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 • • • • 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. 3 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. 5 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. 6 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. 7 Cycle Health of Care Management Aetna Better of Illinois Overview Cycle of Care AETNA BETTER HEALTH Working Relationship Recovery Autonomy Resiliency Aetna Inc. 8 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. 9 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: • • • • • • • • • 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 • 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