Aetna History Aetna Behavioral Health Depression Initiatives
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Aetna History Aetna Behavioral Health Depression Initiatives 1985 Aetna owns Human Affairs International (HAI) 2004 2003 1997 Aetna sells HAI to Magellan Magellan contract amended to consolidate Aetna services Aetna announces decision to launch fullservice BH and EAP business 2006 2005 Transition year, contractual services provided by Magellan until 12/31/05 Aetna enters market as 5th largest BH provider June 2006 Click to edit Master subtitle style 2 Aetna Behavioral Health Strategy Depression: Leading driver of overall cost at worksite Implementation Update Integrated Clinical Programs 80% Specialized Behavioral Health Service Continuum of Behavioral Health Services Employee Assistance Program 70% 60% 50% Counseling Worksite Consultation Work / Life Support Legal / Financial Support Crisis Debriefing Network Care Management Integration with PCPs 40% Intensive Case Management Med/Psych Case Management Disease Management • Depression • Alcohol Use Disorder • Anxiety Disorder Primary Prevention 30% 20% 10% 0% Tertiary Prevention Depression High stress High blood Overweight glucose 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 % Increase in Costs 4 Distress and Medical Illness 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 High blood pressure Source: HERO Study. Goetzel et. al 3 Current tobacco use 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 5 6 1 Impact of Depression on Aetna’s Medical Utilization: Low Back Pain Impact of Depression on Aetna’s Medical Utilization: Diabetes 900 819.88 700 600 670.88 500 400 300 200 Without Depression 560.00 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 With Depression 100 Without Depression 1,848.18 1,000.00 473.74 1,200.00 1,000.00 6.02 1,252.03 800.00 4.00 924.32 600.00 4.77 3.00 400.00 2.00 200.00 1.00 0.00 ER/1000 0.00 1,191.98 1,100.00 1,050.00 1,000.00 Without Depression 1,024.25 900.00 Admits/1000 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. 7,724.65 5,610.96 Days/1000 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 900.00 800.00 700.00 600.00 500.00 400.00 300.00 200.00 100.00 0.00 3.90 Average Length of Stay (days) 8 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 1,200.00 950.00 4.56 Average Length of Stay (days) Impact of Depression on Aetna’s Medical Utilization: CHF 1,150.00 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 7 With Depression 0.00 Admits/1000 6.00 ER/1000 500.00 420.00 7.00 5.00 2,512.93 1,500.00 480.00 440.00 Days/1000 746.3 2,000.00 500.00 460.00 Admits/1000 941.58 2,500.00 551.38 520.00 With Depression 3,199.21 0 1000 900 800 700 600 500 400 300 200 100 0 3,000.00 540.00 4,934.06 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 Coronary Artery Disease 6.48 5.48 Average Length of Stay (days) 9 10 Depression Program Results Medical Psychiatric Case Management Depression Program Program ResultsResults 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 11 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 12 2 Medical Psychiatric Care Management Program and Productivity Primary Care Physician as the frontline for Behavioral Health Member response to intake and discharge questions: 50% of mental health care is provided by PCPs Mental Health Survey Condition Intake Discharge Depression 79% 44% 35% drop in Depression Outcome Energy Level Work Limitations Social Limitations 49% 63% 71% 75% 29% 41% 26% increase in energy Two thirds of psychopharmacological drugs are prescribed by PCPs 34% drop in work limitations 30% drop in social limitations Prescription drug costs make up 50% of all mental health costs Physical Health Survey Condition Intake Discharge On average, only the insured Click3-6% to editof Master subtitle style population will seek treatment from a behavioral health specialist 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 13 Inadequate Detection and Treatment of Depression Depression Care Models Model Three Component Usual Care Aetna Depression Management 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 PRIMARY CARE CLINICIAN Low adherence rates to antidepressants Patient PATIENT PATIENT Underutilization of psychotherapeutic intervention MENTAL HEALTH SPECIALIST 15 16 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 17 3
