You never know what you’re going to get in an emergency room. They can be chaotic places, with crowded waiting rooms and long waits, gurneys jammed into hallways, doctors and nurses rushing from patient to patient, never having as much time as they’d like to spend with each one.
“Patients going to an emergency room may face a pretty unpleasant experience,” said John Moore, Aetna’s medical director for the U.S. Northeast Region.
Moore estimated that about half of emergency room visits are avoidable—and that, in many instances, there are better options: Places for members to get appropriate care, at lower prices, in more convenient settings.
Aetna wants to help its members get access to the care they need in the right place at the right time. And we’ve had notable successes toward this goal, thanks in part to our increasing use of value-based care, through joint ventures and other collaborations with health providers.
Aetna is the only health services company today with five joint ventures
Innovation Health in Northern Virginia
Allina Health | Aetna in Minneapolis
Banner | Aetna in Arizona
Sutter Health | Aetna in San Francisco/Sacramento
Texas Health Aetna in Dallas/Fort Worth
Aetna’s first joint venture was Innovation Health, a collaboration with Inova Health in Virginia. Over a recent two-year period, emergency room visits dropped 9 percent among members who used Innovation Health’s Signature Partners® Network providers.
In the Dallas-Fort Worth area, another joint venture—Texas Health | Aetna—released the “Texas Health Aetna ER Doc” app, which allows members to text or video chat with an emergency room doctor at any time. In other words, members get emergency room guidance without an emergency room visit—at no cost.
Multidisciplinary care teams are a key component of Aetna’s value-based care vision. These teams can include local nurse case managers, social workers, pharmacists, educators, certified medical assistants and medical directors, all working together. While these teams do not provide medical care, they help identify and address each member’s health care needs. They are typically designed for the members who are chronically ill and need the most care. The idea is to help these members better manage their whole health, which should reduce their need for hospitalization.
““Doctors are seeing the value of the value-based care model and are recommending the program to their patients,” said Brigitte Nettesheim, president of Joint Venture Markets. “We’re hearing powerful anecdotes about what a difference this approach is making in people’s lives.””
Donald Yerger’s story is one of those anecdotes. Yerger is an 82-year-old veteran with a history of poorly controlled diabetes, fluctuating high blood pressure, and untreated chronic obstructive pulmonary disease.
A registered nurse case manager—a member of Yerger’s multidisciplinary care team—reviewed his medical history and medications, and provided him with information to help him understand and manage his diabetes. The nurse case manager also discovered the cause of Yerger’s constantly changing blood pressure: He had been prescribed duplicate hypertension medications from both his civilian and Veterans Affairs primary care physicians. And he had been prescribed two inhalers, as well—but he wasn’t using either of them. That was causing his shortness of breath.
A new insurance company created and jointly owned by Aetna and a health system partner. Joint ventures align incentives so everyone is motivated by one objective: improving health outcomes.
The nurse case manager worked with Yerger to address his duplicate medications and connect with his civilian primary care physician. Yerger also worked with a diabetes educator to learn how to use a glucometer and keep a blood sugar log.
“I now have a good understanding of my medical problems and why I take the medications I do,” Yerger said.
Juan Ovalle is another success story. His health journey reflects Aetna’s commitment to developing new ways for members to access physicians and clinicians—ways like expanded telemedicine services, where members can use their phones, computers or tablets to have a remote consultation.
Ovalle, a 56-year-old member of the Banner | Aetna joint venture in Phoenix, had a history of unmonitored diabetes, high blood pressure and major depressive disorder. He participated in an AbleTo® program, which provides counseling sessions with therapists through phone calls or video chats.
Through that program, Ovalle could address his depression. In addition, he worked with a nurse case manager, who helped him find a primary care physician and diabetes educator.
“I am doing fabulous,” Ovalle said. “I feel like there is hope again.”