Aetna Integrated Health and Disability

Aetna Integrated

Health and Disability

Aetna stands alone in

integrating medical and

disability data in real-time

and implementing holistic

care management to

improve outcomes for

employers and their

employees.

Features and Capabilities of Truly Integrated Plans

■

Real-time data integration to predict medical events

and employee disabilities and facilitate coordinated

care management within HIPAA guidelines.

■

Combined disability management and patient

management expertise

to coordinate services for

members, and manage costs and resources.

■

A holistic view of an individual’s situation to create

administrative efﬁciencies and opportunities for early

intervention and physician involvement.

■

Coordinated consistent disability, medical and

rehabilitation services

to provide assessments and

address each individual’s medical condition and

functional requirements at work.

26.02.106.1 (2/04)

Through real-time data integration, predictive

modeling of medical and disability events,

and prospective early intervention, Aetna

gives members the advantage of the earliest

possible clinical support and case management.

In today’s business environment,

controlling beneﬁts costs and maximizing

employee health and productivity are

crucial issues. Aetna can make a

difference with our new model for

linking medical, short term disability

and long term disability plans.

Under our Integrated Health and

Disability (IHD) approach, Aetna

integrates medical and disability

programs two ways:

1.With the employee’s consent, we

integrate medical and disability case

management to coordinate care.

By looking at an employee’s medical

needs and ability to work, we can

identify opportunities to help an

employee prevent a disability altogether,

or return to the workplace sooner and

avoid an extended disability claim.

2.We integrate medical and disability data

through Aetna Integrated Informatics

our data integration and analysis

experts. By analyzing historical claims

data, we have developed medical and

disability predictive models that identify

members at risk for adverse health and

disability events. This allows us to

implement early intervention programs

designed to avoid or lessen disabilities

and time away from work.

IHD is our way of doing business,

and there is no additional cost for

these value-added services.

Linking medical and disability

claims information, claims

processes and case management

offers you several advantages:

■

Providing a consistent medical

case manager for the employee

■

Supporting complete, efﬁcient

interactions between your

employees and Aetna staff on

complex clinical issues

■

Assuring seamless coordination of

health, disability and behavioral

health services, thereby reducing

multiple phone calls from Aetna to

your employees and beneﬁts staff

■

Improving plan administration

■

Increasing employee satisfaction

■

Integrated data analysis and reports

All disabilities involve medical

treatment as a key component of

restoring functionality. Aetna is an

expert in both health and disability,

so we are able to apply a holistic

approach to disabilities that focuses

on employee health needs.

Aetna is a leading beneﬁts company

integrating health and disability data

in real time:

We have the ability to

predict both medical and disability

events, and take

prospective action,

giving us a distinct advantage in being

more timely in our interventions.

This means we can offer improvements

in productivity and absenteeism by:

■

Identifying employees at risk

for adverse medical and related

disability events within HIPAA

guidelines, and helping individuals

and their doctors take steps to

improve health.

■

Coordinating Aetna resources

that can offer early intervention

services designed to assist

employees in their efforts to

successfully address these events.

■

Assisting you in identifying

issues that adversely impact the

health and productivity of the

work force, and offering solutions

to foster increased wellness and

productivity.

■

Simplifying utilization and

improving access to health and

disability beneﬁts.

■

Helping decrease days out of work.

Ultimately, by integrating

health and disability

plans with Aetna, you

can build a healthier, more

productive work force.

A Look at How IHD Works

Employees who have coverage under an

Aetna health plan and an Aetna disability

plan, as well as a diagnosis that triggers case

management, will beneﬁt from this model.

IHD coordinates the activities of Aetna’s

Medical Case Management program,

Aetna Disability, Aetna’s Behavioral Health

program services, and Aetna Integrated

Informatics (AetInfo), our data integration

and analysis experts.

IHD is fully HIPAA-compliant. If Aetna

determines that the employee may beneﬁt

from integrated case management, the

employee will be asked if he or she wishes

to have Aetna medical and Aetna disability

staff share data and coordinate activities.

When the employee agrees, and signs

and returns a Release of Information

form (ROI) available online or by mail,

the medical and disability staffs can share

clinical information and jointly work with

the employee to help him or her address

medical and disability issues.

Located together, medical and behavioral

health case managers act as the clinical

consultants to disability claim analysts for

the disability event as long as the case

remains in case management. Disability

analysts make disability claim decisions.

Contact your broker or local Aetna

representative today!

Find out more about how we can work

together to make a difference in the

outcomes of employee illnesses and injuries.

A Case in Point: Mary’s Story

Mary is a 47-year-old in a sedentary

ofﬁce job. She underwent elective

surgery for a gastrointestinal condition

a few years ago, but continued to

have problems.

During this time, she saw her regular

doctor and some specialists, and

required a number of prescriptions,

home health care and special medical

supplies. Her frequent short-term

hospitalizations triggered our case

management process and she was

referred to a more formal health care

management program.

Another surgical procedure would

require Mary to be out of work and,

when she inquired about her disability

beneﬁts, she learned about Aetna’s

integrated approach to health and

disability and gave permission to share

information. Our disability and health

care managers were then able to use

data integrated in real-time in Aetna’s

common system platform to develop

a course of action.

Mary suffered more setbacks following

her surgery and she was readmitted to

the hospital without being able to

contact her disability specialist to update

her disability status. However, with

combined disability management and

patient management services

, the

disability staff was able to review the

information gathered previously by the

medical nurse case manager and extend

Mary’s disability beneﬁts appropriately.

There was no lapse in Mary’s disability

certiﬁcation, and no need for her to

re-start the beneﬁts process after

discharge from the hospital.

Taking a

holistic view of Mary’s

situation

as she continued to recover,

the nurse case manager and disability

specialist worked together on a plan to

monitor Mary’s progress.

The result: Because Mary’s health and

disability beneﬁts were coordinated

in a consistent, seamless manner

a valuable connection was created

between the two specialists working

on her care. Mary did not suffer

any interruption in her disability

beneﬁts, her physician and employ-

er were not contacted multiple

times for information, and she had

a high degree of satisfaction with

the process. By following her care

management plan, Mary was able

to avoid further short-term

hospitalizations and absences

from work.

“Aetna” is the brand name used for products and services provided by one or more of

the Aetna group of subsidiary companies.HMO, Quality Point-of-Service

, Aetna Open

Access

, Aetna Choice

POS and USAccess

plans are provided or administered by Aetna

Health Inc., Aetna Health of California Inc., Aetna Health of the Carolinas Inc., Aetna

Health of Illinois Inc., Corporate Health Insurance Company, Aetna Health Insurance

Company of Connecticut, Aetna Health Insurance Company of New York and/or Aetna

Health Insurance Company; and in Arizona — Aetna Health Inc. and/or Corporate Health

Insurance Company. Elect Choice, Managed Choice

POS, Open Choice

PPO, Aetna

Choice

POS II, Aetna Open Access

Managed Choice

, Aetna Open Access

Elect Choice,

Traditional Choice

and Aetna HealthFund

medical plans are provided or administered by

Aetna Life Insurance Company.

Group Disability products are provided or administered by Aetna Life Insurance Company.

THE WELLNESS-DISABILITY CONTINUUM

People experience health along a continuum of care

▼

GOALS

TOOLS &

STRATEGIES

WELL BEING/

INDEPENDENCE

■

Keep healthy

■

Avoid migration to

unhealthy condition

■

Informed Health

Line (Self care)

■

Aetna InteliHealth

■

Simple Steps

■

Beneﬁt design

■

Coverage bulletins

CHRONIC

CONDITION

■

Identify risks &

behaviors early

■

Target interventions

■

Manage condition

■

Avoid migration

to acute condition

or disability

■

Informed Health

Line (Self care)

■

Aetna InteliHealth

■

Disease

management

■

Aetna Pharmacy

■

Aetna Behavioral

Health

ACUTE OR

CATASTROPHIC

(illness/injury)

■

Effective decision

making

■

Provider, case manager,

patient interaction

■

Appropriate treatment

■

Avoid migration

to disability

■

Informed Health

Line (Self care)

■

Aetna InteliHealth

■

Integration

> Case management

> Disability management

> Behavioral health

management

■

National Medical

Excellence Program

■

Specialist network

■

Aetna Pharmacy

■

Aetna Behavioral

Health

DISABILITY

■

Minimize duration

■

Support return to

health

■

Facilitate return to

work

■

Avoid migration to

permanent disability

■

Informed Health

Line (Self care)

■

Aetna InteliHealth

■

Integration

> Case management

> Disability management

> Behavioral health

management

■

Clinical duration tools

■

Vocational rehabilitation

■

Specialist network

■

Aetna Pharmacy

OUTCOMES

■

Recovery

■

Residual function

■

Chronic condition

■

Permanent disability

■

Aetna Long Term

Disability

■

Aetna Long Term

Care Insurance

DATA INTEGRATION, REPORTING AND ANALYSIS

Disability stems from health deterioration/health needs.

A consumer-oriented philosophy of medical care offers the opportunity to integrate care, including disability.

▼