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Aetna Better Health® Disability Rights Consortium Meeting Jacqleen Musarra Community Liaison Manager June 27, 2012

1. Aetna Better Health® Disability Rights Consortium Meeting Jacqleen Musarra Community Liaison Manager June 27, 2012. About Aetna Better Health. Medicaid business unit owned by Aetna, Inc. Twenty-three (23) years of experience as a Medicaid Managed Care leader nationally

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Aetna Better Health® Disability Rights Consortium Meeting Jacqleen Musarra Community Liaison Manager June 27, 2012

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  2. Aetna Better Health®Disability Rights Consortium MeetingJacqleenMusarraCommunity Liaison Manager June 27, 2012

  3. About Aetna Better Health • Medicaid business unit owned by Aetna, Inc. • Twenty-three (23) years of experience as a Medicaid Managed Care leader nationally • Serving Families and Children, Aged, Blind and Disabled, Long Term Care, Medicare/Medicaid Enrollees • Manage services for more than 1.3 million Beneficiaries in twelve (12) states

  4. What is the Illinois Integrated Care Program (ICP)? • A Medicaid program designed to link primary, specialty, institutional and community services focused on improving quality through coordination, pay for performance and creation of health homes • Members choose or are automatically assigned a health plan with either Aetna Better Health or IlliniCare Health Plan and receive Medicaid services through those health plans • Persons who are aged, blind and disabled (ABD) in suburban Cook (non-606 zip codes), Will, Dupage, Kane, Kankakee and Lake counties

  5. Integrated Care Service Packages Responsibilities of Aetna Better Health will include all covered services currently funded by Medicaid through the State Plan or waivers, and will be phased in as follows: Service Package I: All medical, pharmacy, dental and behavioral health services for the member. This includes all non-long term care services, mental health services, alcohol and substance abuse services and short term post-acute rehabilitation stays in nursing facilities. Service Package II: Nursing facility services and services provided through the Home and Community Based Services waivers, except those waivers serving individuals with developmental disabilities. Service Package III: Home and Community Base Services Waiver services for individuals with developmental disabilities and ICF/DD services

  6. Integrated Care Management Guiding Principles Focus on each individual member (consumer directed) Work with members and providers to address medical, behavioral, social, and long-term care needs Partner with the member and/or caregiver to maximize the member’s self management ability Enhance quality of care outcomes Support member’s choice of community living

  7. Aetna Better Health of Illinois Overview

  8. Community-Based Integrated Care Team • 30out of 84employees are responsible for direct care coordination • 16Care Coordinators - licensed clinicians; clinical social worker or RNs • 14 Care Management Associates - individuals with medical or behavioral health experience; know the community • 11Provider Representatives – education and support for providers relative to all service issues • 1 Community Liaison Manager – interact with advocates, community and supportive agencies

  9. Pay for Performance and Quality Measures • Illinois Department of Healthcare and Family Services (HFS) will hold Aetna accountable for thirty (30) distinct quality measures including: • Behavioral health assessment within 60 days of enrollment and 30 day follow up for patients with a finding • 7 day follow up after hospitalization for mental illness • Annual Influenza Immunization • Increased use of Diabetes care therapies • Increased use of Congestive Heart Failure therapies • Increased use of Coronary Artery Disease therapies • ER visits per 1,000 patients • Hospital in-patient visits per 1,000 patients • In-patient Hospital re-admission

  10. ICP Status as of June, 2012 Aetna Better Health Members: 18,054 • Total ICP enrollment: 35,768 Aetna Better Health Network Providers • 58 Hospital and Specialty Hospitals • 2,180Primary Care Providers • 3,709Specialists • 38Community Mental Health Centers (CMHC)

  11. Contracted Hospitals (as of June, 2012)

  12. Contracted Hospitals (as of June, 2012)

  13. Contracted Hospitals (as of June, 2012)

  14. Service Package 2: Aetna’s Long-Term Care Principles Assist members and their families with the resources they need to live in the community Provide members their choice of settings and allow them to direct their own care to the greatest extent possible Create a long-term support program that offers access to community-based options Creates a long-term care system that is financially sustainable and better aligns incentives across the system

  15. The Member’s Voice in the Health Plan: Member Advisory Council • Participants include members, family members, advocates and providers • Quarterly meetings scheduled with the first meeting held in October, 2011 • Agenda:Council members draft agenda items; discuss and provide Aetna feedback on issues ranging from network adequacy to customer service

  16. Contact Information JacqleenMusarra Community Liaison Manager Aetna Better Health of Illinois 312-821-0583 musarraj@aetna.com

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