Prioritizing members’ overall needs – including the time and resources needed to get and stay healthy – Aetna has launched Aetna 360TM Behavioral Health. Through this approach, which launched May 1, 2019, Aetna partners with behavioral health and substance use disorder treatment facilities to coordinate care for members, collaborate on holistic discharge planning and provide support for members and their families during treatment and upon discharge.
“Our focus is on how we can help, rather than limiting members to a number of days or conducting traditional reviews,” said MaryEllen Schuman, Director, Clinical Health Services, Aetna Behavioral Health. “This new approach incorporates both a member’s physical and behavioral health, along with any social determinants of health, to ensure we develop a comprehensive, long-term plan that helps them attain and maintain their optimal health.”
Aetna 360 Behavioral Health combines and builds on a pair of recent programs, Member Care Coordination (MCC) and Utilization Management Transformation (UMT). Both programs, which began in late 2017, led to lower readmission rates, higher ambulatory follow-up rates for mental health visits and high engagement and satisfaction rates among members, caregivers and providers.
Under Aetna 360 Behavioral Health, partnering facilities, as well as members and their caregivers, have a single point of contact with Aetna Behavioral Health. The assigned 360 Care Advocate collaborates with the facility to understand the member, family and caregiver’s needs, and then directly with members and caregivers when needed, both during and after discharge. The 360 Care Advocate is supported by a team at Aetna which includes medical, pharmacy, Resources for Living® and others.
“The 360 Care Advocates work behind the scenes to collaborate with providers to ensure members have the resources they need, and then directly with members, family and caregivers to ensure they have access to everything from a primary care provider and transportation to an appointment, to a support group or daycare if they are a caregiver,” said Lynn Watson, Manager, Clinical Health Services, Aetna Behavioral Health. “They also link members to peer support services, several digital resources and community support services to enhance their care and service.”
The 360 Care Advocates collaborate with members’ medical and behavioral health outpatient providers as needed and provide specific resources to caregivers to ensure they can help members navigate the health care system.
At launch, 304 facilities are partnering with Aetna to implement Aetna 360 Behavioral Health. These partnerships extend the successful work that began under the previous pilots.
“We deal with a sick population, but Aetna has been right there with us,” explained Peter Schorr, President and CEO, Retreat Behavioral Health, which operates several substance use disorder and mental health treatment centers, about MCC. “Aetna ensures patients are provided with the stays that they need. It feels good to be trusted and not fight over reviews.”
Facility staff have also benefited from Aetna’s behavioral health initiatives.
“Both our patients and staff view Aetna as an ally that is helping us to tear down barriers to treatment and recovery,” notes Jay Crosson, CEO, Cumberland Heights Foundation, an alcohol and drug treatment center in Tennessee. “The Member Care Coordination program was a real positive mindset change for everyone.”
Aetna will continue to expand the number of partnering facilities implementing Aetna 360 Behavioral Health. Aetna 360 Behavioral Health is currently for Aetna Commercial members of all ages.