Aetna Better Health of Kentucky - July 25, 2019 - Cabinet for Health and Family Services
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Aetna Better Health of Kentucky
©2018 Aetna Inc.
July 25,12019
Outline:
1. Outline
Aetna in Kentucky
2. Quality Outcomes
1.
3. Aetna Better
Innovations
Health of
4. Emergency Department Utilization
Kentucky
5. PMPM
2. Provider
6. Access
Experience
3. Innovation
4. Member and
Community
Experience
©2018 Aetna Inc. 2 2
Aetna in Kentucky 2018
Aetna is
committed to
building a
healthier
Kentucky –
one person, one
community at a
time
©2018 Aetna Inc. 3 3
Quality Outcomes
Aetna Better
Health of
Kentucky
achieved a
commendable
accreditation -
obtaining one of
the highest ratings
among MCOs and
excelling in
consumer
satisfaction.
©2018 Aetna Inc. 4 4
Quality Outcomes
HEDIS 2019 rates trended positive with a 74% increase in rates when compared to HEDIS 2018
Positive point difference: 38% of measures have exceed last year’s rate by 4 or more points
Positive point difference: 5% of measures have exceed last year’s rate by 3 to 4 points
Positive point difference: 10% of measures have exceed last year’s rate by 2 to 3 points
Positive point difference: 20% of measures have exceed last year’s rate by 1 to 2 points
Positive point difference: 27% of measures have exceed last year’s rate by 0 to 2 points
©2018 Aetna Inc. 5 5
Quality Outcome Trends
Adult BMI Assessment
Weight Assessment and Counseling (Children/Adolescents)
Childhood Immunizations (Combo 10)
Improvement Adolescent Immunizations (Combo 2)
Use of Opioids from Multiple Providers
Well Child (W34)
Initiation and Engagement of AOD Dependence Treatment (IET)
Access and Availability
Dental
Screenings: Lead, Cervical, Chlamydia
Performance Respiratory (Asthma, COPD)
Cardiovascular (Controlling High BP, Statin Therapy)
Diabetes
Postpartum Care
Women's Health Screening
Anti-Depressant Medication Management
Follow Up after Hospitalization (30 days)
Opportunities Use of Multiple Antipsychotics in Children and Adolescents
Adolescent Well Care
Follow Up Care for Children Prescribed ADD
©2018 Aetna Inc. Timeliness of Prenatal Care 6 6
VBS Impact
VBS Totals MY 2018 Aetna without VBS Totals MY 2018 All of Aetna per IDSS Admin MY 2018
Measure Num Denom Rate Measure Num Denom Rate Measure Num Denom Rate
AWC 6501 13760 47.25% AWC 13029 32549 40.03% AWC 19530 46309 42.17%
BCS 1076 2135 50.40% BCS 2113 4545 46.49% BCS 3189 6680 47.74%
CCS 6242 10921 57.16% CCS 12907 27044 47.73% CCS 19149 37965 50.44%
CDCEyeExam 1062 2288 46.42% CDCEyeExam 2045 5195 39.36% CDCEyeExam 3107 7483 41.52%
CHLChlamydiaTotal 1665 3061 54.39% CHLChlamydiaTotal 3739 7264 51.47% CHLChlamydiaTotal 5404 10325 52.34%
CISCombo10 319 1295 24.63% CISCombo10 452 2856 15.83% CISCombo10 771 4151 18.57%
W15 685 1156 59.26% W15 1576 2815 55.99% W15 2261 3971 56.94%
CDCTesting 1993 2288 87.11% CDCTesting 4305 5195 82.87% CDCTesting 6298 7483 84.16%
Currently, 38 percent of Aetna enrollees are served by a value-based provider with 43 percent of Aetna-contracted primary care providers
(PCPs) participating in a physician incentive plan.
Amongst our numerous agreements, three of the most successful arrangements include Kentucky Primary Care Association (KPCA), Kentucky
Health Partners (KHP) and St. Elizabeth Healthcare.
©2018 Aetna Inc. 7
Innovations
©2018 Aetna
©2018
Inc. Aetna Inc. 8 8
Diabetic Retinal Screening: Eye SPI (Screen,
Prevent, Improve
DRE Completions
Launch Week (June 20 - 29)
Kiosk 7 27%
Web 19 73%
* Launch week numbers show an increase from an average of 35 to 61 DRE completions
Average Time to Complete DRE (Minutes)
3.4
DRE Mailings
Cards Shipped ~4,399
©2018 Aetna Inc. 9 9
Aetna Innovative Partnership
Kentucky QuIPS (Quit Incentives for Pregnant Smokers)
A pilot initiative for Kentucky’s Medicaid members that
is an incentives-based cessation program.
GOAL: Develop best-in-country strategy to reduce
smoking during pregnancy for Kentucky Medicaid
members
APPROACH: Rapid-cycle pilot tests of program elements
and assumptions to learn quickly and design for scale
for best-in-country program. Aetna Better Health of
Kentucky is partnering on this project with the Center
for Health Incentives and Behavioral Economics at the
University of Pennsylvania.
©2018 Aetna Inc. 10 10Partnering with Independent Pharmacies
Aetna Better Health of Kentucky, the Kentucky Pharmacy Care Network and the
Community Pharmacy Enhanced Services Network (CPESN) are partnering on a 12-month
program that began January 1, 2019. Initially, 6 CPESN pharmacies in Kentucky will be
involved in this program. CPESN will have care
plans to assess and
• Screen Aetna Medicaid members and provide community pharmacy care management-clinical identify Social
check-ins/assessments and updates to the pharmacy care plan with each regular fill of chronic
Determinants of
medications.
• Conduct medication reconciliation and coordinate care in transitions from hospital to home within Health for members,
15 days of discharge allowing our care
• Support foster care placements with same-day review of medications to alert foster homes of managers to assist
medications that need to be filled urgently with transportation,
• Refer members who are high utilizers to establish care with a primary care practice food, and safety
• Assist Aetna and care providers with closure of care gaps
• Conduct reviews of medication appropriateness for members flagged with potential
concerns.
polypharmacy use
• Provide support and education to members with high risk opioid regimens and the prescribers
working with them
©2018 Aetna Inc. 11 11Open cases/Original Referral 97
▪ Cases Open by CPESN identification & ABH approval 27
Referrals to CPESN for
▪ Initial Referral Reason from ABH to CPESN polypharmacy 70 Polypharmacy by ABH: 70; and,
CPESN request member in
▪ Initial Referral Reason from ABH to CPESN- care transition 0 program (ABH approved): 27
▪ Initial Referral Reason from ABH to CPESN- Gap in Care 0
CPESN Results
▪ Initial Referral Reason from ABH to CPESN- ENGAGE member
as of June 15,
0
Closed Member cases 63
2019
▪ Closed due to pharmacist CP achieved results desired 25 Top 3 reasons: No engagement; member not
receptive/interested; optimal care at this time
▪ Closed due to lack of engagement, term/transfer, hospice, etc. 21
▪ Closed due to member declined 17
Conferences between ABH CM, RPH & specific pharmacy's
Case Conferences 29
pharmacist. Discuss cases and determine next steps. 2-3
conferences per Pharmacy
▪ Members cases discussed during conference 175
63 unique members have CP activities
Care Plan Activities 207
48 included Med Synchronization activities
▪ CPA- Medication Review 63
Home delivery +/- adherence packaging
▪ CPA Medication packaging or delivery 15
Topics include: smoking cessation; nutrition & exercise &
▪ CPA- Education 66 weight reduction; diabetes; blood pressure monitoring
Most common medication recommendations to PCP and
▪ CPA- Coordination of Care 46 other providers
Referral to ABH CM; most common SDOH, DME, sleep study,
▪ CPA- Referral to ABH CM for 17 pain consult, OBGYN- family planning, formulary information
SDOH referrals
Referral not associated with Care Plan activity 7
Enrollees rated 6 pharmacies as excellent avg 4.5/5 point
CPESN ©2018Satisfaction
Member Aetna Inc. 4.5/5 scale . 100% would recommend to friend or family 12 12Start Strong Re-Entry Program
"By utilizing this
90 day jail substance abuse program – Kenton County Detention Center
comprehensive solution
Treatment is started during the 90 days (along with programming), and then with individuals before and
individuals are provided with 6 months support. This includes treatment, housing, and after incarceration,
job training. We provide additional supports and ensure members can continue their KCDC will help more people
treatment without any gaps. move beyond addiction
and establish healthy,
• Each Aetna member taken into custody receives an Aetna Start Strong Brochure productive lives. And,
and a letter stating how to get in touch with the reentry coach (case manager), because jails and prisons
are the largest provider of
housed inside the detention center.
behavioral health services
• The program has been presented to 500 inmates in the Kenton County Detention in the country, this effort
Center. may also serve as a
• 40 Aetna members have participated in Start Strong blueprint for treating
• Only 2 members have returned to jail as of June 30, 2019. addiction throughout the
criminal justice system,"
As individuals complete the 90 day Jail Substance Abuse Program (JSAP), they said Jordan Hansen,
will transition to 6 months follow-up with the Life Learning Center. During Hazelden Publishing's
these 6 months, individuals will be given support for ongoing treatment, senior manager clinical
assistance in housing, as well as job-training/placement. Backpacks full of systems.
basic necessities are provided for those who are leaving the jail, and will begin
the next phase of their treatment plan.
©2018 Aetna Inc. 13 13Opioids: Aetna’s Three Year Goals
By 2022 Aetna is committed to the following:
• Increase percent of members with chronic pain treated by an evidence-based
multi-modal approach by 50%
Chronic pain diagnosis include fibromyalgia, neuropathic pain, arthropathies, abdominal
and back pain
Non-opioid modalities include PT/OT, chiropractic care, acupuncture, psychotherapy,
biofeedback, local therapeutic injections
• Reduce inappropriate opioid prescribing for our members by 50%
Members receiving opioids with a known past opioid overdose
Members receiving concomitant benzodiazepines and opioids
Members receiving opioids with existing diagnosis of opioid use disorder
Members receiving opioid prescriptions greater than one week duration for an acute
condition
• Increase percent of members with Opioid Use Disorder treated with
‘Medication Assisted Therapy’ by 50%
Members diagnosed with opioid use disorder receiving buprenorphine or naltrexone
Members diagnosed with opioid use disorder receiving cognitive behavioral therapy
©2018 Aetna Inc. 14 14Aetna’s Comprehensive Strategy to Combat the
Opioid Epidemic
©2018 Aetna Inc. 15 15Ongoing Initiatives
Aetna Better Health plans cover
non-opioid pain treatments (e.g.
Dental super-prescriber intervention 1
chiropractic care and acupuncture)
Behavioral Health and Care Management Prevent
clinicians perform substance abuse
screenings and interventions for new
members and support compliance with Prevent opioid
Aetna Better Health has enacted quantity MAT medications misuse and
limits and day supply limits on initial
abuse
prescriptions on opioids
Screening, Brief Intervention, and
Referral to Treatment (SBIRT) program
encouraged and reimbursed
©2018 Aetna Inc. 16 16Ongoing Initiatives
Lock-in committee consists of
medical and pharmacy directors as
Aetna Foundation providing Grants
totaling $6 million which will fund state
2
well as care managers and
and local projects addressing opioid-
behavioral health clinicians
related challenges; Kentucky was one
of three recipient states of donated Intervene
naloxone (Narcan)
Identify at-risk
Aetna Medicaid Neonatal Abstinence behavior and
Syndrome program supports women Narcan is covered without prior
authorization intervene
whose babies are at-risk for opioid
withdrawal
©2018 Aetna Inc. 17 17Ongoing Initiatives
Encourage the use of evidence-
based treatments such as Enhance ease of access to Narcan
3
medication-assisted treatment
(MAT) and remove barriers to access
Start Strong Re-Entry Program
Support concept of MAT medications as
“chronic medications” and addiction as a
brain disease Jonathan Copley, CEO of Aetna Better
Support
Health of Kentucky, is chairing a task
force of business and industry
representatives who are leading a new
Support
initiative, the Opioid Response access to
Program for Business. The Kentucky evidence-
Chamber Workforce Center is leading based
this work in partnership with the state treatments
cabinets for Health and Family Services
and Justice & Public Safety as well as the
biopharmaceutical company Alkermes
and Aetna Better Health of Kentucky.
Aetna Supports Volunteers of America Mid-States
Aetna’s contribution will support the new Freedom House program in
southeastern Kentucky.
©2018 Aetna Inc. 18 18Sustained Year-over-Year Reduction in Opioid
Medication Claims
Year
Region 2016 2017 2018 PY2019
Region 1 6,339 5,832 5,661 2,089
Region 2 17,364 17,008 15,819 6,403
Region 3 9,577 9,089 8,555 3,881
Region 4 25,006 24,427 22,323 8,558
Region 5 34,841 31,181 29,985 14,372
Region 6 12,882 11,650 10,183 4,533
Region 7 7,236 7,277 7,036 3,167
Region 8 24,854 22,164 26,002 11,621
Annual Total 138,099 128,628 125,564 54,624
©2018 Aetna Inc. 19 19Provider Partnerships
Foster Care
In addition to primary care and specialty medical providers, Aetna’s program integrates Department of
Juvenile Justice, Commission for Children, DCBS and other key agencies, including Kentucky Youth
Advocates, into the individualized care plans for each of these children.
Current Census 5,742, Adopted 502
Children’s Alliance
Aetna has developed a collaborative agreement with the Children’s Alliance to provide a value based
savings arrangement for this unique population of children and adolescents with behavioral health
needs.
KVC
Aetna is finalizing a contract for a 4-phase treatment design to use the wraparound model to avoid youth
entering a higher level of care and to successfully stabilize and reunify youth into their natural home as
timely as possible
KHA
Aetna Better Health of Kentucky recently partnered with the Kentucky Hospital Association by entering
into an agreement to delegate provider credentialing to KHA to reduce administrative burden for
providers.
Delegated Case Management Pilot
Aetna Better Health of KY is teaming up with community partners to enhance Case Management (CM)
for ABH-KY members. Initial launch will include 5 practices and will target approximately 500 members.
©2018 Aetna Inc. 20 20Member Centric Interventions Community
Foster Care: Aetna Duffle Bag Program
This program provides basic necessities for children as they come into the foster care system. In our first
Development offers
distribution, KY provided 500 bags targeted at kid’s ages 8 through teenage years. The Duffle Bags ongoing evidence-
include a water bottle, shampoo, conditioner, toothbrush, toothpaste, hairbrush or comb, body wash, based and internally
fleece blanket, and comfort and stress reduction items (journals, coloring books, colored pencils, stress developed education
balls and fidget spinners). Additional distributions are being planned. courses throughout the
Getting on T.R.A.C.K. community which
Transition Ready Assistance and Core Knowledge is a health literacy program designed specifically for improves the quality
young adults transitioning out of foster care. and promotes healthy
MicroClinics living for all members.
Interactive health program that teaches participants how to adopt practical health behaviors and
changes while receiving periodic health screenings to monitor their progress.
Metamorphosis
A collaborative with Kenton County Alliance is a 10 session series for students and parents to reinforce
repetitive messaging and foster an environment for building skills within familiar settings like school.
Promotes living a substance free life and follows the Monarch Butterfly’s growth and development.
Over 200 children participated.
Food Literacy Project Truck Farm
The Truck Farm is a mobile farm that is used to educate children about horticulture. Approximately
3,440 youth, family and care givers were served March – Nov 2018.
©2018 Aetna Inc. 21 21Emergency Department
Utilization
©2018 Aetna
©2018
Inc. Aetna Inc. 22 22Year Member Visits Visits per 1,000 members Total ED Spend
2015 235,083 776 $89,910,375
2016 209,931 762 $84,127,801
2017 178,868 714 $84,138,808
2018 148,973 645 76,184,741
Top 10 Diagnoses • Musculoskeletal Disorders • Skin Disorder
• ENT Disorders • Cardiac Disorder
• Digestive Disorders • Neurological Disorders
• Respiratory Disorders • Urological Disorders
• Overdose • Mental Health Disorder
Positive Trends • Utilization is decreasing quarter over quarter
• Engaging facilities with high member ED utilization for improved outcomes
• Engaging providers via VBS agreements: ED utilization is a common metric
• Increased enrollment in care management for high utilizers.
©2018 Aetna Inc. 23Per Member/Per Month
(PMPM)
©2018 Aetna
©2018
Inc. Aetna Inc. 24 24Medical Expense PMPM Trends
Placeholder
Expenditure drivers in the most recent 3 years:
• Hepatitis C costs have increased 50% from 2017 to 2019
• Buprenorphine costs have increased 15.7% from 2017 to 2019
• Vivitrol costs have increased 93.8% from 2017 to 2019
• BH utilization has increased 18.2% from 2018 to 2019
• 1.7% increase in acuity of expansion members throughout 2018
©2018 Aetna Inc. 25 25Access Metrics
©2018 Aetna
©2018
Inc. Aetna Inc. 26 26Aetna Network Adequacy ©2018 Aetna Inc. 27
Thank You
Thank You!
©2018 Aetna Inc. 28 28You can also read
