The Health Section

Texas Health Aetna: Improving member experience, quality of care

Since its creation in 2017, Texas Health Aetna has worked to transform member experience, while also improving end-to-end coordination between clinicians to deliver better outcomes at lower costs for the Dallas-Fort Worth (DFW) community.

The Texas Health Aetna joint venture is built on Texas Health Resources’ providers and investment in population health management and Aetna’s health plan expertise, robust technology infrastructure and digital strategies, and sophisticated analytical insights. The plan serves employers and consumers in 16 North Texas counties.

Genevieve Caruncho-Simpson, chief operations officer of Texas Health Aetna, said the joint venture continues to explore ways to provide quality care and make it easier for members of the Dallas-Fort Worth community to manage their health.

In September 2017, Texas Health Aetna released the “Texas Health Aetna ER Doc*” app, which allows certain members to contact a participating emergency room doctor 24/7 without any cost for the virtual visit.

The app increases access while also lowering health costs by permitting members to receive treatment and care for non-emergency** medical issues instead of going to an emergency room.

“We found there’s a real opportunity to deliver better care outside costly ER facilities,” Caruncho-Simpson said. “Through our relationship with Acute Care Transitions, independent ER doctors who are part of the Texas Health Resources’ emergency departments can text or video chat with members to see whether their issues can be quickly addressed without an expensive trip to the emergency room.”

For members with chronic conditions, Texas Health Aetna creates local care teams focused on helping members reach their health goals. The teams are made up of a medical director, nurse, social worker, pharmacist, diabetes educator and other providers to support members. These teams work within the community, and partner with Texas Health Resources’ primary care provider partners, ensuring better coordination among various clinicians and even offer home visits.

“With this new holistic care model, we’re partnering with our members and their families by providing our care management services closer to where they live,” Caruncho-Simpson said.

Texas Health Aetna has already seen successes and achievements, as membership growth accelerates with continued interest from employers, brokers/consultants, providers, and consumers who are excited by the innovative, local solutions that Texas Health Aetna can bring to the DFW community.

While there have been early successes, Caruncho-Simpson emphasized Texas Health Aetna is ultimately about transforming the complicated health care experience through a more personalized engagement approach.  For example, each member who signs up receives a customized onboarding and welcome packet and video, along with access to a navigation center where they can speak with local nurses and customer service representatives. The aim, Caruncho-Simpson said, is to provide local, integrated services to make a member’s experience simpler – whether it is about their health plan or care experience.

While the average physician appointment wait time is 15 days or more, Texas Health Aetna members are offered next day or same day appointments with select primary care physicians who have opted into the plan. Additionally, Texas Health Aetna believes data is essential to providing quality care for members. Therefore, the company will integrate its existing claims data and use Texas Health Resources’ extensive network of hospitals and care facilities to access members’ clinical data to understand their health history and offer care options tailored to their needs.

*Access to the Texas Health Aetna ER Doc application is not included in all plans. To learn whether access to this application is included in your plan, please call the Member Services number on your ID card

**You should always call 911 for medical emergencies. A medical emergency is an event that you reasonably believe threatens your or someone else’s life or limb in such a manner that immediate medical care is needed to prevent death or serious impairment of health. A medical emergency includes severe pain, bad injury, a serious illness or a medical condition that is quickly getting muc