Amidst a pandemic, consumers say they want accessible, affordable and technology-enabled health care, new CVS Health study finds

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Path to Better Health Study also reveals desire for digital health care solutions to support chronic care, mental health needs.

WOONSOCKET, R.I. — The American health care system is undergoing a period of rapid transformation. In recent months, the COVID-19 pandemic has exposed new challenges and opportunities to accelerate advances in health care delivery, solve for systemic health inequities, dramatically improve care outcomes, and better meet consumer expectations for convenience and affordability.

With a global pandemic as the backdrop, CVS Health (NYSE:CVS) fielded the 2020 Path to Better Health Study, where consumers and providers were asked for their thoughts on the state of health care and how they are navigating this evolving landscape. While certain attitudes may have evolved as a result of COVID-19, the study reveals that consumers need more accessible, personalized and technology-driven health care than ever before and are seeking simplicity in the way they engage in their own health.

The use of technology and data analytics in health care is reaching new heights, and the pandemic is accelerating the adoption of digitally based solutions. Consumers are eagerly embracing tech, especially when it comes to communicating with their providers. Forty-eight percent said they would be more likely to communicate with health care professionals if they were able to do so through digital messaging (up from 41% in 2019), via telehealth (32%, up from 19% in 2019) and through virtual office visits such as Skype or FaceTime (29%, up from 20% in 2019). Additionally, 40% of consumers said they would be very likely to receive care for mental and behavioral health virtually.

"The pandemic has forced countless Americans to rethink their approach to health and explore different avenues of care," notes Larry Merlo, CEO of CVS Health. "Whether in the community, in the home or in the palm of their hand, people are discovering new ways to conveniently and affordably address their health care needs, including mental and behavioral health. We expect these changes will transform the way care is delivered moving forward."

The need to manage chronic conditions and mental health concerns is clearly top of mind for many consumers. A significant number of people indicated that members of their households are struggling with high blood pressure (41%), obesity (35%), mental illness (28%) and diabetes (17%).

Addressing mental health concerns is also of growing importance, especially among those aged 18 34 and 35 50, where social isolation is a top concern. For example, 44% of those aged 18 to 34 and 45% of those aged 35 to 50 indicated they no longer have a desire to be social, while only 29% of those aged 51 to 64 said the same. This resembles the 2019 findings, in which 48% of those 18 to 34 and 45% of those 35 to 50 reported they did not have a desire to be social, versus 35% of people aged 51 to 64.

The desire for accessibility is pushing people to explore new avenues of care. While a majority (62%) of consumers still go to their primary care physician (PCP) to treat a minor illness or injury, nearly one-third (31%) are likely to visit a non-emergency walk-in clinic. This is up from 2019, in which 59% of consumers reported going to their PCP for a minor illness or injury, while 28% said they would visit a non-emergency walk-in clinic. Digital solutions such as telemedicine are also growing in popularity with both patients and providers.

Most consumers (92%) said it is very or somewhat important that health care be convenient a factor that has only become more critical as a result of COVID-19.

About one-third (35%) of people said health care costs are an obstacle to staying healthy, and close to half (49%) have not visited a doctor when they had a minor illness or injury due to cost. Despite cost emerging as a top barrier to care, it is not often a topic of discussion between patients and health care providers. Two-thirds of patients (66%) said their PCP and other health care providers had not asked about the "affordability" of health care and/or discussed resources to assist with these costs, up slightly from 64% in the 2019 Path to Better Health Study.

Other highlights from the study include:

  • Health care providers are increasingly turning to digital tools and technologies to care for and connect with their patients. Telemedicine is of particular interest, with 40% of providers saying it is very valuable for communicating with patients, up from 22% in the 2019 study. The future outlook for incorporating predictive analytics or artificial intelligence into provider practices also looks strong, with more than one-third (39%) indicating they already have or are very or somewhat likely to integrate these technologies into their practices within the next several years.

  • Providers are expressing the need for additional support for important community resources, but access is improving. For example, many providers said they have fair or poor access to substance abuse counselors (56%) and mental health counselors (50%), down from 63% and 55% in our 2019 study, respectively.

  • Many providers are experiencing burnout symptoms. Three-fourths (75%) of all providers said they feel burned out very frequently, frequently or sometimes. About one-quarter (27%) said the main cause of burnout is time spent documenting care/electronic record systems, followed by administrative/management requirements/paperwork (25%).

Read the full study.

About the study

The Path to Better Health Study by CVS Health, first released in 2018 and called the Health Ambitions Study, was conducted in March 2020 and included two surveys fielded by Market Measurement, a national market research consulting firm. The consumer survey comprised 1,000 participants 18 and older, located throughout the U.S. It also oversampled 12 metropolitan statistical areas Atlanta, Austin, Boston, Cleveland, Dallas, Houston, Los Angeles, New York City, Philadelphia, Providence, Hartford, San Francisco, Tampa and among two ethnic groups: African American and Hispanic people. The survey of 400 providers focused on primary care physicians and specialists with at least two years' experience, as well as nurse practitioners, physician assistants and pharmacists.

About CVS Health

CVS Health employees are united around a common goal of becoming the most consumer-centric health company. We're evolving based on changing consumer needs and meeting people where they are, whether that's in the community at one of our nearly 10,000 local touchpoints, in the home, or in the palm of their hand. Our newest offerings from HealthHUB locations that are redefining what a pharmacy can be, to innovative programs that help manage chronic conditions are designed to create a higher-quality, simpler and more affordable experience. Learn more about how we're transforming health at www.cvshealth.com.

Contacts

Kathleen Biesecker
bieseckerk@aetna.com
703-472-8466

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Path to Better Health Study 2020

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CVS Health’s 2020 Path to Better Health Study finds that consumers are seeking a more accessible, affordable and technology-enabled health care experience than ever before. 

The American health care system is undergoing a time of accelerated innovation and transformation. Consumer expectations for convenient and personalized health care support, coupled with the exploding use of technology and data analytics, are just several trends driving critical change. The unprecedented COVID-19 pandemic has also provided an opportunity to further advance health care delivery and utilization to better meet the needs of our patients, our customers and our communities.

According to our 2020 Path to Better Health Study, now in its third year, consumers and providers are hungry for this care transformation and want health solutions that meet them where they are — in store, in home and in hand.

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40%

of consumers said they would be very likely to receive care for mental and behavioral health virtually.

71%

of consumers indicated they were greatly concerned with treating chronic illness due to cost. 

81%

of providers reported that they always, often or sometimes recommend that their patients establish health goals during routine office visits.

Importance of accessibility and affordability

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. 

We found that people’s desire for accessibility is pushing them to explore new avenues of care. While a majority of consumers still go to their primary care physician (PCP) to treat a minor illness or injury, nearly one-third of consumers are likely to visit a non-emergency walk-in clinic.

Consumers are receiving routine support for minor illnesses or injuries at several sites of care: 62% report visiting their primary care physician; 31% report using emergency walk-in clinics; 18% report visiting a hospital emergency room; and 15% report visiting community health clinics.

“Consumers are demanding convenience and ease in how they access health services. Technological solutions have the power to simplify health care and significantly expand the ways we deliver it,” said Larry Merlo, CEO of CVS Health, adding that COVID-19 has provided an unprecedented opportunity to accelerate transformation and drive lasting and systemic change in the American health care system. “Our growing local presence and expansion of virtual care, telemedicine, and other omnichannel programs will be critical to meeting the health needs of our members and customers, both during and after the pandemic.”

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Affordability is also top-of-mind for consumers. About one-third (35%) of people said health care costs are an obstacle to staying healthy, while close to half (49%) have not visited a doctor when they had a minor illness or injury due to cost, suggesting that consumers could use additional support in this area.

Increasing appetite for technology-enabled care

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.

The use of digital tools to facilitate communication between patients and providers is on the rise. Digital messaging among consumers is up 7% from 2019 with an overall usage of 48%. Among providers, digital messaging is down 2% from 2019 but overall usage is at 36%. Telehealth services, have shown a 14% increases among consumers, with a 32% overall usage rate. Among providers, usage of telehealth services increased 18% with a 40% usage overall.

Our study shows that people want to use technology to enhance communication with their health care providers, by adopting tools like digital messaging, telemedicine and virtual office visits. Among providers, their use of digital technologies to care for and connect with patients is also expanding. Telehealth is of particular interest, with 40% of providers saying it is very valuable for communicating with patients, up from 22% in our 2019 study.

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Our Path to Better Health Study also found that:

  • Mental health is of critical concern for consumers, especially among those aged 18 to 34 and 35 to 50, with the issue of social isolation being a top concern.
  • Consumers, as well as their friends, family and other household members, are struggling with chronic conditions, including high blood pressure, obesity, mental illness and diabetes. 
  • Health care providers still need more support in accessing important community-based resources, such as nutritionists and social workers, but this access is improving. 
  • Many providers are experiencing burnout symptoms at least some of the time. 
  • Awareness of and involvement in value-based care models is growing.
A woman sits at a dining room table eating a salad and a piece of bread while quietly smiling and reading a tablet computer.

Methodology 

The Path to Better Health Study by CVS Health, first released in 2018 and called the Health Ambitions Study, was conducted in March 2020 and included two surveys fielded by Market Measurement, a national market research consulting firm. The consumer survey comprised 1,000 participants 18 and older, located throughout the U.S. It also oversampled 12 metropolitan statistical areas — Atlanta, Austin, Boston, Cleveland, Dallas, Houston, Los Angeles, New York City, Philadelphia, Providence, Hartford, San Francisco, Tampa and among two ethnic groups: African Americans and Hispanics. The survey of 400 providers focused on primary care physicians and specialists with at least two years’ experience, as well as nurse practitioners, physician assistants and pharmacists.

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Addressing out-of-pocket costs for diabetes patients

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Rising costs are a burden for too many people living with diabetes today. Patients with a high-deductible health plan shoulder all of their medication costs while in the deductible phase of their insurance, which means they may be forced to make difficult decisions about whether they can afford their medications and fill their prescription.

Recent data reveal there is uncertainty on how to manage and predict the out-of-pocket costs associated with diabetes management. For example, nearly one-third of patients (32 percent) do not feel they have the resources needed to manage their own out-of-pocket costs. To address this challenge, CVS Health is working to eliminate member cost as a barrier to medication adherence.

Improving medication affordability and adherence

Improving diabetes outcomes while reducing costs is a priority for CVS Health. We recently launched RxZERO to enable employers and health plan sponsors to leverage formulary and plan design approaches to offer all categories of diabetes medications at zero dollar out of pocket for their members without raising costs for the plan sponsor or increasing premiums or deductibles for all plan members. The new plan design enables plan sponsors to eliminate member out of-pocket costs for the entire diabetes therapeutic area — including oral medications for Type 2 diabetes — and fully adhere to American Diabetes Association standards.

“Traditionally, the focus of affordability for diabetes medications has been on insulin, which is the cornerstone of therapy for the five percent of people with diabetes who are living with type 1 diabetes. However, the new CVS Caremark solution expands affordable options to include the entire range of diabetes medications — improving affordability for the 95 percent of people with diabetes who are living with type 2 diabetes.”

— Troyen A. Brennan, M.D., M.P.H., is Executive Vice President and Chief Medical Officer of CVS Health

CVS Caremark analysis shows that members taking branded diabetes medications spend on average, $467.24 out-of-pocket per year, with nearly 12 percent spending over $1,000 annually.

A comprehensive approach to diabetes management

A person living with diabetes is required to take many tasks to manage their therapy annually. To make disease management affordable, accessible and local, CVS Health offers numerous programs to help people with diabetes effectively manage their condition and stay on track with their prescribed treatment plan.

We provide supportive care at our HealthHUB locations to complement the care that patients receive from their primary care physicians. Our HealthHUB model provides a first-of-its-kind community-based store that offers a broader range of health services, new product categories, digital and on-demand health tools and trusted advice. In these locations, people living with diabetes are able to receive the coordinated care and services they need all within our own four walls.

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POLITICO Partnership Elevates Discussion on Social Determinants of Health

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Tom Moriarty, chief policy and external affairs officer, and general counsel, recently spoke to 100 health care and policy influencers at a POLITICO Live event in Philadelphia, Pennsylvania, about the importance of local and personalized solutions in addressing the social determinants of health. The event was part of the Health Care Innovators series, sponsored by CVS Health, which showcases leading voices and practices in health care innovation.

Watch the full remarks here.

Understanding Community Health Care Needs

Most of our health and well-being happens outside of the doctor’s office where we live, learn and work. Furthermore, data show that 60 percent of our life expectancy is determined by factors such as housing, transportation, education and food.

Moriarty noted that these factors underscore why we must understand and analyze how local environments impact health—and the importance of data in the U.S. News & World Report Healthiest Community Rankings. In Philadelphia, nearly one in five residents smoke and more than one-fourth are grappling with obesity. According to Moriarty, our communities are ripe for health care innovation and we have an opportunity to improve health outcomes by creating meaningful touchpoints to care.

Expanding Access to Care Locally

Access remains a key challenge in helping patients manage their conditions. According to Moriarty, community health care access can be defined by two tracks: the availability of primary care and the ability to get to where care is offered.

To demonstrate how CVS Health can address these tracks, Moriarty shared an example of “Diane,” a single mother of two who recently received a diabetes diagnosis. There could be a number of obstacles in her way. First, it may be hard for her to take time off during business hours for appointments. Next, she may face difficulties in getting the testing and labs she needs for diabetes. Research shows 40 percent of physician-ordered lab tests aren’t completed—oftentimes as a result of facilities not having extended hours and the patient lacking access to public transportation to that facility.

According to Moriarty, this is where CVS Health is making a difference. Today, 71 percent of Americans live within five miles of a CVS Pharmacy location. And people come to their pharmacy frequently: whereas a patient with diabetes like “Diane” might only see her physician four to five times a year, she will likely see her pharmacist as many as 18-24 times in the same year.

Moriarty highlighted how we’re utilizing our community footprint to provide timely and targeted interactions with patients like “Diane.” For example:

  • Our MinuteClinic offering is complementary and collaborative to primary care—and helpful to the system overall. We offer treatment for 125 conditions from trusted providers. Furthermore, our extended hours and broad community reach can help address gaps in care.

  • To build on our MinuteClinic services and improve care coordination, we recently piloted HealthHUB—a new, first-of-its-kind concept offering new product categories, digital and on-demand health tools and trusted advice. This concept will be brought to the Philadelphia and Southern New Jersey market in the coming months.

Improving Health Care Affordability

Along with access to care, affordability is a top health care priority for patients. Moriarty emphasized how CVS Health is doing more to help ensure patients get the medications and care they need at the best possible cost.

For example, data show that 40 percent of patients do not pick up their prescriptions when out-of-pocket costs per prescription exceed $200. Moriarty noted that if patients are unable to afford their medications, they get sicker and their care becomes even more expensive. CVS Health has developed solutions to change that.

  • Through our real-time benefits program, we’re providing tools to doctors so they can see what a medicine is going to cost, and recommend lower cost, clinically appropriate options to the patient. More than 100,000 prescribers are using this program—leading to an average of $90 savings per prescription.

  • We’ve also pioneered digital tools, including the Rx Savings Finder, which help our retail pharmacists find patients savings when they do reach the pharmacy counter.

We look forward to continuing to address the social determinants of health in the communities we serve.

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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Providing Discounted Care to Special Olympics Athletes at MinuteClinic

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Athletes, perhaps more than anyone else, understand the importance of being on top of their physical health.

To make it easier for some of our country’s most impressive athletes to access lower cost, high-quality care, MinuteClinic is working with Special Olympics to provide sports physicals at a discounted rate.

From now through July 31, 2020, Special Olympics athletes will be able to present a voucher at any MinuteClinic location in CVS Pharmacy or Target and receive a sport physical at the discounted rate of $49, no appointment necessary.Local state organizations may have alternate arrangements.

This promotion provides all Special Olympics athletes with access to this necessary care regardless of their insurance status or whether they have a primary care provider.

Easy-to-Access, Lower-Cost Care

Athletes aren’t the only ones who benefit from the type of proactive care that MinuteClinic offers. With 1,100 locations in 33 states and Washington, D.C., patients have access to a wide range of services at MinuteClinic, including wellness screenings, vaccinations, and chronic condition monitoring.

And when a minor illness or injury does arise, MinuteClinic’s nurse practitioners and physician assistants can often provide care for those conditions as well, including earaches, sprains, skin conditions such as rashes or poison ivy, sore throats and infections of the respiratory system or urinary tract.

At CVS Health, we’re committed to ensuring that patients have access to the quality, affordable care that will keep them in their best health and at the top of their game.

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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Streamlining Prescription Onboarding with Specialty Expedite

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As CVS Health looks to transform health care and contribute to a better, more efficient system, we are looking at ways to leverage and improve the use of technology to improve quality of care and patient outcomes.

This is especially important in specialty pharmacy and why we’ve introduced Specialty Expedite.Specialty Expedite is available exclusively for providers who use compatible electronic health record (EHR) systems including Epic Systems and others that participate in the Carequality Interoperability Framework. All data sharing and usage complies with applicable privacy laws. Patients receive real-time prescription status updates only after providing consent to CVS Specialty. Our connected capability transforms prescription onboarding for our CVS Specialty patients, on average shortening the specialty pharmacy onboarding process to as little as three days and ultimately helping to get patients started on appropriate therapy faster.

Getting Patients the Medications They Need Quickly and Efficiently

For patients with complex medical conditions requiring specialty medications, getting started on their prescriptions quickly and efficiently is crucial to their care. But the process has not always been that simple, with patients sometimes having to wait as long as several weeks to complete the manual onboarding and prior authorization process.

Specifically, the process to get started on a specialty medication often requires physician’s offices and insurers to fax appropriate patient records and/or required approvals before a prescription can be filled, which can be time consuming but is a critical step to ensure that patients are receiving the most appropriate medication.

In addition, across the health care system, the Federal government is looking at ways to help enable and improve health information technology (IT) systems and as part of that, officials have even called for health care to be a “fax free zone by 2020.”

How It Works

Specialty Expedite works by securely gathering appropriate patient information, including insurance, lab work and diagnosis codes via a doctor’s electronic health record (EHR) system instead of sharing through fax. The process also cuts down on paperwork and phone calls, resulting in fewer errors and more efficiencies.

In addition, patients also now have the option of receiving real-time status updates via email or text, so that they can stay informed on the status of their prescriptions and any prior authorization requirements. Patients are also able to choose how they want to get their specialty medications — at their local CVS Pharmacy or though specialty mail serviceWhere allowed by law. In-store pick up is currently not available in Oklahoma. Puerto Rico requires first-fill prescriptions to be transmitted directly to the dispensing specialty pharmacy. Products are dispensed by CVS Specialty and certain services are only accessed by calling CVS Specialty directly. Certain specialty medication may not qualify. Services are also available at Long’s Drugs locations. via Specialty Connect. Research shows that when patients have more flexibility and choice, they are able to start their therapies sooner and adherence and satisfaction improves.

Helping patients with complex medical conditions get the specialty medication they need more quickly and efficiently through technology and solutions such as Specialty Expedite is one more way we are helping people on their path to better health.

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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Aetna to provide pharmacy rebates at time of sale, encourages transparency from drug manufacturers

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HARTFORD, Conn. — Beginning in 2019, Aetna will automatically apply pharmacy rebates at the time of sale for its Commercial fully insured plan members. While the majority of rebates have always been passed on to plan sponsors and their employees through lower premiums, Aetna believes that greater transparency is needed throughout the pharmaceutical supply chain in response to the nearly 25 percent increase in drug prices between 2012 and 2016.

"We have always believed that consumers should benefit from discounts and rebates that we negotiate with drug manufacturers," said Mark T. Bertolini, Aetna chairman and CEO. "Going forward, we hope this additional transparency will encourage these companies to rationalize their pricing and end the practice of annual double-digit price increases."

An estimated 3 million Aetna members could potentially benefit from these rebates when filling prescriptions.

As another example of its commitment to transparency, Aetna has reiterated its support for holistic improvements to Medicare Part D, including adding a true out-of-pocket cap for consumers as recommended by the Medicare Payment Advisory Commission. In addition, Aetna continues to support eliminating "gag clauses" that prohibit pharmacists from telling customers that paying cash for prescription drugs may be cheaper than using their health insurance. The company does not require these clauses in contracts with pharmacists, and is encouraged by pending and recently passed legislation aimed at ending this practice.

"Additional reforms are needed to bring down rising drug prices that are driving increased spending across the health care system," Bertolini continued. "Payers are required to spend the vast majority of premium dollars on medical costs, not overhead or profits. Drug manufacturers should be held to the same high standards."

About Aetna

Aetna is one of the nation’s leading diversified health care benefits companies, serving an estimated 37.9 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, 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, see www.aetna.com.

Media Contact:

T.J. Crawford
212-457-0583
crawfordt2@aetna.com

Investor Contact:

Joe Krocheski
860-273-0896
krocheskij@aetna.com

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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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2018 Health Care Trends

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Download the 2018 Health Care Trends report, provided by Aetna.

Despite the United States’ position as an economic powerhouse at the forefront of the tech boom, our health lags behind some countries. World Health OrganizationWorld Health Organisation – Global Health Observatory data http://www.who.int/gho/mortality_burden_disease/life_tables/situation_trends_text/en/ (WHO) figures show that our average life expectancy is lower than 30 other countries, including Switzerland, Australia and Canada. But the tide may finally be turning, with a monumental shift in how we approach health care, towards a personalized approach that focuses on each individual and all aspects of their well-being. Rather than concentrate solely on treating people when they’re sick, health care providers are placing a greater emphasis on keeping them healthy. Instead of visiting clinical facilities for the majority of their care, people are using technology to monitor their health and receive treatment in their homes.

Doctors, hospitals and health companies now have insight into all factors that can affect patient health – from lifestyle to income to genetics. And they are using that information to connect people to a wide range of health and social services within their communities.

The Aetna 2018 Health Care Trends Report explores the key factors driving this shift: New strategies that yield better results from our country’s investment in health care; innovative ways wearables could reduce spending on chronic diseases; the role of diversity in shaping a new health care system; how health companies can help conquer the scourge of opioid addiction. Read on to see how the development of these trends in the years to come can result in healthier communities, happier individuals and better health outcomes for all.

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Pay Flex CEO Shines Light on Opportunity for Payers, Providers to Collaborate on Revenue Cycle

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When it comes to health care costs, many consumers feel left in the dark. In fact, the No. 1 reason people do not pay their health care bills is due to confusion over the often antiquated and clunky payment process.

At the HIMSS Annual Conference & Exhibition in Las Vegas this week, PayFlex CEO and President Erin Hatzikostas hosted a session, “Equipping Consumers To Be The Chief Financial Officer Of Their Own Health Care,” to discuss how providers and health plans can work together to engage consumers to better understand and manage their health care expenses. PayFlex is a part of the Aetna family.

With the rise of consumer directed health plans turning patients into larger financial stakeholders in their care, “Consumers are left woefully behind in getting the information they need,” said Hatzikostas.

Consumers cannot make informed choices about their elective health care if they do not know what it costs. Furthermore, even after patients receive care, they are often left in a thicket of mail from providers and their insurer, including Explanations of Benefits (EOBs) which may look like bills, bills from providers that look like EOBs, etc.

While this is confusing for the patient, it also negatively affects doctors who performed services with the promise of getting compensated quickly. Collections typically take 3-5 months to process and only 17 percent of bills are collected. This delay is not linked to an unwillingness or inability by the patient to pay – three-fourths of people are willing and/or able to pay for their health care costs – but a lack of understanding of the payment system and process. “The No. 1 reason is that people were confused,” said Hatzikostas.

As a complex issue, the health care payment crisis requires a complex solution. Convenience and consumerism are hard to balance and simple solutions will not work.

In 2014, PayFlex launched Money Square for Health to help equip consumers to be better financial stewards of their health care. After just three years, the service earned over 200,000 users, with many repeat users. Beta testing confirmed the huge opportunity in the ecosystem to engage consumers and, with the learnings from Money Square for Health, Aetna launched AetnaPay to further empower consumers to become the CFO of their health care finances.

There is still much work to be done in supporting consumers to own their health care finances, but progress is being made. As we continue to shine a light on the payment black box, it will be imperative for providers to collaborate with health plans on solutions and work together to share quality data and advance work flows.

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