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Building a Healthier World

Aetna Story 2015
Together, we are driven to make a healthful difference
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Aetna Story 2015
2014 Medicare Advantage
Serving an estimated
46 million people
Government Business
of Aetna’s total
health premiums in 2014
Aetna Story 2015
Aetna is committed to building healthier lives. We
are building a simpler, more connected health care system
that allows consumers to get the right care at the right time,
with less hassle.
Aetna Story 2015
Charting a new course to help a young life
Babies are not supposed to suffer strokes. But that’s exactly what
happened to a baby girl in utero in 2012, leaving her parents
devastated. Her health care team needed to come up with a plan to
help her thrive.
For Heather Hodder-Hoth, a care advocate nurse team leader, the
case was unlike any other. The baby suffered bleeding in the brain in
utero, making an emergency cesarean necessary. The baby was nine
weeks early. Within a short time, physicians determined that the baby
was ignoring everything on her left side. Also, she could not be fed
normally because her sucking response was poor. She spent 53 days in
neonatal intensive care.
Her outpatient care included physical therapy, occupational therapy
and speech therapy. But her health plan covered only 60 days of
outpatient treatment. Her family cut back the amount of therapy she
was receiving weekly so her allotment would not run out as quickly.
Alarmingly, she began to regress.
There’s no protocol for a child having a stroke. Heather and other team
members quickly determined she needed more therapy to help her
brain rewire itself for normal, healthy activity. They then came up with
an extended treatment plan and submitted it to the plan sponsor. They
recommended that the customer enhance its Summary Plan
Document to include a new child-based protocol. The customer
agreed, and the little girl – now two years old – continues to show
great improvement.
“The parents sent me a video of her walking, and it’s just awesome,”
says Heather. “She’s greatly improved her ability to use her left side.
She can say five words now, and she’s also learned sign language.
You can see her in the video saying ‘hi’ and waving her hand. It was
just a beautiful moment, knowing that we helped her have a chance.
That’s my role, to be their advocate, to be their voice when they don’t
have one.”
Building healthier lives means giving even the smallest among us a
voice and a chance at a normal life.
Heather Hodder-Hoth, National Care
Management, Medical Management,
with daughter Ryan Grace Hodder
Aetna Story 2015
Collaboration solves a mystery, saves a life
A 44-year-old woman was nearly desperate for relief when she
came to the attention of Aetna’s Mercer Health Advantage (MHA)
program in 2014. In the previous five months, she had 10 inpatient
admissions for gastrointestinal issues at five different facilities. She
lost 100 pounds.
The patient had been diagnosed with gastroparesis, a condition in
which food moves very slowly or not at all from the stomach through
the intestines. It is often a complication of diabetes. Gina Gennantonio
Keaton, a Clinical Manager for Mercer Health Advantage and Mercer
Marketplace, works with a team of care managers, in particular helping
to guide the more complex cases. In this case, the team saw an
understandably frustrated patient who was doubtful that Aetna would
make a difference.
A care manager right away consulted with a medical director,
providers, a pharmacist, a registered dietitian, a social worker and
others to find more effective treatments. Gina also made sure the
member’s complex case was discussed at a monthly meeting of the
entire team, which includes the MHA medical director, to get fresh
insights and ideas. The result was a recommendation that the patient
see a different kind of specialist at an out-of-town facility.
Though initially hesitant, the member saw the new specialist. The
visit resulted in a new diagnosis of cyclic vomiting syndrome, which
changed the patient’s medication regimen. The care manager worked
to ensure benefits were extended to allow for the care that was
needed. She worked with various providers on a new course of
treatment. It saved the patient’s life.
“She slowly made progress and was able to return to work,” says Gina.
“She has not been hospitalized since, and she no longer needs a
suitcase full of medications. She now takes only a multi-vitamin and
has returned to a normal diet. As an advocate for the member, that’s
where I get my passion. When you see a person go from possibly the
worst stage of her life to near normal, then you know you’ve really
made a difference.”
Building healthier lives happens one person at a time. Together,
we make it happen every day.
Gina Gennantonio Keaton,
National Accounts Customer Care
Management Solutions
Aetna Story 2015
Aetna Story 2015
Aetna is building healthier communities. We invest in
programs that support community health and are making
being healthy simpler and more convenient than ever.
Aetna Story 2015
Helping new communities help each other
Dan Tedesco, a senior director and counsel for Aetna’s Procurement
department, knows just how vital it is to have healthy communities. In
raising a 10-year-old son with autism, he saw that many patients and
family members would benefit from greater community support. He
also knew he was uniquely positioned to do something about it.
Dan had an idea that Aetna’s huge pool of member data could be used
to match individuals with similar clinical issues and preferences. He
took his idea of bringing together families living with autism to the
Aetna Idea Incubation Challenge, a brainstorming contest. It was
selected for development by Aetna Innovation Labs. The CarePal
pilot program was launched in October 2014, initially for the breast
cancer community.
CarePal today reviews data to bring together newly diagnosed breast
cancer patients with survivors of the disease. By telephone and email,
breast cancer survivors help ease the strain on new patients by helping
them sort through a variety of issues, such as health questions and
family matters. An expanded CarePal pilot is expected to help families
living with autism in the future.
“Aetna members have a lot of personal knowledge and insight to
share,” says Dan. “Members who are facing the same challenge for
the first time can be guided and encouraged by a credible, truly
empathetic mentor.”
Together, Dan and Aetna helped a community come together where
none existed before.
Dan Tedesco, Procurement
Aetna Story 2015
Collaboration solves a mystery, saves a life
The communities most often underserved by health care resources
because of race and ethnicity also own and use mobile phones at
higher rates compared with white Americans. The Aetna Foundation
knew this represents an important chance to make a difference.
In 2014, the Aetna Foundation launched the Healthier World
Innovation Challenge. It’s part of a $5.7 million commitment through
2016 to bring digital health innovation to vulnerable communities. The
Challenge makes up to $4.5 million available to six winners that
demonstrate their solutions can reduce health disparities and improve
health outcomes. These digital health solutions, in short, will need to
reach targeted audiences where they spend their time. They must
easily fit into their daily lives as well.
“This is an opportunity for better health management because we
don’t just have our eye on the patient but on the community they
come from,” says Aetna Foundation President Garth Graham.
“You need to be innovative. The traditional health care setting is very
limited in what it can do in these communities. We look at the context
of where people live. Then we look at what needs to be done so that
people don’t tip over the edge to poor health. We are meeting people
where they are to help them better manage their health, not just their
disease. It’s powerful.”
We believe we can improve community health in ways unforeseen just
a few years ago.
Garth Graham, Aetna Foundation
Aetna Story 2015
Giving babies better beginnings
Aetna employees demonstrate an amazing spirit of giving,
volunteering more than 420,000 hours of service in 2014. One
cause inspiring such passion and commitment is the prevention of
premature births and birth defects.
In fact, a community has come together in recent years within Aetna
to help support the March of Dimes. It started with just a handful of
employees working on a single project in Hartford. The group has
grown to include employees in many Aetna locations across the
country. Employees have raised about $750,000 for the March of
Dimes in the past 12 years.
Debbie Della Valle, a business process manager for Human Resources,
has been a key part of the team in Hartford. Teams in locations such as
Hartford; Phoenix; Houston; Harrisburg, PA; and Blue Bell, PA; organize
and launch activities meant to engage employees in the fight against
birth defects.
Debbie Della Valle, Human Resources
Aetna’s Community Relations and Urban Marketing organization
helps to pay for projects ranging from walks and dinners to providing
youngsters with laptops and children’s games. But most of the work is
carried out by the volunteers. Debbie was named the March of Dimes
2014 Connecticut Volunteer of the Year. Christi Lundeen, chief
innovation officer for Aetna’s Mercy Care Plan, was named 2014
Volunteer of the Year by the March of Dimes Arizona chapter.
“We are glad for the opportunity to give back because this work is
important to the communities we serve,” says Debbie. “It’s not just
about raising money but also making people aware. It’s about
helping to give babies a better chance at a healthier life. That’s why
we help fund important research and programs that help moms have
healthy babies.”
There may be no better way of building a healthier world than by
helping babies everywhere be healthier.
Christi Lundeen, Medicaid
Regional Operations
Aetna Story 2015
Aetna Story 2015
Aetna is committed to building a healthier nation. We
use evidence-based analytics to help patients get the right
care at the right time. We are focused on improving health.
Aetna Story 2015
Reaching Medicare members before they fall
through the cracks
You would not expect a 100-year-old man with multiple health
conditions to suddenly stop seeing his doctors. But that’s what Patricia
Smith, a Physician Outreach nurse case manager, found while visiting
a doctor’s office one day in 2014.
Patricia’s job takes her to many doctors’ offices to discuss how Aetna’s
Medicare Advantage members are doing. She helps decide whether
extra or specialized help is needed for some patients. In this case, the
doctor’s office staff confirmed the patient Patricia found was no
longer being seen much. Patricia referred the case to Aetna’s case
management nurses for follow-up.
What they found was a 100-year-old man who was devoted to the
care of his 92-year-old wife in poor health. With no children for
support, the couple only had each other. The husband began avoiding
doctors and other support because he was afraid someone would find
they were no longer well enough to remain in their home.
Understanding their needs, Aetna set up home care visits. A social
worker helped set up assistance with the basics, such as meals and
“He had stopped talking to case managers to protect his wife and keep
her near him,” says Patricia. “It’s heartbreaking. They were both sick
and struggling, with little or no money. But our case managers were
able to gain his trust, and we were able to get them the care and help
they needed. I’m happy we made a difference for them and kept them
from falling through the cracks.”
An important part of building a healthier nation is making sure older
adults are given the chance to maintain good health on their terms.
Patricia Smith, National Care Management
Aetna Story 2015
MedQuery scans for medical issues 24/7
For years Liz Thomas had taken medication to successfully control her
seizures. Suddenly, the seizures came back as often as five a day. “I
couldn’t figure out what was going on,” says Liz, a grandmother of
two. She became frustrated and depressed. She was no longer able to
enjoy the things she loved, like playing tennis and spending time with
her grandkids.
Then one day a letter arrived from ActiveHealth Management’s
MedQuery program. Called a Care ConsiderationSM, the letter is
powered by our CareEngine® technology. Linda Mako, a nurse with
Aetna National Care Management, says the MedQuery program
compared Liz’s health information against current care guidelines. It
generated an alert when it identified a possible issue with an antibiotic
recently prescribed for an infection. Liz discovered the new drug could
make her more likely to have seizures.
“When we saw that, we went straight back to the neurologist,” says Liz.
“Now I have an answer. For your system to cross-check between a
medication I was taking and my condition — we were just so
impressed and so grateful. And it was all on Aetna’s initiative.” These
days Liz is back to kayaking and playing tennis with her grandkids.
“We can have this kind of impact because our MedQuery patient
safety program constantly analyzes member health information,”
says Linda. “The program finds opportunities, in collaboration with
the physician, to improve health. It also sends messages directly to
members about changes in lifestyle that can lead to better health.
By identifying and communicating opportunities for improved care,
Aetna helps prevent adverse events from happening.”
MedQuery is just one of many tools Aetna uses in building a
healthier nation.
Linda Mako, National Care Management
Aetna Story 2015
Linking consumers to vital health information
anytime, anywhere
It’s not unusual for a friendly game of basketball to result in a sprained
ankle or a sore knee. But no one expects to risk life or limb in pursuit of
a little exercise.
That’s exactly what happened to the husband of Rose Rich, a clinical
program consultant for Aetna National Accounts. Her husband, Jim,
was playing basketball in an amateur league last year when he was hit
in the thigh. By the time he got home, the pain in his leg increased. A
short time later, he couldn’t walk.
Rose knew something was wrong. She used the iTriage® app on her
smartphone to look up his symptoms. One of the potential causes
listed was compartment syndrome, a condition in which the pain
suffered is out of proportion to the injury. The condition occurs when
bleeding inside a muscle compartment causes swelling and a buildup
of pressure. Surgery is often required to prevent loss of the limb.
It sounded right. Rose looked up the location of nearby emergency
rooms on iTriage, and off they went. Jim did have compartment
syndrome and underwent surgery the next morning. The surgery went
well. Jim today is more active than ever.
iTriage is a leading health care application that’s free to consumers on
the web, iPhone®, iPad® and Android™ devices. It enables people to
check symptoms, learn about conditions, find and connect with
doctors and facilities nationwide, and manage their own information
– all in one place. It’s become Rosemary’s go-to health information
resource, one that she’s convinced helped save her husband’s leg.
“I use iTriage a lot,” says Rose. “iTriage convinced me we needed to get
to the ER right away. This could have been a game-changer for Jim.
Where he’d be without the surgery, I don’t even like to think about it.
I’m amazed at where he is now. He’s recovered 100 percent. iTriage
really has made our world healthier.”
Sometimes building a healthier nation means having a trusted health
information resource available no matter where you are.
Rose Rich, National Accounts,
with husband Jim Rich
Aetna Story 2015
Aetna Story 2015
Aetna is committed to building a healthier world.
We invest in programs that support healthy populations.
We are focused on the quality, safety and value of health
care across borders.
Aetna Story 2015
Helping populations across the globe
be healthier
While diabetes is a worldwide health crisis, the problem is acute in the
Middle East. In fact, a recent Rand Health Advisory Services study,
commissioned by Aetna, notes that Saudi Arabia, Kuwait, Qatar,
Bahrain and the United Arab Emirates take the top five spots for
highest prevalence of diabetes in the world*.
Countries with established health systems are raising public
awareness about preventing diabetes. They also are finding that they
are in a unique position to develop better systems of care. Aetna is
there to help.
Aetna is now helping countries around the globe build programs that
focus on improving the health of populations. Dr. Sneh Khemka, vice
president of Population Health at Aetna International, oversees
Aetna’s efforts to turn America’s long history of population health
management into a customized approach that can help other nations.
Our services range from wellness programs for corporations to direct
intervention with patients through disease management.
“We are advancing our population health management activities to
other nations as part of Aetna’s drive to make the world a healthier
place,” says Dr. Khemka. “This effort is crucial to both the needs of
developing economies and Aetna’s global relevance.”
The Middle East has a long and storied history of leadership in the
medical world, going back hundreds of years. Today, with Aetna’s help,
these same countries have a chance to lead a global movement to true
population health management.
* Rankings exclude the Pacific and Caribbean islands
Dr. Sneh Khemka, Aetna International
Aetna Story 2015
Extending a lifeline far from home
When you’re far from home, it’s nice to know you have a team on your
side. Aetna’s International Health Advisory Team (IHAT) is there for
members around the clock. This team of experienced doctors and
nurses can be your best travel companion.
A 19-year-old woman was living and working in Phnom Penh,
Cambodia, when she was in a serious car accident. With several
fractures and possible internal injuries, she was quickly evaluated
for evacuation.
Aetna’s evacuation partner consulted with the treating doctor.
Together, they decided that the woman needed immediate evacuation
to Bangkok with a full medical team. Aetna quickly provided a
guarantee of payment for her medical care there. Jennifer Pan,
our IHAT case manager in Shanghai, got after-hours landing permits
in Bangkok.
“I was in constant contact with her parents in Canada, her employer
and the medical team,” says Jennifer. “When her parents decided to
fly to Bangkok, I was able to find them an affordable hotel near the
hospital so they could support their daughter’s recovery.”
Once the young woman was out of danger, Aetna flew her back to
Cambodia to recover. Aetna sent her father along, as well. The parents
were grateful for the help. “Thank you very much for the superior level
of assistance that you have provided our daughter,” they said. “You
and the rest of the team have been so helpful every step of the way.”
Building a healthier world goes on around the clock.
Jennifer Pan, Aetna International
Medical Management
Aetna Story 2015
Providing support without borders
For a parent, perhaps the scariest news you can hear is that your child
is seriously ill. It’s even worse when there’s no specialist nearby to
provide treatment. Luckily, the parents of an 18-month-old toddler
had Aetna’s International Health Advisory Team (IHAT) to help.
While living with his parents, who were on assignment in Kuwait, the
young boy developed a limp. The local doctor diagnosed a suspicious
tumor. With no pediatric oncologists available, his parents were
advised to seek treatment in the United Kingdom (U.K.). However,
the cost of treatment in the U.K. was above the reasonable and
customary cost for the region. Without timely intervention, the family
would have had to bear the cost difference. That’s when IHAT
physician Sanober Sheikh stepped in.
“We knew we had to act quickly to both coordinate this young
boy’s care and guarantee payment,” says Dr. Sheikh. “We got the head
of International Care Management to sign off on the additional
costs and coordinated a further diagnosis. That was critical for a
successful outcome.”
The IHAT team provided emotional support, as well. Team members
reached out to the family during treatment in the U.K. and after they
returned to Kuwait. Recently, the family told Dr. Sheikh that their son
is finishing up his chemotherapy and is an active toddler.
The parents appreciated how Dr. Sheikh and the IHAT team are
working to build a healthier world. “We raise our hats for your prompt
action and coordination,” they wrote.
Dr. Sanober Sheikh, Aetna International
Medical Management
Aetna Story 2015
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