CMSA Today - Issue 4, 2014 - (Page 23)

Q&A An Interview with Aetna's Jennifer Sinni Interview by Cheri Lattimer, RN, BSN I n January 2012, Aetna, one of the nation's leading diversifi ed health care benefi ts companies, launched the Aetna In Touch CareSM program, a new option in care management that gives members more personalized care support, tools, and programs to engage them early and keep them motivated. The program includes two options for customers to select. The Regional Premier In Touch Care model provides members with specialized acute and chronic care management. The National Customer Care Unit In Touch model provides expanded, comprehensive care management from prevention to post-acute care. Regional Premier ITC currently serves more than 100,000 members. The National Customer Care Unit currently serves more than 2 million members. CMSA Executive Director Cheri Lattimer, RN, BSN, recently had the opportunity to interview Jennifer Sinni, RN, BSN, MSN, CCM, with Aetna, where she works as the supervisor within Regional Premier In Touch Care. Sinni is a relative newcomer to the fi eld of case management, having started at Aetna in 2005 in the commercial sector after receiving a BSN degree from Temple University and an MSN degree in Leadership and Management of Health Systems from Drexel University. In December 2011, Sinni obtained her Case Management Certifi cation, and in September 2011 she assumed a supervisor position of the Custom Care Management Unit and Regional Premier In Touch Care team, where she aided in the launch and implementation of the program. As a current supervisor, she continues to assess and manage the needs of both the team and the program itself on a daily basis. Read more about Sinni's work with the program below. CMSA EXECUTIVE DIRECTOR CHERI LATTIMER, RN, BSN (CL): WHILE YOU WERE IN NURSING SCHOOL, OR SHORTLY AFTER GRADUATION, WAS CASE MANAGEMENT A CAREER GOAL, OR WAS IT EVEN ON YOUR RADAR? Jennifer Sinni, RN, BSN, MSN, CCM (JS): I can honestly say I didn't have a goal that specifi c. I knew that I liked working with populations and I also liked the business end of nursing. I think the fi eld of nursing is so big, when you enter it; you're not sure where moves will take you. But, I always tried to keep my options open, and I did know some people in case management. Finally, the opportunity came along at a time that I felt comfortable making the move. I was still involved with clinical, even as I moved into the business component of case management. I think for all of us, it's an adventurous ride to get where we are; none of us really know where we will end up. CL: TELL ME ABOUT YOUR SIGNATURE PROJECT, THE AETNA IN TOUCH CARE PROGRAM. JS: It's a relatively new program which began in January 2012. It was preceded in 2011 by a similar program called the Custom Care Management program. We are now into its third year of delivering services. Jennifer Sinni, RN, BSN, MSN, CCM Essentially, it is a holistic program in that the model involves the patient, family, and a single nurse. The focus includes proactive identifi cation of at-risk individuals. Most programs of this type tend to be reactive and operate by providing information to patients after they have received a partiwOur focus on the other hand is to prevent events from occurring. The program operates over an algorithm that compiles all claims data (pharmacy, doctor, hospital, home care, etc.) Each month the algorithm allows us to stratify people into one of three tiers: 1. Low Urgency 2. Moderate 3. High Urgency Patients that are classifi ed in the low state are independent, generally well, capable of self-educating, and navigate the health care system pretty well, so they are directed to the virtual care channel. Aetna Navigator (our online resource platform) makes a wide variety of tools available to these people to manage already-diagnosed conditions, and these tools are fully integrated with our Care Management platform called Aetna Total Clinical View. The moderate group needs a higher level of interaction, which includes calls from our team to make appointments and assist in a variety of ways. This group is similar to the people we would typically see in a disease management program, but also includes those at a higher risk for an avoidable inpatient admission. Our goal with the moderate group is to reach and engage them and to help them make changes through member-centric goals, as well as to modify conditions before they get worse. Issue 4 * 2014 CMSA TODAY 23

Table of Contents for the Digital Edition of CMSA Today - Issue 4, 2014

President’s Letter
President-Elect’s Letter
Cmsa Corporate Partners
Association News
Value-Driven Health Care
The Dmaic Six Sigma Approach
Motivational Interviewing
Q & A
Medication Non-Adherence
Index of Advertisers

CMSA Today - Issue 4, 2014