We use immediate impact programs to change the way healthcare is delivered.
- Patient outreach: We help with both acute care and chronic health issues. Our care navigators reach out to patients with chronic or multiple conditions to improve health results, while also focusing on preventive and educational approaches to wellness. Together, these efforts improve patient health through coordinated care.
- Referral management: Patients who need referrals are directed to providers in our integrated network for quality care at a lower cost, ensuring that each member receives the quality and attention he or she deserves and all care providers are kept in the loop.
- Education on emergency rooms: Some patients have a large number of ER visits that could have been avoided. We let them know about the benefits of a primary care physician and ongoing wellness care instead.
- Generic prescriptions: Using generics means lower healthcare costs without losing quality of care. We focus on educating members about how they can achieve their best health without unnecessary expenses.
Together, these steps remove waste, steer care in a more positive direction and lead to sustainable savings.
Changing How Healthcare Is Delivered
Aetna gathered a number of statistics from different providers that show exactly where savings can be seen in an integrated care model:
- Between 28 to 60 percent of patients reach their blood pressure and cholesterol level goals
- 19 percent fewer avoidable ER visits, and a seven percent better use of medical services
- Hospital bed stays down 50 percent, with 32 percent fewer hospital readmissions
- 10 percent fewer high-tech imaging scans
- 9 percent reduction in radiology use over the span of one year
- 11 percent increase in generic prescriptions
- 12 percent improvement in PMPM payments
We focus on these kinds of clear efficiency measures with set target improvement percentages. These include surgical and medical admits, plus avoidable ER visits and lower re-admission rates, as well as low-cost, generic medications that save members money while delivering the same excellent quality of care.
At the same time, we emphasize wellness care, such as reminding members about timely breast cancer and colon cancer screenings. Nurse navigators coordinate care with chronic conditions like diabetes or asthma as well. The results of improved treatment coordination, more comprehensive preventive screening and extensive patient education add up to a superior system of care for all our members.