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Aetna International

CARE team plan helps member heal, save over $629,000

Dec 19 2016
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After a member was unable to heal properly following an amputation, Aetna International’s Care and Response Excellence (CARE) team worked with doctors to create a patient-centric treatment plan. The treatment improved the member’s quality of life, and led to a savings of £500,000 — or $629,897.50.

Desmond, whose name was changed to protect his privacy, is a 74-year-old diabetic living in London, England. As a lifelong smoker, he suffers from peripheral vascular disease (PVD).

PVD affects blood circulation by narrowing blood vessels, according to the World Health Organization. The condition occurs primarily in the legs, and there is a higher risk of amputation or infection for affected limbs. Tobacco use also increases the risk and severity of PVD by decreasing blood flow and increasing the risk of diabetes.

A common symptom of PVD is muscle cramping in the hips, thighs or calves when walking, climbing stairs or exercising, according to the American Heart Association. Other symptoms include foot or toe wounds that don’t heal, heal slowly or a decrease in temperature in lower legs compared to the rest of the body.

PVD affects blood circulation by narrowing blood vessels

Amputation

Because of the poor circulation in his legs, Desmond’s toe on his left leg had to be amputated. He also underwent an above-the-knee amputation on his right leg. Complications from PVD prevented his right leg from healing properly — which in turn prevented him from returning home.

Desmond’s doctor proposed another operation to reroute his femoral artery to allow blood flow to the area. The CARE team became involved after Desmond’s doctor requested authorization for the surgery.

A focus on patient-centric care

While discussing the pros and cons of the treatment plan, the group realized Desmond’s left leg also had poor circulation. The CARE team decided against the surgery to reroute his femoral artery and worked closely with Desmond’s doctor to create a patient-centric care plan.

With the care plan, Desmond was discharged from the hospital and a nurse visited him at home daily. At home, he received IV antibiotics and physical therapy.

Had Desmond undergone the surgery, his rehab and recovery time meant he would have had to stay in the hospital at least three months.

With his progress, Desmond qualifies for a prosthesis, which will give him the quality of life he desires.

An infographic detailing Aetna International's CARE team's treatment plan for a member, which led to a savings of over $629,000.

Savings

“A win-win situation”

The CARE team worked for about 10 hours on Desmond’s case. Working with the hospital and his doctor, the CARE team helped develop a care plan that avoided unnecessary surgery and led to a better outcome for Desmond, while at the same time saving $629,897.50, including the cost of the surgery and Desmond’s recovery and rehabilitation. The savings from the CARE team’s plan will help keep medical inflation down.

“We were able to save our member from having unnecessary surgery, which would have prolonged his stay in the hospital,” said Mitesh Patel, MD, a medical director for Aetna International. “He wanted to be at home with his family, and we were able to get him home — and healthier — sooner. We also achieved significant savings in the process. It was a win-win situation.”

Read more about other cases the CARE team was involved with, including a medical emergency evacuation in Mozambique and helping a member recover from leprosy.