Aetna joint ventures reduced unnecessary hospitalizations by 7% in the first four months of 2018 as compared to CY17, according to Brigitte Nettesheim, president, North Central Region & Joint Ventures for Aetna. Nettesheim says the improvement in hospitalization rates is supported by coordinated care and direct contact with patients and their physicians.
“As an example, one of our Banner|Aetna members, an 82-year-old male veteran, had a history of poorly controlled diabetes, hypertension, fluctuating blood pressure, chronic shortness of breath, weakness and fatigue,” Nettesheim says. “His civilian and VA providers were not communicating with each other. He was identified by our multidisciplinary care team through multiple events that popped up in the data.” Banner|Aetna is a joint venture that taps the expertise of the provider and health plan.
A care manager visited the member, reviewed his history and medications, and provided coaching. They also coordinated his care with a pharmacist and his associated physicians and went along with him to visit his primary care physician.
The member’s health took a turn for the positive with the coordinated care he received.
“His diabetes medicine was decreased, which cured his low blood sugar, and the member is now keeping a strict blood pressure and sugar log,” Nettesheim says. “At the end of the day, the member felt he had a strong understanding of the problems and why he is taking the medications he takes. Having a coordinated effort like that, where it feels like the entire network of providers is working on your behalf, is what we’re trying to accomplish.”
Another success area is the nurse-on-call program that is staffed by Banner Health nurses, says Chuck Lehn, president of Banner Health Network.
“We’ve had a good volume of people who are willing to call the nurse instead of going to the ED,” he says. “That’s a good example of getting people to the right care setting. We help people understand that if we can do something ambulatory instead of inpatient, that lowers the cost of healthcare.”
See related article: Joint venture removes provider, patient and payer barriers