AETNA BETTER HEALTH®
Doing the right thing for the
right reason
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.
AETNA BETTER HEALTH
Aetna Inc.
What is the Illinois Integrated Care Program
(ICP)?
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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
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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
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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.
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:
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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.
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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.
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Service Package III: Home and Community Base Services Waiver services
for individuals with developmental disabilities and ICF/DD services
AETNA BETTER HEALTH
Aetna Inc.
Integrated Care Management Guiding
Principles
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Focus on each individual member
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Work with members and providers to address medical,
behavioral, social, and long-term care needs
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Partner with the member and/or caregiver to maximize the
member’s self management ability
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Enhance quality of care outcomes
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Support member’s choice of community living
AETNA BETTER HEALTH
Aetna Inc.
Cycle Health
of Care
Management
Aetna Better
of
Illinois
Overview
Cycle of
Care
AETNA BETTER HEALTH
Working
Relationship
Recovery
Autonomy
Resiliency
Aetna Inc.
Community-Based Integrated Care Team
• 35 out of 85 employees are responsible for direct care
coordination
• 21 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.
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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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.
ICP Status as of April 2012
Aetna Better Health Members: 18,447
• Total ICP enrollment: 35,518
Aetna Better Health Network Providers
• 56 Hospital and Specialty Hospitals
• 1,982 Primary Care Providers
• 3,569 Specialists
• 45 Community Mental Health Centers (CMHC)
AETNA BETTER HEALTH
Aetna Inc.
Provider Payment
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Direct Patient Care: $.88 per ICP dollar must be spent on
patient care.
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Timely Payment: 90% of all clean claims for covered
services will be paid in 30 days; 99% of all clean claims for
covered services to be paid within 90 days
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Reimbursement: no less than State Medicaid fee schedule
AETNA BETTER HEALTH
Aetna Inc.
Phase 2: Aetna’s Long-Term Care Principles
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Assist members and their families with the resources they
need to live in the least restrictive setting
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Provide members their choice of settings and allow them to
direct their own care to the greatest extent possible
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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.
The Member’s Voice in the Health Plan:
Member Advisory Council
• Participants include members, family members, advocates
and providers
• Quarterly meetings scheduled with three held on October
26, 2011, January 25, 2012 and April 18, 2012
• 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.
Contact Information
Robert Mendonsa
Chief Executive Officer
Aetna Better Health of Illinois
312.821.0502 office
312.235.9909 mobile
mendonsajrr@aetna.com
Jacqleen Musarra
Community Liaison Manager
Aetna Better Health of Illinois
312-821-0583
musarraj@aetna.com
AETNA BETTER HEALTH
Aetna Inc.