Aetna Behavioral Health
Depression Initiatives
June 2006
Click to edit Master subtitle style
Aetna History
1985
Aetna owns
Human Affairs
International
(HAI)
1997
Aetna sells
HAI to
Magellan
2003
Magellan
contract
amended to
consolidate
Aetna services
2004
Aetna announces
decision to
launch fullservice BH and
EAP business
2005
Transition year,
contractual services
provided by Magellan
until 12/31/05
2006
Aetna enters
market as 5th
largest BH
provider
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Aetna Behavioral Health Strategy
Implementation Update
Integrated Clinical Programs





Counseling
Worksite Consultation
Work / Life Support
Legal / Financial Support
Crisis Debriefing
Primary
Prevention
Specialized
Behavioral
Health
Service
Continuum of
Behavioral
Health
Services
Employee
Assistance
Program



Network
Care Management
Integration with PCPs



Intensive Case Management
Med/Psych Case Management
Disease Management
• Depression
• Alcohol Use Disorder
• Anxiety Disorder
Tertiary
Prevention
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Depression: Leading driver of
overall cost at worksite
80%
70%
60%
50%
40%
30%
20%
10%
0%
Depression High stress High blood Overweight
glucose
Source: HERO Study. Goetzel et. al
Current
tobacco
use
High blood
pressure
% Increase in
Costs
4
Depression and Medical Illness

Co-Occurring depression is common in medical illness
– 40-65 percent of heart attack
– 10-25 percent of stroke
– 25 percent of cancer survivors

Risk of medical events increase with depression
– 4 fold increased risk of MI
– 3 fold increased risk for stroke in African Americans
– 68 percent increased risk of stroke in Caucasian male
Source: NIMH and Centers for Disease Control and Prevention
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Distress and Medical Illness


90% of the 10 most common presenting
complaints/symptoms in the primary care setting have no
organic basis.
Half of HMO patients identified as “high utilizers” are
psychologically distressed – the top 10% account for:
– 52% of all specialty visits
– 40% of all inpatient days
– 29% of PCP visits
– 26% of all prescriptions
1 Katon W, VonKorff M, Lin E, et al: Distressed high utilizers of medical care: DSM-III-R diagnoses and treatment needs. Gen
Hosp Psychiatry. 12:355-362, 1990
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Impact of Depression on Aetna’s Medical
Utilization: Diabetes
900
5,000.00
4,500.00
4,000.00
3,500.00
3,000.00
2,500.00
2,000.00
1,500.00
1,000.00
500.00
0.00
800
700
With
Depression
819.88
600
670.88
500
400
300
200
Without
Depression
100
0
3,199.21
Days/1000
Admits/1000
1000
900
800
700
600
500
400
300
200
100
0
4,934.06
7.00
6.00
941.58
5.00
746.3
4.00
6.02
4.77
3.00
2.00
1.00
0.00
ER/1000
Average Length of Stay (days)
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Impact of Depression on Aetna’s
Medical Utilization: Low Back Pain
560.00
3,000.00
540.00
520.00
With
Depression
2,500.00
551.38
2,000.00
500.00
1,500.00
480.00
1,848.18
1,000.00
460.00
473.74
440.00
Without
Depression
500.00
420.00
0.00
Admits/1000
Days/1000
4.60
4.50
4.40
4.30
4.20
4.10
4.00
3.90
3.80
3.70
3.60
3.50
1,400.00
1,200.00
1,000.00
1,252.03
800.00
600.00
2,512.93
924.32
400.00
200.00
0.00
ER/1000
4.56
3.90
Average Length of Stay (days)
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Impact of Depression on Aetna’s
Medical Utilization: CHF
8,000.00
7,000.00
6,000.00
5,000.00
4,000.00
3,000.00
2,000.00
1,000.00
0.00
1,200.00
1,150.00
With
Depression
1,191.98
1,100.00
1,050.00
1,000.00
1,024.25
950.00
Without
Depression
900.00
Admits/1000
900.00
800.00
700.00
600.00
500.00
400.00
300.00
200.00
100.00
0.00
7,724.65
5,610.96
Days/1000
6.60
6.40
6.20
6.00
5.80
5.60
5.40
5.20
5.00
4.80
862.10
587.35
ER/1000
6.48
5.48
Average Length of Stay (days)
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Depression Screening
Resources
Our patient and disease management team screen for depression in all of
the existing Aetna plans and programs. Up to 8000 members are
screened per month.

Moms-to-Babies

Cardiac Post DC

Disease Management

Coronary Artery Disease

Integrated Health Disability
 Chronic Heart Failure

Antidepressant Pharmacy Data
 Diabetes

Simple Steps HRA
 Low Back Pain

PULSE
 Asthma
 Coronary Artery Disease
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Depression
Program
Results
Medical
Psychiatric
Case Management
Program Description:







Focused on members with co-occurring chronic medical
disorder (e.g. CHF, Diabetes) and depressive disorder
Depression screening and referral process for all members
in Aetna’s medical case and disease management program
Use of pharmacy and PULSE data to identify potential
enrollees
Collaboration between medical and behavioral health case
managers
Coordinate medical and behavioral care and enhance
adherence
Minimum monthly member outreach by behavioral health
care managers
Facilitated access to BH specialists with expertise in Medical
/ Psychiatric issues
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Depression
Program
Program
ResultsResults
Med / Psych SF 12 (N=1571)
8.9% Physical Health Improvement
44.9% Mental Health Improvement
3.95 Average work days gained per month
Utilization Impact
ER Utilization Reduction
Inpatient Length of Stay Reduction
Outpatient Visits – No change
Total Pharmacy Cost – Increase
Antidepressant accounted for 28% of increase
Net Medical Cost Reduction with 2:1 ROI
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Medical Psychiatric Care Management
Program and Productivity
Member response to intake and discharge questions:
Mental Health Survey
Condition
Intake
Discharge
Outcome
Depression
79%
44%
35% drop in Depression
Energy Level
Work Limitations
Social Limitations
49%
63%
71%
75%
29%
41%
26% increase in energy
34% drop in work limitations
30% drop in social limitations
Physical Health Survey
Condition
Intake
Discharge
Outcome
General Health
5%
9%
4% increase in General Health
Work Limitations
61%
Does Less Work
64%
48%
45%
Bodily Pain
12%
5%
13% drop in work limitations
19% increase in work
7% decrease in bodily pain
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Primary Care Physician as the
frontline for Behavioral Health
 50% of mental health care is provided by PCPs
 Two thirds of psychopharmacological drugs are
prescribed by PCPs
 Prescription drug costs make up 50% of all
mental health costs
 On average,Click
onlyto3-6%
of the
insured
edit Master
subtitle
style
population will seek treatment from a
behavioral health specialist
Inadequate Detection and Treatment of
Depression
Although 50% of those with depression are seen by PCPs,
one-third to one-half go undiagnosed and under treated.

stigma

Inadequate time – 7 minutes per office visit

insufficient screening

Reimbursement
Low adherence rates to antidepressants
Underutilization of psychotherapeutic intervention
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Depression
Care
Models Model
Three
Component
Usual Care
Aetna Depression Management
PRIMARY CARE
CLINICIAN
Patient
PATIENT
PATIENT
MENTAL HEALTH
SPECIALIST
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Aetna
Depression
Management
Aetna’s
Depression
Management:
Aetna
Depression
Management:
Program
Component
Program
Components
Program
Component
 Enhanced reimbursement to PCPs for assessment and
treatment
 Web and CD-ROM based CME program
 Empirically validated standardized depression assessment
tool (PHQ9)
 Care management support for members and PCP’s
 Psychiatric consultation to PCP’s
 National dissemination
 Outcomes measures and program effectiveness evaluation
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