The use of technology across the health care continuum has been rising at a rapid rate. As a result of COVID-19, the pace of technological transformation will only quicken and greatly influence the future of care delivery.
Delivering accessible, high-quality care at any time is a key health care priority — and has become even more significant during the COVID-19 pandemic. According to our study, consumers agree, with 92% indicating that it was very or somewhat important that health care be convenient.
Plans help provide access to high-quality care for members across the nation
HARTFORD, Conn. — For the seventh consecutive year, Aetna® , a CVS Health® company (NYSE: CVS), announced its 2021 Medicare Advantage Prescription Drug (MAPD) plans outpace the Medicare Advantage industry in the percentage of members in plans rated 4 stars or higher (out of 5 stars) by the Centers for Medicare & Medicaid Services (CMS). Star Ratings data for 2021 contracts show 83 percent of Aetna MAPD members are currently enrolled in 4 star-rated plans or higher, compared to 77 percent for the industry.
"This year's Star Ratings demonstrate our consistency in bringing quality and value to our members," said Christopher Ciano, president of Aetna Medicare. "Now more than ever given the COVID-19 pandemic, we're unrelenting in our focus on the total health of our members and making sure they have access to quality care that's affordable, safe and close to home. We work closely with our physician partners and community organizations to help our members age and thrive in the comfort and safety of their homes, especially during these uncertain times."
Aetna 4.5-star rated contracts:
H2663 Coventry Health Care of Missouri, Inc. (AR, IL, KS, MO, OK HMOs)
H3959 Aetna Health Inc. (PA HMO)
H3597 Aetna Health Inc. (ME HMO)
H5522 Health Assurance Pennsylvania, Inc. (PA PPO)
H7301 Coventry Health Care of Illinois (IL PPO)
Aetna 4-star rated contracts:
H1609 Aetna Health Inc. (FL/IA HMOs)
H5521 Aetna Life Insurance Company (AL, AZ, CA, CO, CT, DC, DE, FL, GA, IL, IN, KY, LA, MA, ME, MI, MS, NC, NJ, NV, NY, OH, PA, SC, TN, UT, VA, WA, WI, WY PPOs)
H5793 Aetna Health Inc. (CT HMO)
H7149 Aetna Health Inc. (NE HMO)
CMS' Medicare Star Ratings rank the performance and quality of Medicare Advantage and Medicare prescription drug plans to help beneficiaries and their families compare plans. Medicare Advantage plans are rated on how well they perform on five different categories:
Managing chronic (long-term) conditions
Member experience with the health plan
Health plan customer service
MAPD plans are also rated on how well they perform on three additional categories:
Drug plan customer service
Member experience with drug plan
Aetna Medicare Advantage and SilverScript prescription drug plans are available to Medicare beneficiaries for selection during the Annual Enrollment Period, which starts on October 15, 2020, and runs through December 7, 2020. Enrollment becomes effective on January 1, 2021.
The star ratings are posted at www.medicare.gov. Visit AetnaMedicare.com to learn more about Aetna's 2021 Medicare plans or call toll-free at 1-855-335-1407 (TTY: 711). Hours are from 8 AM to 8 PM, local time, seven days a week. A licensed agent will answer your call.
NOTE: Information in this release is based on 2021 star ratings data published by CMS on October 8, 2020, and Medicare Advantage and Medicare prescription drug plan enrollment as of September 2020.
Aetna, a CVS Health business, serves an estimated 34 million people with information and resources to help them make better informed decisions about their health care. Aetna offers a broad range of traditional, voluntary and consumer-directed health insurance products and related services, including medical, pharmacy, dental and behavioral health plans, and medical management capabilities, Medicaid health care management services, workers' compensation administrative services and health information technology products and services. Aetna's customers include employer groups, individuals, college students, part-time and hourly workers, health plans, health care providers, governmental units, government-sponsored plans, labor groups and expatriates. For more information, visit www.aetna.com and explore how Aetna is helping to build a healthier world.
Aetna Medicare is a HMO, PPO plan with a Medicare contract. Our SNPs also have contracts with State Medicaid programs. Enrollment in our plans depends on contract renewal. See Evidence of Coverage for a complete description of plan benefits, exclusions, limitations and conditions of coverage. Plan features and availability may vary by service area.
SilverScript is a Prescription Drug Plan with a Medicare contract marketed through Aetna Medicare. Enrollment in SilverScript depends on contract renewal.
Every year, Medicare evaluates plans based on a 5-star rating system.
Sophia*, who speaks Spanish, was admitted to the hospital multiple times for cellulitis and extremely high blood pressure. Although she was surrounded by medical professionals, she couldn’t easily convey what she was feeling or understand the care needed until Crystal Ring reached out.
Crystal is an Aetna American Health Holding (AHH) case management nurse who advocates for patients with Limited English Proficiency (LEP). Using an interpreter from Aetna’s language services program, she helps AHH members like Sophia overcome linguistic, cultural and health literacy barriers.
“When I first spoke to Sophia she was frustrated, scared and overwhelmed. She felt pushed aside and didn’t feel she was getting better. Because of this, Sophia wasn’t attending her follow-up appointments and refused to take her high blood pressure medicine,” explains Crystal. “I calmed Sophia down and shared with her the medical rationale behind the physician’s instructions so she could understand the potential danger of stopping her treatment.”
According to the U.S. Census Bureau, over 21 percent of the population speaks a language other than English. As these numbers rise, nurses like Crystal play a critical role meeting challenges related to care and education for this diverse population.
Along with patients who have high blood pressure, Crystal works with patients with diabetes, heart disease, kidney failure and wounds. Her case load varies from 30 to 45 patients.
“I just love to help people. At the end of the day, I want to know that I did everything I could for my patients,” says Crystal, adding that some of her patients cried when their case was closed.
Thanks to Crystal’s dedication and thoughtful approach, Sophia is doing well and her blood pressure is no longer in the danger zone. Crystal even recommended changing Sophia’s medication, which improved her cellulitis and allowed her to become a candidate for vascular surgery. In fact, Sophia’s physician sent Crystal a note thanking her for her knowledge and leadership: “We are very appreciative of the amazing work you are doing for our patients.”
So are we! Thank you, Crystal, for bridging the communications gap and bonding with your patients. Your care makes all the difference.
*Name changed for privacy purposes
Heart At Work recognizes CVS Health heroes across the country who bring their hearts to work, helping people on their path to better health. Read their stories, watch their videos and celebrate our CVS Health Heart At Work heroes along with us!
Five years ago, we made the bold decision to eliminate tobacco products from all of our CVS Pharmacy stores nationwide, and we’re still the only national pharmacy to do so.
Not only did our decision lead to 100 million fewer packs of cigarettes being sold in the first year since their removal, but we also took our efforts beyond our stores, helping 228 colleges and universities become tobacco free over the past five years and committing $50 million to deliver the first tobacco-free generation through our Be The First initiative.
And with the significant rise in teen e-cigarette use, we’re now working to combat vaping, too, including a $10 million commitment in 2019 to support youth smoking and e-cigarette prevention strategies and education in partnership with Discovery Education and CATCH Global Foundation, and our pledge earlier this year not to work with advertising or public relations agencies who work with tobacco and e-cigarette companies.
Beyond tobacco: Taking steps to transform health care
But our decision to eliminate tobacco was just the start. As a health care company now combined with Aetna, we’re taking even bolder steps to transform the consumer health care experience and help lead our customers, patients and the communities we serve on a path to better health.
On our shelves, customers now have access to more health-focused products and services than ever before. And we recently became the first and only national retailer to require that all vitamins and supplements undergo third-party testing to confirm they meet our high standards.
We’re also removing chemicals like parabens and phthalates from our store brand products and we took SPF less than 15 off our shelves.
At the local level, we’re building healthier communities with a $100 million investment in health and wellness, which includes programs aimed at helping people manage the most prevalent chronic diseases such as diabetes, heart disease and cancer.
Moving into 2020, we will expand our focus on tobacco cessation and prevention, particularly within the Medicaid program where smoking rates are considerably higher than among all adults. We’ll be working with Aetna Better Health managed Medicaid plans and together with CVS Caremark clients interested in creating or expanding smoking cession efforts for their Medicaid members.
At CVS Health, we know that health is a personal journey. And from tobacco removal to our many other health-focused services and offerings, we’re committed to navigating that journey hand-in-hand with our customers and patients to ensure that the future of care is one in which everyone can achieve their best health.
Welcome to Healthy Conversations, an open discussion among healthcare professionals about the latest innovations, what we've learned on the front lines of the pandemic, and how our industry is changing in real time. There might not be a specific moment when we can hit the reset button and start to tackle systemic healthcare challenges with a clean slate, but smaller resets are already underway. Join us as we examine what a COVID-19 Reset looks like for doctors, nurses, and other healthcare professionals.
We spoke with Dr. Rushika Fernandopulle, founder and CEO of Iora Health, about how physicians have addressed the pandemic in their own practices and the changing perceptions around value based care. You can find Dr. Fernandopulle’s full interview in the accompanying podcast (below) episode.
As discussed earlier in this series, COVID-19 is causing us to rethink and readjust how we deliver care. Broader systemic change starts within individual systems. For insight into how CVS is changing its own systems, we spoke to Dr. Dan Knecht and Angie Meoli.
One of the most eye-opening impacts of COVID-19 has been the dramatic disparities highlighted in our healthcare system. Dr. Dela Taghipour and Dr. Nadia Abuelezam will discuss how we can collectively reimagine community healthcare to address those disparities.
A global health pandemic comes with tremendous uncertainty and anxiety. Patients deserve stability and peace of mind when it comes to their health care — the last thing that should create additional concern is whether they can access the medicines or care they need while staying socially distant.
Recognizing our responsibility to provide patients with additional support at the onset of the COVID-19 pandemic, we tapped into our solutions to ensure that all patients continue to get their medications and care without leaving the home — and at a price they can afford.
Avoiding potential exposure without avoiding care
When the pandemic spread, routine and preventive medical care plummeted. In fact, Health Care Cost Institute estimates that millions of Americans continue to forego this type of care.
Avoiding health care needs can have serious consequences that come at a cost to individual health — and the system as a whole — in the future. Similarly, avoiding care for chronic conditions, such as diabetes and high blood pressure, can cause more problems down the road. Patients who stop taking needed medications, or don’t get started on them, also face the risk of complications.
Our digital and remote pharmacy touchpoints help to keep patients safe, healthy, and at home as much as possible. To help prevent potential gaps in care and keep people safe at home, CVS Health led an early effort with local agencies to change regulations and enable greater remote pharmacy care management. Additionally, we made changes to our business to help minimize trips to the pharmacy, including early refill prescriptions, expanded access to 90-day supplies of maintenance medications by mail and free prescription delivery from retail stores.
Specialty members warrant added attention
We are working with hospitals and providers across the country to continue to support solutions that create much-needed hospital bed capacity and ensure streamlined care for many specialty patients. Through Coram, clinicians can deliver a clinically appropriate in-home care setting for patients recovering from a range of illnesses, which can help minimize their risk of contracting COVID-19 during treatment.
For patients, especially those living with complex or chronic illnesses, ensuring an uninterrupted supply of needed medications is crucial to their care. In the face of the enormous pressure the COVID-19 pandemic has placed on the U.S. health care system, our responsibility to ensure members have affordable access to the medications they need – when they need them – is critical.
From the onset of the pandemic, we’ve adapted our business practices to maintain the services that our clients and more than 100 million Americans depend on. We recognize that for someone living with a condition, such as lupus or asthma, going without a medication can create negative and costly consequences.
Monitoring prescription supply to meet member needs
The current landscape has required the drug supply chain to be more responsive and effective. We work across the supply chain to carefully monitor prescription availability, potential shortages and spikes in demand. This way, we can stay one step ahead of utilization trends to help ensure that people have access to the medicines needed to manage their health and avoid costly complications down the road.
Using predictive analytics, we can monitor prescription usage trends and adapt drug supplies as needed.
Moving forward, it will be important to use these analytics not only to understand supply and demand trends but analyze where pharmaceutical ingredients are coming from. Early in the pandemic, we shifted our practices to account for COVID-19 spikes in locations like Northern Italy, India and China, which are central to the pharmaceutical supply chain.
Because no two clients’ needs are the same, we customize our services, tools and programs to deliver the greatest value to both clients and their unique member populations. As our clients face the economic realities as a result of the COVID-19 pandemic, we’re working in a consultative role to ensure they can continue to keep their populations and workforces adherent to their medicines and care, which in turn creates positive health outcomes and drives longer-term health savings.
The pharmacy is the location where patients most frequently interact with their health care. By expanding health capabilities and services within our pharmacy benefits, we can have a positive impact on patient and member health. Beyond securing the lowest possible cost for medicines, we also work with clients to design benefits that include digital touchpoints and personalized support so that every member can start and stay on their medicines.
As telemedicine and digital health remain paramount, these digital touchpoints are critical in keeping our 100 million members engaged in their health.
Benefits that meet patients where they are
COVID-19 has underscored how important it is for us to maintain and enhance our services for clients and members in our physically distant world.
For example, members with chronic conditions have access to specially trained clinicians at their fingertips through our Pharmacy Advisor program. The program offers personalized support over the phone – or in person if preferred – for questions on managing a chronic condition, how different medicines may affect each other and how to handle side effects.
Through our nurse-led chronic care management program, Accordant, patients with rare, chronic diseases can get virtual support and remote monitoring to help with managing their benefits and conditions.
Our Point Solutions Management offering helps employers and health plans augment their pharmacy benefits with carefully vetted digital solutions that address key aspects of health care costs. These tools guide members in strategies to reduce worry and anxiety, improve heart health, get better sleep and make smarter nutritional choices. They are easy to use and come at no additional cost to members enrolled in a participating health plan.
We’re bringing these practical solutions to our clients and members through an integrated model that draws upon our deep knowledge, longstanding partnerships and industry expertise.
Prescription medicines are the most cost-effective part of our health care ecosystem, but they’re only clinically effective if patients can afford them. The amount that patients pay out-of-pocket has long been a point of contention in our health care system. Further underscoring this point, a recent CVS Health survey found that more than 70% of patients are concerned about the cost of their prescriptions.
The COVID-19 pandemic continues to create financial hardship in virtually every community. Recognizing this reality, solutions that help ensure that patients have access to prescriptions will be mission critical.
Clinical strategies to manage drug costs
Utilization management strategies are a cornerstone of our pharmacy benefit strategies. They enable appropriate use of medicines and help to mitigate the impact of high-cost drugs that do not demonstrate a clear clinical benefit.
We are closely monitoring trends in utilization, particularly high-cost specialty drugs, to stay ahead of the curve and ensure that patients can access clinically appropriate new therapies, while reducing wasteful spend.
We use innovative strategies to encourage the use of lower cost and clinically equivalent generic options when appropriate. Through these strategies, we continue to blunt the impact of price inflation, prioritize lower-cost generic options when clinically appropriate, and keep members’ out-of-pocket costs in check.
Prioritizing member savings and adherence
We also know that patients want to know whether their drug is covered, what it will cost out-of-pocket and have the ability to discuss with their provider. Just because a drug is expensive, doesn’t mean it’s the best option for every patient. That’s why we utilize patient-centric programs to make sure patients can access medicines that will create the best clinical outcome at the lowest possible cost.
Our approximately 100 million members, their prescribing physicians and pharmacists provides have immediate access to real-time prescription benefit information, including how much a drug will cost. With this information at hand, physicians and pharmacists can identify an alternative, clinically appropriate option, when possible.
We also offer a robust set of consumer-friendly tools to help members better understand how to access the most effective medicine at the lowest cost. With the digital tool Savings Advisor, members can view costs readily, enabling them to make more informed decisions about medicines choices.