximize the
member’s self management ability
•
Enhance quality of care outcomes
•
Support member’s choice of community living
AETNA BETTER HEALTH
Aetna Inc.
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Cycle Health
of Care
Management
Aetna Better
of
Illinois
Overview
Cycle of
Care
AETNA BETTER HEALTH
Working
Relationship
Recovery
Autonomy
Resiliency
Aetna Inc.
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Community-Based Integrated Care Team
• 30 out of 84 employees are responsible for direct care
coordination
• 16 Care Coordinators - licensed clinicians; clinical social
worker or RNs
• 14 Care Management Associates - individuals with medical or
behavioral health experience; know the community
• 11 Provider Representatives – education and support for
providers relative to all service issues
• 1 Community Liaison Manager – interact with advocates,
community and supportive agencies
AETNA BETTER HEALTH
Aetna Inc.
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Pay for Performance and Quality Measures
Illinois Department of Healthcare and Family Services (HFS)
will hold Aetna accountable for thirty (30) distinct quality
measures including:
•
•
•
•
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•
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Behavioral health assessment within 60 days of enrollment and 30 day
follow up for patients with a finding
7 day follow up after hospitalization for mental illness
Annual Influenza Immunization
Increased use of Diabetes care therapies
Increased use of Congestive Heart Failure therapies
Increased use of Coronary Artery Disease therapies
ER visits per 1,000 patients
Hospital in-patient visits per 1,000 patients
In-patient Hospital re-admission
AETNA BETTER HEALTH
Aetna Inc. 10
ICP Status as of June, 2012
Aetna Better Health Members: 18,054
• Total ICP enrollment: 35,768
Aetna Better Health Network Providers
• 58 Hospital and Specialty Hospitals
• 2,180 Primary Care Providers
• 3,709 Specialists
• 38 Community Mental Health Centers (CMHC)
AETNA BETTER HEALTH
Aetna Inc. 11
Contracted Hospitals (as of June, 2012)
Aetna Better Health® of Illinois
Service Location Name
ADVENTIST BOLINGBROOK
ADVENTIST GLENOAKS
ADVENTIST HINSDALE
ADVENTIST LAGRANGE
ADVOCATE CHRIST MEDICAL CENTER
ADVOCATE CONDELL HOSPITAL
ADVOCATE GOOD SAMARITAN HOSPITAL
ADVOCATE GOOD SHEPHERD HOSPITAL
ADVOCATE ILLINOIS MASONIC MEDICAL CENTER
ADVOCATE LUTHERAN GENERAL HOSPITAL
ADVOCATE SOUTH SUBURBAN HOSPITAL
ADVOCATE TRINITY HOSPITAL
AURORA CHICAGO LAKESHORE
CENTRAL DUPAGE HOSPITAL
DELNOR COMMUNITY HOSPITAL
HOLY FAMILY MEDICAL CENTER
JOHN H STROGER HOSPITAL OF COOK COUNTY
JACKSON PARK HOSPITAL
KINDRED CHICAGO CENTRAL HOSPITAL
KINDRED HOSPITAL CHICAGO
AETNA BETTER HEALTH
County
Will
DuPage
DuPage
Cook
Cook
Lake
DuPage
Lake
Cook
Cook
Cook
Cook
Cook
DuPage
Kane
Cook
Cook
Cook
Cook
Cook
Service Location Physical Address
500 Remington Blvd.
701 Winthrop Ave.
120 N Oak Street
5101 S. Willow Springs
4440 West 95th Street
801 S Milwaukee Ave.
3815 Highland Ave.
450 West Highway 22
836 W Wellington Ave.
1775 Dempster St.
17800 S Kedzie Ave.
2320 E 93rd Street
4840 North Marine Drive
25 N Winfield Rd.
300 Randall Rd.
100 N. River Road
1900 W Harrison St. G16
7531 Stony Island Avenue
2544 W Montrose Av.
365 E. North Avenue
City
Bolingbrook
Glendale Heights
Hinsdale
LaGrange
Oak Lawn
Libertyville
Downers Grove
Barrington
Chicago
Park Ridge
Hazel Crest
Chicago
Chicago
Winfield
Geneva
Des Plaines
Chicago
Chicago
Chicago
Chicago
State
IL
IL
IL
IL
IL
IL
IL
IL
IL
IL
IL
IL
IL
IL
IL
IL
IL
IL
IL
IL
Zip Code
60440
60139
60521
60525
60453
60048
60515
60010
60657
60068
60429
60617
60640
60190
60134
60016
60612
60649
60618
60164
Aetna Inc. 12
Contracted Hospitals (as of June, 2012)
Aetna Better Health® of Illinois
Service Location Name
KINDRED HOSPITAL SYCAMORE
LORETTO HOSPITAL
LOUIS A WEISS MEMORIAL HOSPITAL
MACNEAL HOSPITAL
MERCY HOSPITAL & MEDICAL CENTER
METHODIST HOSPITAL OF CHICAGO
NORTHWESTERN LAKE FOREST HOSPITAL
NORTHWESTERN MEMORIAL HOSPITAL
NORWEGIAN AMERICAN HOSPITAL
OAK FOREST HOSPITAL OF COOK COUNTY
OUR LADY RESSURECTION MEDICAL CENTER
PALOS COMMUNITY HOSPITAL
PROVENA MERCY MEDICAL CENTER - AURORA
PROVENA ST. JOSEPH HOSPITAL - ELGIN
PROVENA ST. JOSEPH MEDICAL CENTER - JOLIET
PROVENA ST. MARY'S HOSPITAL - KANKAKEE
RESURRECTION MEDICAL CENTER
RIVEREDGE HOSPITAL
RIVERSIDE HOSPITAL
RML HEALTH PROVIDERS LTD. PARTNERSHIP
ROSELAND COMMUNITY HOSPITAL
SACRED HEART HOSPITAL
AETNA BETTER HEALTH
County
Dekalb
Cook
Cook
Cook
Cook
Cook
Cook
Cook
Cook
Cook
Cook
Cook
Kane
Kane
Will
Kankakee
Cook
Cook
Kankakee
DuPage
Cook
Cook
Service Location Physical Address
225 Edward Street
645 S Central Ave.
4646 N. Marine Dr.
3249 S Oak Park Avenue
2525 S Michigan Ave.
5025 N. Paulina Street
660 N Westmoreland Road
251 E Huron St.
1044 N Francisco
15900 S Cicero Ave.
5645 West Addison Street
12251 South 80th Ave.
1325 N Highland Ave.
77 N Airlite Street
333 N Madison St.
500 W. Court Street
7435 W. Talcott Avenue
8311 Roosevelt Road
350 N Wall St.
5601 S. County Line Road
45 W 111th Street
3240 W Franklin Blvd.
City
Sycamore
Chicago
Chicago
Berwyn
Chicago
Chicago
Lake Forest
Chicago
Chicago
Oak Forest
Chicago
Palos Heights
Aurora
Elgin
Joliet
Chicago
Chicago
Forest Park
Kankakee
Hinsdale
Chicago
Chicago
State
IL
IL
IL
IL
IL
IL
IL
IL
IL
IL
IL
IL
IL
IL
IL
IL
IL
IL
IL
IL
IL
IL
Zip Code
60178
60644
60640
60402
60616
60640
60045
60611
60622
60452
60634
60463
60506
60123
60435
60615
60631
60130
60901
60521
60628
60624
Aetna Inc. 13
Contracted Hospitals (as of June, 2012)
Aetna Better Health® of Illinois
Service Location Name
SAINT JOSEPH HOSPITAL
County
Cook
Service Location Physical Address
2900 N. Lake Shore Drive
City
Chicago
State
IL
Zip Code
60657
SAINTS MARY AND ELIZABETH MEDICAL CENTER
Cook
1431 North Claremont
Chicago
IL
60622
SHERMAN HOSPITAL
SILVER CROSS HOSPITAL
SOUTH SHORE HOSPITAL
ST. FRANCIS HOSPITAL
ST. MARY OF NAZARETH HOSPITAL
Kane
Will
Cook
Cook
Cook
1425 N Randall Road
1900 Silver Cross Blvd.
8012 S Crandon Ave.
355 Ridge Ave.
2233 W Divison Street
Elgin
New Lenox
Chicago
Evanston
Chicago
IL
IL
IL
IL
IL
60123
60451
60617
60202
60622
ST. JAMES HOSPITAL & HEALTH CENTERS - OLYMPIA
FIELDS
Cook
Olympia Fields
IL
60461
ST. JAMES HOSPITAL - CHICAGO HEIGHTS CAMPUS
SWEDISH COVENANT HOSPITAL
Cook
Cook
1423 Chicago Road
5145 N California
Chicago Heights
Chicago
IL
IL
60411
60625
UNIVERSITY OF ILLINOIS MEDICAL CENTER OF
CHICAGO
Cook
1740 W. Taylor Street
Chicago
Il
60612
VHS WESTLAKE HOSPITAL INC.
VISTA MEDICAL CENTER EAST
VISTA MEDICAL CENTER WEST
WEST SUBURBAN MEDICAL CENTER
Cook
Lake
Lake
Cook
1225 West Lake Street
1324 North Sheriden Road
2615 Washington Street
3 Erie Court
Melrose Park
Waukegan
Waukegan
Oak Park
IL
IL
IL
IL
60160
60085
60085
60302
AETNA BETTER HEALTH
20201 S. Crawford Ave.
Aetna Inc. 14
Service Package 2:
Aetna’s Long-Term Care Principles
•
Assist members and their families with the resources they
need to live in the community
•
Provide members their choice of settings and allow them to
direct their own care to the greatest extent possible
•
Create a long-term support program that offers access to
community-based options
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Creates a long-term care system that is financially
sustainable and better aligns incentives across the system
AETNA BETTER HEALTH
Aetna Inc. 15
The Member’s Voice in the Health Plan:
Member Advisory Council
• Participants include members, family members, advocates
and providers
• Quarterly meetings scheduled with the first meeting held in
October, 2011
• Agenda: Council members draft agenda items; discuss and
provide Aetna feedback on issues ranging from network
adequacy to customer service
AETNA BETTER HEALTH
Aetna Inc. 16
Contact Information
Jacqleen Musarra
Community Liaison Manager
Aetna Better Health of Illinois
312-821-0583
musarraj@aetna.com
AETNA BETTER HEALTH
Aetna Inc. 17

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