Continuing its provider outreach initiative, Aetna sent more than 1,100 letters to clinicians in the United States, who prescribed antibiotics to treat an acute bronchitis diagnosis.
Color shows average fail rate per state. Number (on state) shows count of providers within the state. The data is filtered on three criteria: provider must be a key specialty, provider must have at least five members and the state must have at least five providers.
After analyzing claims data from 2015 and working with the U.S. Centers for Disease Control and Prevention (CDC), Aetna identified 1,115 clinicians who diagnosed five or more patients with acute bronchitis and prescribed antibiotics as treatment at least 50 percent of the time. CDC guidelines recommend against prescribing antibiotics to treat acute bronchitis because it’s caused by a viral infection. Antibiotics are used to treat and prevent bacterial infections. The clinicians included family physicians, internists, nurse practitioners and physician assistants.
“Appropriate prescribing of antibiotics is imperative to preventing the emergence and spread of superbugs,” said Harold L. Paz, M.D., M.S., executive vice president and Aetna’s chief medical officer. “Reaching out and reminding doctors of evidence-based treatment practices for acute bronchitis will keep patients and families healthy in the long run.”
Harold L. Paz, M.D., M.S., executive vice president and chief medical officer for Aetna, signs a letter sent to a clinician for over-prescribing antibiotics. | Eric Vo
The overuse of antibiotics is accelerating the creation and spread of resistant bacteria. Over 30 percent of antibiotic prescriptions written in an outpatient care setting in the U.S. from 2010 to 2011 were prescribed unnecessarily, according to a study published in the Journal of the American Medical Association.
The 1,115 clinicians received a letter signed by Paz, which contained the CDC’s guidance on “Avoidance of Antibiotic Prescribing for Acute Bronchitis.”
In addition, Aetna sent 127 letters thanking clinicians who followed proper treatment guidelines and did not prescribe antibiotics to treat acute bronchitis for any of their patients.
The letters are a continuation of the “super-prescriber” initiative Aetna launched in 2016, on the premise that clinicians are data-driven and want to conform with evidence-based best practices. This program started with a campaign to battle the opioid epidemic. At that time, Aetna sent letters to over 1,000 doctors that were identified as prescribing opioids at a higher rate than their peers.
And in May 2016, the company sent letters to hundreds of dentists and oral surgeons, who were also identified as “super-prescribers” of opioids. Aetna continues to look for ways to use our data analytics capabilities to help clinicians serve their patients.
Aetna is aiming to reduce inappropriate opioid prescribing to members by 50 percent by 2022.
The company is also aiming to increase evidence-based multi-modal approaches when treating members with chronic pain and using medication assisted therapy (MAT) for member with opioid use disorder by 50 percent by 2022.
“These goals are Aetna’s North Star – they are benchmarks against which all of our opioid efforts will be measured and the standard to which we hold ourselves accountable,” said Harold L. Paz, M.D., M.S., executive vice president and chief medical officer for Aetna.
Aetna’s goals are a part of the company’s larger, comprehensive strategy to combat the opioid epidemic. In Aetna’s opioid strategy paper published in June 2017, Paz writes how the company is using data analytics, clinical insights and collaborations to drive improved outcomes.
“We’re working to prevent misuse and abuse, intervene when we identify at-risk behavior and support those who are addicted through evidence-based treatments,” Paz wrote.
Aetna created an enterprise-wide opioid task force in 2016, which is chaired by Paz. The task force is made up of representatives from various business areas, such as Health & Clinical Services, Pharmacy, Dental and Behavioral Health, and meets monthly.
In 2016, Aetna analyzed its claims data to identify over 1,000 physicians, who were super-prescribers, or an over-prescriber, of opioids. Those physicians were sent letters warning them of their prescribing patterns and given educational information. In 2017, Aetna continued the initiative and identified and sent letters to over 1,000 dentists and oral surgeons that were over-prescribing opioids to patients.
Note: Data only includes Aetna commercial and Medicare members.
The company also removed the pre-certification of burprenorphine products in 2016, increasing access to treat opioid use disorder.
Aetna is also enhancing its Controlled Substance Use Program, which identifies patients who might misuse or abuse opioids. The program also allows Aetna to alert prescribers and reach out to the member to offer help.
The company also alerts pregnant Medicaid members at risk for neonatal abstinence syndrome, which occurs in newborns who experience withdrawal from opioids they were exposed to in the womb.
Note: Data only includes Aetna commercial and Medicare members.
The various initiatives have resulted in a reduction in opioid prescriptions.
Based on data from the first quarter of the year, Aetna estimates there will be 8,958,842 opioid prescriptions filled in 2017 among its commercial and Medicare members – a 10.85 percent decrease from 2016. The company is also estimating an 11.9 percent decrease of members with an opioid prescription in 2017, compared to 2016.
Note: Data only includes Aetna commercial and Medicare members.
In May 2017, six U.S. senators reached out to Aetna to learn more about what the company is doing to confront the opioid crisis. In his reply, Aetna Chairman and CEO Mark T. Bertolini outlined numerous programs and initiatives Aetna has in place to prevent, identify and combat addiction.
With the global incidence of diabetes doubling from 1989 to 2014, the disease has heavily impacted the health care system, according to the World Health Organization (WHO).
Click to read Aetna International’s white paper.
Aetna International believes battling the disease through a comprehensive care management program can help members better manage their condition and increase medication adherence to live healthier lives.
In a June 2017 white paper called, “Diabetes: the world’s weightiest problem,” Aetna International calls for the revolutionizing of how health care is managed and delivered for diabetes patients. The white paper also describes how Aetna International is identifying members and providing them with tailored support and using technology to help them track and understand their condition.
Aetna International has also developed innovative tools, such as a new virtual care service that allows access to end-to-end medical services and provides individuals with access to a uniquely integrated healthcare journey.
“We believe that by fundamentally changing the way health care is managed and delivered, innovation and technology can help to turn the tide – not just on diabetes but also on a spectrum of other diseases and conditions,” said Mike Delamere, regional general manager of the Americas for Aetna International. “We are calling for others to join us in revolutionizing the global healthcare system.”
The white paper also includes details of various studies, such as an Aetna International study of the Americas population in 2014 that found the costs of early detection and disease management strategies are far lower than costs associated with acute inpatient hospital treatment for diabetes.
That study found a 15.4 percent increase in retinal eye exams and a 9.2 percent increase in screenings for kidney disease among members with diabetes.
The white paper examines the various factors contributing to the rise of diabetes. The WHO estimates 422 million adults were living with diabetes in 2014. Urbanization, or the shift towards less physically demanding jobs and increased access to cars, computers, television and fast food, plays a role in the rise of obesity – a precursor to diabetes.
With increased prevalence, diabetes heavily impacts the health care system. In 2016, diabetes’ direct annual cost was $827 billion, according to the WHO’s Global Report on Diabetes.
Taking a holistic approach addressing the diabetes epidemic in the world will allow people to be educated and receive the proper screenings, treatment, support and follow-ups, according to Aetna International’s white paper.
“We need to create a world in which communities and schools teach good nutrition and encourage active lifestyles, where food producers and restaurants offer healthy food as default choices and where medical professionals are trained and equipped to diagnose and treat all forms of diabetes,” the white paper states. “And we need to transform the health care ecosystem for individuals around the world, bringing together health care providers, employers and benefits and services partners through virtual care for the benefit of individuals.”
U.S. News & World Report, the global authority in health care rankings, and the Aetna Foundation, the independent charitable and philanthropic arm of Aetna, today announced they are teaming up to evaluate which communities across America are doing the best job of improving the health of their citizens. The new U.S. News/Aetna Foundation Healthiest Communities project, coming in 2018, will feature in-depth reporting, analysis and research highlighting communities that are producing better health results through innovative partnerships, programs and policies.
“For more than 25 years, U.S. News has measured health care quality in the U.S. in order to improve it,” said Brian Kelly, editor and chief content officer of U.S. News. “Similar to what we’ve accomplished with our Best Hospitals and Best Children’s Hospitals rankings, we are going to evaluate how cities and counties decrease chronic disease, keep people out of the hospital, provide access to health care and ultimately lower costs. Our findings will allow communities to learn from each other and improve their efforts.”
“Our mission is to promote wellness, health and access to high-quality care for everyone,” said Garth Graham, MD, MPH, president of the Aetna Foundation. “Working with U.S. News on the Healthiest Communities project will allow us to shine a light on communities and the steps they are taking to improve the health of individuals and families. We hope this accelerates change in the way communities think about and pursue improvements in public health.”
U.S. News will host a special panel discussion on “Building Healthy Communities” at its annual Healthcare of Tomorrow conference, taking place November 1-3, 2017 at the Renaissance Downtown Hotel in Washington, DC. For more information about the conference or to register, visit usnewshot.com.
Healthiest Communities is the third multimedia platform developed by U.S. News to showcase how government leaders and public policies best serve their citizens.. U.S. News unveiled Best States in 2017 and Best Countries in 2016.
U.S. News & World Report is a digital news and information company that empowers people to make better, more informed decisions about important issues affecting their lives. Focusing on Education, Health, Personal Finance, Travel, Cars and News & Opinion, USNews.com provides consumer advice, rankings, news and analysis to serve people making complex decisions throughout all stages of life. More than 30 million people visit USNews.com each month for research and guidance. Founded in 1933, U.S. News is headquartered in Washington, D.C.
About The Aetna Foundation
The Aetna Foundation is the independent charitable and philanthropic arm of Aetna (NYSE:AET). As a national health foundation, we promote wellness, health, and access to high-quality health care for everyone. This work is enhanced by the time and commitment of Aetna employees, who volunteered 430,000 hours in 2016 alone. For more information, visit www.aetna-foundation.org
Aetna opened its first Mindfulness Center in its Hartford, Connecticut, headquarters this week. The center will help Aetna associates learn and engage with mindfulness and aim to change workplace culture.
“This is igniting the transformation. We’re going to be offering programs and trying to gradually change the workplace culture,” said Andy Lee, the chief mindfulness officer at Aetna. “Stress affects all companies. Mindfulness is an effective way to provide people with the tools to help manage their stress.”
From left to right: Cheryl Jones, director of mindfulness at Aetna; Andy Lee, chief mindfulness officer at Aetna; and Cheryl DuBois, a senior project manager and mindfulness advocate at Aetna. | Eric Vo
Mindfulness is paying attention or noting whatever is happening in the moment with a gentle and open mind. It’s about being present in the moment.
Aetna employees participate in a mindfulness exercise in the company’s Mindfulness Center in Hartford, Connecticut. | Eric Vo
Richard Watson, manager of Wellness and Fitness at Aetna, said mindfulness is an integral part of the company’s well-being strategy.
“We are excited to have the Mindfulness Center open in Hartford. Building state-of-the-art well-being facilities sends a powerful statement to our employees, customers and the community that we are committed to building a healthier world,” Watson said. “The Mindfulness Center is a part of unique resources that helps create a supportive, healthy work environment to help our employees achieve their health ambitions.”
Aetna employees visit the Mindfulness Center in Hartford, Connecticut. | Eric Vo
Aetna’s Mindfulness Center, which opened on June 1, 2017, will give people the opportunity to participate in mindfulness activities and learn how to incorporate the exercises in their everyday life. In the beginning, activities will be held three to four times a week. Eventually, Lee said, the center will host external speakers and courses.
For those that don’t work in the Hartford location, they can attend programs at the Mindfulness Center virtually.
The Mindfulness Center at Aetna’s Hartford, Connecticut, location. | Eric Vo
Opening the Mindfulness Center was a project that took over a year. Its opening signifies Aetna’s commitment to mindfulness.
“It’s a part of the company’s broader strategy,” said Cheryl Jones, the director of mindfulness at Aetna. “We’re evolving beyond the mindfulness-based wellness programs and aiming to create a workplace culture of well-being.”
In 2011, Aetna began offering mindfulness-based programs to associates. Those programs produced more than a 35 percent decrease in perceived stress. Participants also reported a 20 percent improvement in sleep.
In 2016, Aetna launched its first Mindfulness Challenge, which yielded significant interest among the workforce, Lee said. The company will also start another challenge in 2017 to coincide with the opening of the Mindfulness Center.
About 450 million people in the world suffer from a mental health condition. Mental health disorders are among the leading cause of ill health and disability worldwide. Despite this, mental health conditions remain poorly understood.
With one in five people in the world estimated to be affected by a mental health condition at some point in their lives, it’s important to know how to identify emotional suffering and what can be done to be healthy.
In March 2015, the Campaign to Change Direction—a national initiative to change the culture of mental health in America—started. Aetna is a founding partner of the campaign, which encourages people to learn the five signs of emotional suffering to help those in need receive the support they deserve. Emotional health is just as important as physical health and together, we’re joining millions to make a difference.
Eating a well-rounded diet, sleeping enough and being active are activities that are important and critical to mental health.
Regular checkups for emotional well-being is as important as physical exams and dental appointments. Talk with your doctor, a counselor, a faith-based leader, family and friends to make sure you’re doing well emotionally.
Engage and connect wisely
Pay attention to relationships in your life to see if any are unhealthy.
Stress can heavily impact a person’s health. Left untreated, stress can make existing problems worse and cause other disease and conditions, according to the American Psychological Association. Find ways to help you reduce stress. Learn what works best for you: meditate, run, knit, dance, sing, write, walk, etc.
In 2017, Aetna Behavioral Health released Get Ahead of StressSM, a product that helps people reduce their stress and take better control of life’s circumstances. Available to everyone, Get Ahead of Stressgives people the opportunity to speak with a Life Balance Advisor to create a personalized de-stressing plan from the comfort and privacy of home. Unlimited access to the Resources for Living website is also available to anyone who signs up.
Aetna Behavioral Health also released the MindCheckSM online tool in 2016 to help people get a quick read on their emotional health. Also available to everyone, this online tool asks four simple questions and matches people to a color and level of distress to provide insight into their emotional health. They can learn how to maintain a positive outlook and find tips, articles and videos on a variety of topics such as relationships, fitness and nutrition, and more. An app version is available for download at no cost for AndroidTM and iPhone® mobile devices.
A pilot between Aetna and the United Parcel Service (UPS) found that employees on short-term disability who completed an online pain assessment and participated in pain management programs for several weeks had a 50 percent higher return-to-work rate and 22 percent shorter duration of disability.
The pilot, which took place in 2016, allowed Aetna to analyze UPS’ disability claims. Six musculo-skeletal diagnoses were flagged. If a claim was submitted with one of the diagnoses, a nurse would provide members with more information on their disability and alternative ways to manage pain.
Dr. Mike Lacroix, associate medical director for Aetna’s Disability and Absence Management Services, said opioids can be prescribed to people who are on disability to manage their pain. If prescribed in high doses, Lacroix added, opioids can lead to chronic pain and result in a longer duration of disability.
“Studies have shown repeatedly that the longer people are on disability, the less likely they are to return to work,” Lacroix said. “What tends to happen when people get off work is they start to be more sedentary. As they’re more sedentary they can become depressed.”
Knowing this, Aetna aimed to educate doctors and members on diagnosis-related pain and how they can best cope with it
If one of the six flagged diagnoses were included in a disability claim, the member would be told about PainCAS, a web-based tool that assesses pain and risk of opioid addiction. Members would answer a series of questions and receive a report detailing the factors behind their diagnosis, Lacroix said. And if they were interested, the member could also access painAction, which offers mobile programs and tools to manage pain.
In principle, educating people on their diagnosis should allow them to better understand what could be contributing to their pain so they would be less dependent on opioids.
“This particular tool is useful and we can use it to educate folks and help them better understand their particular issues and how to better deal with them,” Lacroix said.
Those who used the mobile programs experienced 28 fewer days of disability on average, compared to the one-third of members who did not participate in the pilot. They also had a 30 percent lower migration rate from short-term disability to long-term disability.
“Effective patient-doctor communications are a key factor in making sure that every person — whether in a crisis or not — gets whatever help he or she needs to enjoy optimum care,” said Marty Strang, RN, CCM, WELCOA® Certified, director of clinical strategy analysis for Aetna National Accounts. “The pilot with Aetna and UPS improved patient-doctor communications and the process related to administering and documenting patient pain and opioid risk assessments.”
The PainCAS and painAction tools have also been validated with patients in medical offices and clinics, and Aetna is now looking at further studies.
Aetna will expand televideo to self-insured plans in every state in the United States, increasing access to behavioral health services and resources.
“Access to quality behavioral health services is critical to our members’ wellbeing, as well as their overall physical health,” said Hyong Un, M.D., chief psychiatric officer for Aetna. “Having televideo-based mental health services is just another example of our continued effort to improve access and provide choices to our members in how they access behavioral health services.”
Televideo counseling services are currently offered through Aetna Resources for Living and to fully-insured behavioral health members in 34 states that mandate coverage.
Fully-insured and self-insured plans are two different ways to pay for health benefits. In a fully-insured plan, an organization pays a premium to an insurance company, which covers claims by employees. In a self-insured plan, the organization pays for employee claims and the insurance company (Aetna) administers their plan.
The expanded televideo service will be made available to self-insured plan sponsors who have a behavioral health benefit with Aetna starting Oct. 1, 2017. There is no change in benefit structure or cost. A plan sponsor can opt out if they believe televideo is not a good fit.
Televideo, or telemedicine, involves having a remote patient-doctor consultation through technology, such as videoconferencing on a smartphone, tablet or computer. The service offers convenience and is attractive to people with busy schedules, for rural residents or for the sick or elderly that can’t travel easily.
The expanded televideo services will be provided through Arcadian Telepsychiatry, Inpathy and MDLive. The providers will use the American Telemedicine Association guidelines to assess whether televideo services are clinically appropriate for the member.
“We are looking for these services not to just meet the needs in underserved areas, such as rural or frontier locations where behavioral health resources are limited, but also as a strategy to increase access in urban areas, where traffic, parking and long work hours are barriers to access,” said Mark Friedlander, M.D., M.B.A., chief medical officer for Aetna Behavioral Health. “These services may also increase the likelihood of members engaging more actively with professional help.”
Since August 2016, Aetna has seen a 7 percent reduction in the rate of monthly opioid prescriptions among its commercial pharmacy membership. There has also been a 5 percent reduction in the rate of monthly opioid prescriptions among its Medicare Advantage pharmacy membership.
The decrease in prescriptions are a result of several company-wide efforts to fight the opioid epidemic in the United States.
One of those efforts is an initiative Aetna launched in 2016, when letters were sent to nearly 1,000 doctors, who were identified as being “super-prescribers” of opioids. They worked in various specialties and prescribed opioids at a higher rate than their peers.
In 2017, the company initiative by identifying and sending letters to 480 super-prescribing dentists and 249 super-prescribing oral surgeons in the U.S. Dentists were considered super-prescribers if they wrote more than four prescriptions for more than a 7-day supply over the past two years, based on Aetna’s claims data. Oral surgeons, who typically treat more severe conditions, were considered super-prescribers if they wrote more than five prescriptions for more than a 7-day supply over the past year.
“Dentists and oral surgeons are second only to family physicians when it comes to prescribing opioids, and are the leading prescribers of opioids to children ages 10-19,” said Harold L. Paz, M.D., M.S., executive vice president and chief medical officer for Aetna. “We strongly believe that dentists and oral surgeons want to act in the best interests of their patients. Aetna is using its considerable data resources to help clinicians understand how their prescribing patterns compare to their peers and to established guidelines. This will enable them to reduce misuse and abuse and prevent the diversion of unused pills which represents a major driver of the opioid epidemic.”
The dentist letters, which were signed by Dr. Paz and Mary Lee Conicella, DMD, FAGD, chief dental officer for Aetna, provides a link to the Pennsylvania Dental Association’s guidelines on prescribing opioids for dental pain.
Letters sent to oral surgeons were signed by Dr. Paz, Dr. Conicella and Douglas W. Fain, DDS, M.D., FACS, president of the American Association of Oral and Maxillofacial Surgeons. The letter contains a link to the Minnesota Dental Association’s protocol for assessment and treatment of oral and facial pain.