To increase the quality of care for its members, Hartford-based Aetna has launched an electronic version of its Care Considerations initiative, which delivers analytics-driven care alerts to healthcare providers. Alerts will be triggered during the health insurance eligibility-check transaction process and delivered electronically. Previously, Care Considerations were delivered via phone, fax or mail.
Under the new delivery model, Aetna (more than $1.7 billion in 2006 net income) believes it can provide the information in a more timely manner, without placing an additional burden on the physician offices, according to Paul Marchetti, the carrier's head of national networks and contracting services. "We wanted to link it into a standard physician office workflow so ... it wouldn't require any changes to be made on the provider side," he explains of linking the alerts to eligibility transactions, which typically are completed a day or so prior to a patient's visit. "We want to complement the information [providers] already have and help deliver a higher quality of care."
The Care Considerations alerts are a product of Aetna's data analytics tool, MedQuery. Developed by independent Aetna subsidiary ActiveHealth Management, MedQuery analyzes member data -- such as claims, lab and pharmacy history, demographics, and information contained within members' personal health records (PHRs) -- and compares it against evidence-based guidelines and standards of care. "When it runs [the data] against those evidence-based guidelines, it identifies the potential omissions in care," such as potential drug-to-drug interactions, Marchetti relates.
A Net of Information
The new electronic delivery method is available to providers using NaviNet, a Web-based healthcare administration solution from Cambridge, Mass.-based NaviMedix. According to Marchetti, 320,000 Aetna network providers -- about 39 percent of its network -- already use the NaviNet solution.
Eventually, Aetna also plans to leverage NaviNet to allow doctors to view pertinent information in an individual's PHR, Marchetti adds. That effort is set to begin this summer. Marchetti stresses that members will decide if they want to share their PHR information with their physicians.
Currently, Marchetti estimates, 4 million Aetna members have access to PHRs. For those who agree to share the information with their providers, the health benefits could be substantial, he contends.
"Providers are aware of the times they've seen [a patient], but they're not always aware or don't always have the information from when [the patient] goes outside of their circle -- when patients go see another specialist -- or medications they may have been on since the last time they came in," Marchetti says. "That personal health record becomes a useful tool in terms of comprehensively sharing all that information about all the interactions a patient has had ... outside his or her specific physician."