Addressing Social Isolation Among Seniors

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With studies showing social isolation can be as damaging to your health as smoking a pack of cigarettes a day, loneliness can be just as dangerous as high blood pressure and high cholesterol.

That's why addressing social isolation is a major focus for Aetna’s Medicare business and care managers, who are taking a more holistic view of senior health to help get them on a path to better health.

With studies showing social isolation can be as damaging to your health as smoking a pack of cigarettes a day, loneliness can be just as dangerous as high blood pressure and high cholesterol.
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“The most common challenge with our senior patients, honestly, is that so many of them have no one,” says Aetna Field Case Manager Sarah Fischer, RN. “So many of them don’t have families. One lady said to me, ‘I’m the only one left.’"

Watch the video to see how case managers are introducing seniors to benefits such as the SilverSneakers fitness program, community volunteering and other opportunities for social connection.

“We get them involved, get the area office on aging involved. There are senior newspapers, things like that,” says Sarah. “We just bring these benefits to the member and say, ‘Let’s get you involved in something.’”

For more information about CVS Health’s efforts to improve care across the nation, visit our News & Insights page and the CVS Health Impact Dashboard. To stay informed about the latest updates and innovations from CVS Health, register for content alerts and our Leaders in Care newsletter.

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We Can All Help Prevent Suicide

We Can All Help Prevent Suicide
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Suicide is a serious public health problem that impacts people, families and communities, including the workplace. While suicide rates have increased in nearly every state between 1999 and 2016, it is a cause of death that is also preventable.  

At CVS Health, we understand that a commitment to holistic health includes supporting mental and emotional health and working to prevent suicide. That’s why Aetna works in partnership with the American Foundation for Suicide Prevention (AFSP) to advocate for suicide prevention through engagement, awareness and education.  In observance of National Suicide Prevention Month, we’re highlighting some of Aetna’s initiatives to reduce suicide. 

To start, Aetna Behavioral Health is endorsing updated screening tools which are easy to administer and more effective at reaching all populations. 

“We believe there should be universal screening for everyone, not just high-risk individuals,” said Aimee Prange, senior strategic planner for Aetna Behavioral Health. “There are lots of individuals who may not demonstrate signs but are still thinking about suicide. If we ask questions, we can begin to create a safety net.” 

Aetna is also integrating patient safety planning and proactive outreach to members days after a suicide attempt with messages of hope. 

“We want to make sure members have a reason, and an avenue, to reach out to us to receive care management and other help,” said Prange. 

We are also working to engage caregivers, family members and friends to help impact suicide prevention. Support systems can help members develop important life skills and encourage them to get treatment and stick with it. In addition, they can provide safety and support to avert a time of crisis.

If you or someone you know is in crisis, please call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255) or contact the Crisis Text Line by texting TALK to 741741.

For more information about CVS Health’s efforts to improve care across the nation, visit our News & Insights page and the CVS Health Impact Dashboard. To stay informed about the latest updates and innovations from CVS Health, register for content alerts and our Leaders in Care newsletter.

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Navigating a Behavioral Health Issue (Hint: Avoid the Internet)

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Unlike the flu – which a physician can typically diagnose and prescribe any necessary treatment for in a single office visit – navigating a behavioral health issue such as depression or substance use disorder is less clear.

“Understanding behavioral health conditions, and knowing where and when to seek help, can be a completely new experience for a member,” said Antonio Rocchino, Senior Director, Network Management, Aetna Behavioral Health. “We understand the instinct to try to find a facility on Google or seek help from a doctor featured on the news, but they may not provide the quality or expertise required in the particular situation.”

According to researchAetna Behavioral Health surveyed 273 members of the Building a Healthy Tomorrow and Aetna Medicare Communities from September 14 – 24, 2018. conducted by Aetna Behavioral Health, nearly 50 percent of consumers relied on the internet to identify inpatient behavioral health services. For those seeking an outpatient behavioral health provider, consumers asked their doctor for a referral (29 percent), called their insurance company (26 percent) or utilized a personal recommendation (17 percent).

“When seeking to access behavioral health care, attempting to reconcile a variety of recommendations, and the associated costs, should not be another source of stress,” said Rocchino.

Aetna is ready to help members identify appropriate care in their communities.

Aetna Behavioral Health can help members and their loved ones identify resources that best fits the situation, including facilities that are part of its Institute of Quality® network. These facilities, available in certain states, meet strict criteria and specialize in treating substance use disorder. Aetna Behavioral Health is also collaborating with certain facilities to go a step further and provide a personalized experience for the member, as well as their family and caregivers. Services could include certified peer support specialists and resources to improve social determinants of health, such as financial and legal issues.

Finally, and equally important, going in network may mean less money out of members’ pockets, and more services covered within agreed upon rates with providers.

Ready to learn more about behavioral health and accessing care? Aetna Behavioral Health has produced a series of new Let’s Talk Videos to help members better understand the variety of specialized resources within the Behavioral Health network, and the high-quality and value of the providers. Learn more about quality and costs by viewing the first two videos now. Videos on facing a mental health crisis, specialty resources and questions to ask will be available soon.

Watch Now

Coming Soon

  • Let’s Talk: The Value of a Network During a Mental Health Crisis
  • Let’s Talk: Specialty Resources Available In-Network
  • Let’s Talk: Questions to Consider When Choosing a Program or Facility

Aetna members can use DocFind to ensure they are always using an in-network provider. Members can simply log into their account on Aetna.com and select the type of provider they need and their location. The system will return providers in their area that are accepting new patients.

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Teaming Up to Provide Vision Care to Chicago Students

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Aetna and OneSight partnered with CPS to offer free eye exams and eyeglasses to hundreds of Chicago students.

Nearly 90 percent of Chicago Public Schools (CPS) students screened on the first day of a vision clinic provided by Aetna and OneSight – the leading global vision care nonprofit organization – were identified as needing vision correction.

As part of our efforts to engage people with the care they need, when they need it, Aetna and OneSight partnered with CPS to offer free eye exams and eyeglasses to hundreds of CPS students, who would otherwise have limited or no access to vision care.

Glasses were manufactured onsite, allowing students from Youth Connection Charter School – Truman Middle College and the Truman College Child Development Lab School to receive their pair the next day. Roughly, 12,000 adult students from the largest English as a Second Language and GED programs in Illinois were also eligible to use the clinic.

“We have a district of over 361,000 students, many with vision related needs and our school-based/school-linked vision exam program helps us eliminate poor vision as a barrier to learning,” said D. Kenneth L. Fox, Chicago Public Schools chief health officer.

Clear sight helps students comprehend and learn up to twice as much, increasing productivity by 35 percent and reducing dropout rates by 44 percent, according to a study by OneSight and Deloitte. Aetna’s partnership with OneSight will serve this vulnerable student population and help raise community awareness about the importance of vision care.

“At least 60 percent of our overall health comes from our social and physical environment, or social determinants of health, which play an important role in how young people grow and thrive,” said Jerome Dioguardi, vice president, Aetna dental and vision. “We are happy to support an effort that contributes to vision wellness.”

More than 55,000 CPS students have minimal to no access to optometry and ophthalmology services. Vision changes can occur without a child or parent noticing them, and students should have their eyes examined annually, or more frequently if recommended by an eye doctor.

“Our fight for clear sight is essentially a fight for human potential,” said Janet Duke, clinic manager at OneSight. “We have hosted over 900 charitable clinics and are happy to bring this experience to Chicago Public School students.”

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Jersey Cares Launches Fitness Initiative in Newark

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More than 30 Aetna and CVS employees volunteered alongside Sussex Avenue students.
More than 30 Aetna and CVS employees volunteered alongside Sussex Avenue students.
The Health in the Community Initiative will directly impact students across three Essex County elementary schools.
The Health in the Community Initiative will directly impact students across three Essex County elementary schools.
More than 30 Aetna and CVS employees volunteered alongside Sussex Avenue students.
More than 30 Aetna and CVS employees volunteered alongside Sussex Avenue students.
More than 30 Aetna and CVS employees volunteered alongside Sussex Avenue students.
More than 30 Aetna and CVS employees volunteered alongside Sussex Avenue students.

Aetna Foundation grant funds healthy initiative for students

With a $250,000 grant from the Aetna Foundation, Jersey Cares, a nonprofit organization committed to creating impactful projects that address critical community-identified needs, launched the Health in the Community Initiative at Sussex Avenue Renew School in Newark, New Jersey. This innovative experiential learning program encourages a culture of health in schools by providing nutrition and fitness education for kindergarten through fifth-grade students.

The Health in the Community Initiative will directly impact students across three Essex County elementary schools with extended benefits to families and peers. Key aspects of the program include the building of greenhouses and gardens at each school, providing onsite gardening programs to instruct the students on the importance of healthy eating, as well as creating enhanced outdoor spaces to encourage active play as classroom and activity-based fitness workshops are provided.

“Health in the Community is a ground-up program that will be evolved through the participation of parents, guardians, teachers, and school leaders, built with the incredibly generous support of the Aetna Foundation and powered by the intention to give children a real, sustainable likelihood of a healthy and brighter future,” said Brian Dean, President and CEO of Jersey Cares. “This initiative is a compelling opportunity to demonstrate what all of us can accomplish by working together as individuals and as organizations.”

The Aetna Foundation, a philanthropic arm of CVS Health, presented the check to Jersey Cares and kicked off the initiative by having more than 30 Aetna and CVS employees volunteer alongside Sussex Avenue students in activities that included raised garden bed assembly, a fit and fun exercise workshop, and school library organization.

For 25 years Jersey Cares has worked to address social determinants that affect the health outcomes of students in Newark Public Elementary schools, helping hundreds of nonprofits recruit and develop volunteers. They expanded their program offering in 2006 to engage nearly 2,000 volunteers and gave slightly over 4,000 hours of service to programs that engaged more than 26,000 volunteers to produce over 89,000 hours of service last year.

“At CVS Health, we know that the path to good health starts locally in our schools and homes. Today we are excited to have the opportunity to work collaboratively with the team at Jersey Cares on this important initiative with the Newark school system,” said Dr. Garth Graham, President of the Aetna Foundation. “The Health in the Community Initiative is an innovative project that will give students and their families’ access to the tools they need to make good decisions when it comes to nutrition and fitness, critical components to establishing long-lasting health and wellness.”

The Aetna Foundation grant to Jersey Cares builds upon the tradition of community investment by CVS Health and Aetna and advances our purpose of helping people on their path to better health. Learn more about the Health in the Community project, here: https://www.jerseycares.org/.

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Aetna 360 Behavioral Health Supports Members, Caregivers Through Health Care Journey

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Prioritizing members’ overall needs – including the time and resources needed to get and stay healthy – Aetna has launched Aetna 360™ Behavioral Health. Through this approach, which launched May 1, 2019, Aetna partners with behavioral health and substance use disorder treatment facilities to coordinate care for members, collaborate on holistic discharge planning and provide support for members and their families during treatment and upon discharge.

“Our focus is on how we can help, rather than limiting members to a number of days or conducting traditional reviews,” said MaryEllen Schuman, Director, Clinical Health Services, Aetna Behavioral Health. “This new approach incorporates both a member’s physical and behavioral health, along with any social determinants of health, to ensure we develop a comprehensive, long-term plan that helps them attain and maintain their optimal health.”

Aetna 360 Behavioral Health combines and builds on a pair of recent programs, Member Care Coordination (MCC) and Utilization Management Transformation (UMT). Both programs, which began in late 2017, led to lower readmission rates, higher ambulatory follow-up rates for mental health visits and high engagement and satisfaction rates among members, caregivers and providers.

Under Aetna 360 Behavioral Health, partnering facilities, as well as members and their caregivers, have a single point of contact with Aetna Behavioral Health. The assigned 360 Care Advocate collaborates with the facility to understand the member, family and caregiver’s needs, and then directly with members and caregivers when needed, both during and after discharge. The 360 Care Advocate is supported by a team at Aetna which includes medical, pharmacy, Resources for Living® and others.

“The 360 Care Advocates work behind the scenes to collaborate with providers to ensure members have the resources they need, and then directly with members, family and caregivers to ensure they have access to everything from a primary care provider and transportation to an appointment, to a support group or daycare if they are a caregiver,” said Lynn Watson, Manager, Clinical Health Services, Aetna Behavioral Health. “They also link members to peer support services, several digital resources and community support services to enhance their care and service.”

The 360 Care Advocates collaborate with members’ medical and behavioral health outpatient providers as needed and provide specific resources to caregivers to ensure they can help members navigate the health care system.

At launch, 304 facilities are partnering with Aetna to implement Aetna 360 Behavioral Health. These partnerships extend the successful work that began under the previous pilots.

“We deal with a sick population, but Aetna has been right there with us,” explained Peter Schorr, President and CEO, Retreat Behavioral Health, which operates several substance use disorder and mental health treatment centers, about MCC. “Aetna ensures patients are provided with the stays that they need. It feels good to be trusted and not fight over reviews.”

Facility staff have also benefited from Aetna’s behavioral health initiatives.

“Both our patients and staff view Aetna as an ally that is helping us to tear down barriers to treatment and recovery,” notes Jay Crosson, CEO, Cumberland Heights Foundation, an alcohol and drug treatment center in Tennessee. “The Member Care Coordination program was a real positive mindset change for everyone.”

Aetna will continue to expand the number of partnering facilities implementing Aetna 360 Behavioral Health. Aetna 360 Behavioral Health is currently for Aetna Commercial members of all ages and Aetna Federal Employee Plans.

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Certified Peer Support Specialists: Transforming Traditional Recovery for Members

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Following treatment for a behavioral health condition, ranging from inpatient levels to outpatient care, members often need encouragement in their recovery or assistance adjusting to a “new normal.” Having someone by their side who has lived that journey themselves – and can help promote a positive recovery – can help members understand the process, what to expect, and how to avoid and manage setbacks.

Traditionally found in Medicaid, Aetna is one of the first commercial insurers to cover peer support for members, an evidence-based behavioral health service that assists people with achieving long-term recovery from a psychiatric disorder or addiction. Over 70 percent of Aetna members that have been referred to peer support as part of Aetna Behavioral Health’s ongoing transformation initiatives have engaged with a specialist.

“Certified peer support specialists have first-hand knowledge of our members’ experience,” said Karen McBride, director, Network Management, Aetna Behavioral Health. “Their shared experience allows them to engage and connect with members, as well as their caregivers, to serve as an integral component of the treatment team.”

Aetna has also partnered with MAP Care Solutions (a provider of peer support services) to provide telephonic and video peer support to members for up to 12 months after they are discharged from treatment.

“Virtual peer support has enabled access for more members in addition to in-person specialists. Peer support has transformed the traditional process of recovery for members by ensuring treatment doesn’t stop the moment members transition to a new level of care,” said Malaika Vasiliadis, LMHC, implementation director, Behavioral Health Transformation, Aetna Behavioral Health.

Peer support can include talking to members, and to their family with a member’s permission, about the recovery process, sharing their knowledge to prevent a relapse and teaching practical recovery skills. In addition, peer support specialists can connect and accompany members to community resources to support their treatment, such as support groups, or even an auto mechanic, if the situation calls for it.

Recently, an Aetna member arrived home after being discharged from treatment to find his car wouldn’t start. Ryan Schweiger, the member’s peer support specialist, was fortunately by his side and able to support him through any negative recovery outcomes due to additional stress. Ryan had accompanied the member home and partnered with him to jump the battery and get the car to a mechanic for repairs.

“Small inconveniences like a dead car battery can be a huge stressor for someone who is in recovery for substance use disorder,” said Ryan, peer support team leader, Penn Foundation, a mental health and substance abuse treatment center in Pennsylvania. “They are vulnerable, and a situation like this can serve as a trigger.”

Aetna has empowered Ryan to do whatever is necessary to support recovery, and he is always ready to step in and help members. Beyond his impromptu trips to the mechanic, his work has ranged from jumping on the phone with members to remind them they are doing great, to attending recovery conferences together, to helping them find housing when needed and even organizing a trip to the barber to help them feel better about their appearance and connect them back to the community.

“As someone who has been through this, I know how difficult this can be.”

He notes though that each member journey is unique.

“Everyone has their own pathway; I don’t have the answers for my peers in recovery,” explains Ryan. “What worked for me won’t necessarily work for someone else. But I take my experience and help show them different pathways to recovery and provide explanations. Our job is to not judge, it is to support the person’s journey.”

As of April 1, 2019, there is no cost shareFully insured plans are waived. Self-insured plan sponsors have the option to exclude, and high-deductible health plan members must pay the deductible before cost share is waived. for Aetna members who utilize peer support. Aetna is continuing to expand its network of behavioral health and addiction facilities that provide certified peer support services to improve the length and quality of members’ recovery.

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Accountable care organizations: Transforming care delivery to support members, increase cost savings

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For over a decade, Aetna has been focusing on transforming the health care delivery system. Members are at the center of Aetna’s accountable care organizations, with the goal of improving health by providing access to high-quality, effective, patient-centric care.

Accountable care organizations are integrated networks of hospitals, doctor offices and other health care facilities that get paid by an insurer based on the quality and effectiveness of care their patients receive. Aetna has over 500 accountable care organization arrangements across its Commercial and Medicare lines of business.

Aetna’s accountable care organizations have seen broad successes. At 4 in every 5 accountable care organizations, members were more successful in managing chronic diseases, such as diabetes and heart disease, than members who did not participate in a similar care model.12 months through June 2016 versus 12 months through June 2015. Market comparison includes all attributed non-value-based contract members. Results exclude individual, student health and coordination of benefits. Results differ due to differences in time periods and adjustments.

Members of Aetna accountable care organizations also saw an average savings of $29.25 per month from June 2015 to June 2016.Compared to broad Aetna network plans. Actual results may vary; savings may be less when compared to other value-based or narrow network plans. And an October 2017 study of Aetna accountable care organizations found there were lower costs for emergency room, inpatient and physician visits in 2016.Inaugural ACO Product Evaluation Study results, October 2017, for members with 2016 effective dates. Six-month baseline period prior to ACO effective date and six-month study period after ACO effective date.

“Accountable care organizations combine the best of both worlds by bringing together the capabilities of a health insurer focused on wellness with all that health systems, doctors, and other care givers across the community do to deliver high quality care,” said Paul McBride, CEO of Accountable Care Solutions at Aetna. “These collaborations are helping to drive improvement in outcomes, affordability and access for our members.  We aren’t only focused on the care members receive when they have chronic or acute health care needs. We also are committed to providing a better member experience and helping members achieve their health and wellness goals.”

Accountable care organizations take a proactive approach to health care. Rather than waiting until members visit a doctor’s office, care teams use technology and digital tools to connect with them in between appointments. The arrangements allow clinicians to have more information about a patient when they visit, including if they’re regularly filling prescriptions or the results of recent tests.

Increased engagement with the patient also can result in the need for fewer in-person appointments, McBride said.

In Arizona, Aetna and Banner Health had a five-year accountable care organization arrangement called “Aetna Whole Health℠ – Banner Health Network.” The relationship has led to:

  • A 24 percent decrease in avoidable surgery admissions;
  • A 4 percent increase in generic prescribing; and
  • An 11.5 percent overall reduction in medical costs.

The success of Aetna Whole Health℠ – Banner Health Network led to the development of Banner|Aetna, a joint venture aimed at bettering the member experience and improving health outcomes and engagement with providers while reducing the cost of health care in Arizona.

In 2016, Aetna launched Aetna Premier Care Network Plus, a plan focused on simplifying health care access and services for members by putting many high-performing accountable care organizations together in a common network. Members can then easily find in-network providers that provide high-quality care in 47 of the largest communities coast to coast.

Aetna Premier Care Network Plus is built on providing both simplicity and quality. Specialists and hospitals in the network use data-driven decision making and shared clinical pathways to improve quality and efficiency. On average, this results in shorter hospital visits and fewer hospital readmissions.

Aetna Premier Care Network Plus is configured to produce the greatest medical cost savings through designated providers, who are chosen based on measures of quality and efficiency that lead to improved outcomes.

 

An infographic describing the results of Aetna's five-year accountable care organization with Banner Health in Phoenix, Arizona.

Care Teams Support Members

Helping people achieve their health goals means supporting them outside of the doctor’s office. Whether it’s connecting members to specialists or community services or answering questions about medications, accountable care organization care teams can help better coordinate care.

For example, Aetna’s Delaware Valley accountable care organization sent a social work care coordinator and nurse care coordinator to conduct a home visit with a 75-year-old patient. The member’s doctor was concerned her medical condition and living situation put her at an increased risk for a fall. The member’s care goals included living at home and maintaining independence.

The member had a chronic, neurological disease impairing her motor skills and muscle control. She fell several times when trying to stand up from a chair and while retrieving items in another room. The care coordinators also discovered the member was unable to carry meals from her kitchen to the living room while using a walker.

The care coordinators:

  • Connected the member to a local volunteer program that delivers weekly meals.
  • Set the member up with a medical alert system that would call for help in the event of a fall.
  • Found a charitable organization to pay for a chair lift to help her safely stand from sitting in her chair.
  • Set the member up to receive physical and occupational therapy in her home.

The care coordinators followed the member’s progress for six months. With the additional assistance and resources, she avoided falls and emergency room visits, while still living on her own.  This is the type of member experience Aetna strives to make the norm. Accountable care organization relationships support that outcome.

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The five signs of suffering: Know the symptoms and ask for help

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The suicides of Kate Spade and Anthony Bourdain are poignant reminders that friends, neighbors, coworkers, and even family members may be suffering emotionally and don’t recognize the symptoms or won’t ask for help.

Check out these five signs that may mean that someone close to you is in emotional pain and may need help:

  • Their personality changes. You may notice sudden or gradual changes in the way that someone typically behaves. He or she may behave in ways that don’t seem to fit the person’s values, or the person may just seem different.

  • They seem uncharacteristically angry, anxious, agitated, or moody. You may notice the person has more frequent problems controlling his or her temper and seems irritable or unable to calm down. People in more extreme situations like this may be unable to sleep or may explode in anger at minor problems.

  • They withdraw or isolate themselves from other people. Someone who used to be socially engaged may pull away from family and friends and stop taking part in activities they used to enjoy. In more severe cases the person may start failing to make it to work or school.

  • They stop taking care of themselves and may engage in risky behavior. You may notice a change in the person’s level of personal care or an act of poor judgment on his or her part.

  • They seem overcome with hopelessness and overwhelmed by their circumstances. That person may be suffering from extreme or prolonged grief, or feelings of worthlessness or guilt. People in this position may say that the world would be a better place without them.

What do you do if someone you know is suffering?

You can connect with them, reach out, and offer them your help. Showing compassion and caring to help find a solution when a person may not have the will or drive to help themselves can go a long way.

Aetna Chairman and CEO Mark Bertolini recently shared his struggles following a skiing accident that left him in “incredible” pain and, in his darkest days, contemplating suicide.

Learn more about what you can do to help someone. Check out these three animation videos from the Campaign to Change Direction detailing several of the signs of suffering.

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Health Ambitions Study: Transforming care delivery

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Aetna’s inaugural Health Ambitions Study explores consumers’ health goals and the relationship between consumers and providers in the evolving health care system. Click here to read an infographic highlighting the study’s findings.

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