Aetna Inc. AETNA BETTER HEALTH AETNA BETTER HEALTH® Doing the right thing for the right reason 1.

Aetna Inc.AETNA BETTER HEALTH

AETNA BETTER HEALTH®Doing the right thing for the right reason

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Aetna Better Health®Disability Rights Consortium Meeting

Jacqleen MusarraCommunity 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• 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

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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

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Integrated Care Service PackagesResponsibilities 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

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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

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Aetna Better Health of Illinois OverviewCycle of Care

Recovery

ResiliencyAutonomy

Working Relationship

Cycle of Care Management

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Community-Based Integrated Care Team

• 30 out of 84 employees are responsible for direct care coordination

• 16 Care Coordinators - licensed clinicians; clinical social worker or RNs

• 14 Care Management Associates - individuals with medical or behavioral health experience; know the community

• 11 Provider Representatives – education and support for providers relative to all service issues

• 1 Community Liaison Manager – interact with advocates, community and supportive agencies

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Pay for Performance and Quality MeasuresIllinois 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

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ICP Status as of June, 2012Aetna Better Health Members: 18,054• Total ICP enrollment: 35,768

Aetna Better Health Network Providers• 58 Hospital and Specialty Hospitals• 2,180 Primary Care Providers• 3,709 Specialists• 38 Community Mental Health Centers (CMHC)

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Contracted Hospitals (as of June, 2012)

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Aetna Better Health® of Illinois

Service Location Name County Service Location Physical Address City State Zip

CodeADVENTIST BOLINGBROOK Will 500 Remington Blvd. Bolingbrook IL 60440

ADVENTIST GLENOAKS DuPage 701 Winthrop Ave.Glendale Heights IL 60139

ADVENTIST HINSDALE DuPage 120 N Oak Street Hinsdale IL 60521ADVENTIST LAGRANGE Cook 5101 S. Willow Springs LaGrange IL 60525ADVOCATE CHRIST MEDICAL CENTER Cook 4440 West 95th Street Oak Lawn IL 60453ADVOCATE CONDELL HOSPITAL Lake 801 S Milwaukee Ave. Libertyville IL 60048ADVOCATE GOOD SAMARITAN HOSPITAL DuPage 3815 Highland Ave. Downers Grove IL 60515ADVOCATE GOOD SHEPHERD HOSPITAL Lake 450 West Highway 22 Barrington IL 60010ADVOCATE ILLINOIS MASONIC MEDICAL CENTER Cook 836 W Wellington Ave. Chicago IL 60657ADVOCATE LUTHERAN GENERAL HOSPITAL Cook 1775 Dempster St. Park Ridge IL 60068ADVOCATE SOUTH SUBURBAN HOSPITAL Cook 17800 S Kedzie Ave. Hazel Crest IL 60429ADVOCATE TRINITY HOSPITAL Cook 2320 E 93rd Street Chicago IL 60617AURORA CHICAGO LAKESHORE Cook 4840 North Marine Drive Chicago IL 60640CENTRAL DUPAGE HOSPITAL DuPage 25 N Winfield Rd. Winfield IL 60190DELNOR COMMUNITY HOSPITAL Kane 300 Randall Rd. Geneva IL 60134HOLY FAMILY MEDICAL CENTER Cook 100 N. River Road Des Plaines IL 60016JOHN H STROGER HOSPITAL OF COOK COUNTY Cook 1900 W Harrison St. G16 Chicago IL 60612JACKSON PARK HOSPITAL Cook 7531 Stony Island Avenue Chicago IL 60649KINDRED CHICAGO CENTRAL HOSPITAL Cook 2544 W Montrose Av. Chicago IL 60618KINDRED HOSPITAL CHICAGO Cook 365 E. North Avenue Chicago IL 60164



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CodeKINDRED HOSPITAL SYCAMORE Dekalb 225 Edward Street Sycamore IL 60178LORETTO HOSPITAL Cook 645 S Central Ave. Chicago IL 60644LOUIS A WEISS MEMORIAL HOSPITAL Cook 4646 N. Marine Dr. Chicago IL 60640MACNEAL HOSPITAL Cook 3249 S Oak Park Avenue Berwyn IL 60402MERCY HOSPITAL & MEDICAL CENTER Cook 2525 S Michigan Ave. Chicago IL 60616METHODIST HOSPITAL OF CHICAGO Cook 5025 N. Paulina Street Chicago IL 60640NORTHWESTERN LAKE FOREST HOSPITAL Cook 660 N Westmoreland Road Lake Forest IL 60045NORTHWESTERN MEMORIAL HOSPITAL Cook 251 E Huron St. Chicago IL 60611NORWEGIAN AMERICAN HOSPITAL Cook 1044 N Francisco Chicago IL 60622OAK FOREST HOSPITAL OF COOK COUNTY Cook 15900 S Cicero Ave. Oak Forest IL 60452OUR LADY RESSURECTION MEDICAL CENTER Cook 5645 West Addison Street Chicago IL 60634PALOS COMMUNITY HOSPITAL Cook 12251 South 80th Ave. Palos Heights IL 60463PROVENA MERCY MEDICAL CENTER - AURORA Kane 1325 N Highland Ave. Aurora IL 60506PROVENA ST. JOSEPH HOSPITAL - ELGIN Kane 77 N Airlite Street Elgin IL 60123PROVENA ST. JOSEPH MEDICAL CENTER - JOLIET Will 333 N Madison St. Joliet IL 60435PROVENA ST. MARY'S HOSPITAL - KANKAKEE Kankakee 500 W. Court Street Chicago IL 60615RESURRECTION MEDICAL CENTER Cook 7435 W. Talcott Avenue Chicago IL 60631RIVEREDGE HOSPITAL Cook 8311 Roosevelt Road Forest Park IL 60130RIVERSIDE HOSPITAL Kankakee 350 N Wall St. Kankakee IL 60901RML HEALTH PROVIDERS LTD. PARTNERSHIP DuPage 5601 S. County Line Road Hinsdale IL 60521ROSELAND COMMUNITY HOSPITAL Cook 45 W 111th Street Chicago IL 60628SACRED HEART HOSPITAL Cook 3240 W Franklin Blvd. Chicago IL 60624



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CodeSAINT JOSEPH HOSPITAL Cook 2900 N. Lake Shore Drive Chicago IL 60657

SAINTS MARY AND ELIZABETH MEDICAL CENTER Cook 1431 North Claremont Chicago IL 60622

SHERMAN HOSPITAL Kane 1425 N Randall Road Elgin IL 60123SILVER CROSS HOSPITAL Will 1900 Silver Cross Blvd. New Lenox IL 60451SOUTH SHORE HOSPITAL Cook 8012 S Crandon Ave. Chicago IL 60617ST. FRANCIS HOSPITAL Cook 355 Ridge Ave. Evanston IL 60202ST. MARY OF NAZARETH HOSPITAL Cook 2233 W Divison Street Chicago IL 60622

ST. JAMES HOSPITAL & HEALTH CENTERS - OLYMPIA FIELDS

Cook20201 S. Crawford Ave.

Olympia Fields IL 60461

ST. JAMES HOSPITAL - CHICAGO HEIGHTS CAMPUS Cook 1423 Chicago RoadChicago Heights

IL 60411

SWEDISH COVENANT HOSPITAL Cook 5145 N California Chicago IL 60625

UNIVERSITY OF ILLINOIS MEDICAL CENTER OF CHICAGO

Cook 1740 W. Taylor Street Chicago Il 60612

VHS WESTLAKE HOSPITAL INC. Cook 1225 West Lake Street Melrose Park IL 60160VISTA MEDICAL CENTER EAST Lake 1324 North Sheriden Road Waukegan IL 60085VISTA MEDICAL CENTER WEST Lake 2615 Washington Street Waukegan IL 60085WEST SUBURBAN MEDICAL CENTER Cook 3 Erie Court Oak Park IL 60302


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

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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

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Contact Information

Jacqleen MusarraCommunity Liaison ManagerAetna Better Health of [email protected]

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mailto:[email protected]

Aetna Inc. AETNA BETTER HEALTH AETNA BETTER HEALTH® Doing the right thing for the right reason 1.

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