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Aetna CMO: Harness the power of scale to cut costs, improve outcomes


Supporting better care today

In addition to working with healthcare providers, Aetna and Humana have both developed clinical programs that are filling current gaps in care, particularly with the Medicare population. The Humana at Home program sends care managers to accompany seniors to medical appointments and also check that medications are taken correctly. The program also provides home-based technology that tracks blood pressure, weight changes and more--even motion around the house--so changes in health conditions are quickly detected. Beyond simply providing healthcare, they also arrange for social services like transportation and groceries. By providing this care at home, Humana is keeping its members out of the hospital with 42 percent fewer hospitalizations and 56 percent fewer hospital readmissions.

Aetna's Compassionate Care Program supports people with advanced illness by giving them access to hospice care earlier and allowing people to continue receiving curative care while in hospice. Our nurse case managers receive special training in advanced illness and palliative care issues and frequently help address concerns that may be difficult to share in a face-to-face setting.

The Aetna Medicare Advantage members in the care management portion of our program have seen 82 percent reduction in days spent in a hospital receiving acute care; 86 percent reduction in days spent in Intensive Care Units; and 77 percent reduction in ER use, according to research published in Health Affairs. We also typically see a drop of about $13,000 in healthcare costs for each person in our program as a result of our members receiving the most appropriate care at the right time, as noted in a Wall Street Journal article.

With approximately 11,000 baby boomers aging in to Medicare every day and an expected shortage of as many as 90,000 physicians by 2025, according to the Association of American Medical Colleges, delivering this type of support will be essential to maintain the health of the Medicare population. With the combined capabilities of both companies, Aetna and Humana can also use their experience with the Medicare population to create similar programs for people with the most common and costly chronic health conditions, such as diabetes, asthma and congestive heart failure. We will provide better-coordinated, higher-touch, holistic care to our members through health solutions tied to a person's specific health and life situation.

Creating more healthy days

These programs demonstrate tangible ways that Aetna and Humana have already helped improve care on their own. Our combined clinical knowledge and capabilities will advance these programs and allow us to innovate collaboratively with more healthcare professionals. Most importantly for me, and the more than 4,000 clinicians at Aetna, is our enhanced ability to help people have more healthy days.

We all got into healthcare to make a difference and improve people's health, and our combined company has an unparalleled opportunity to do that for more people. Aetna welcomes the chance to talk with any healthcare system interested in accelerating its own move to value-based care and making it easier for patients to get the care they need.