Managed Care - November 2008 - (Page 19)

Health plans are evaluating whether to stop carving out drug benefits, disease management, and even behavioral health management looked back. The idea was to create a “holistic, member-centric way of acting,” says Laurie Brubaker, head of Integrated Health and Productivity Solutions. According to Brubaker, the company uses its claims database to stratify members into four segments: healthy or low risk, at risk for disease or injury, managing a chronic disease, and experiencing major and catastrophic health care events. Aetna Health Connections is the company’s disease management program. All this is pretty sophisticated, and Aetna prides itself on being ahead of the curve. “We have developed the leverage, through our technology, to build bridges across an entire spectrum of care,” says Brubaker, including behavioral health care and the complications associated with a number of chronic diseases. “It’s a seamless system between medical and pharmaceutical that improves quality, reduces costs, and offers payers a paradigm shift in how health care is delivered.” Integration of medical, pharmacy, and behavioral health data improves quality, says Laurie Brubaker, head of Integrated Health and Productivity solutions at Aetna. promotes what it calls its “CareEngine System” personal health record. What such plans offer purchasers is the ability to manage — not just treat — a chronic disease, interacting with patients in a personal and aggressive manner. The CareEngine System is a proprietary technology developed by ActiveHealth Management, Aetna’s own DM company for high-risk patients. The technology continuously scans an individual’s health data and claims information against medical literature and alerts members and physicians to “possible urgent situations and opportunities to improve care,” the company says. It integrates data from medical, pharmacy, and laboratory claims and is tied into the personal health record that a member can access and update with family medical histories. Aetna decided several years ago to bring most carved-out services back into a fully integrated delivery system — and the company really never Experience counts Integration is all well and good, says Al Lewis, president of the Disease Management Purchasing Consortium International, but DM uses protocols that were developed over time by vendors — and is still delivered, at least on the state and regional levels, more effectively by those with the most experience. “Without question there is a trend toward internal provision of DM by large health plans,” he says. “But we maintain a large database of outcomes, and it shows that outsourced vendors tend to do better. They provide better training and get better results. They already know all the tricks. In most cases they’ve been doing it for a much longer time.” And they remain a force to reckon with on a regional and state basis. The HIRC report stated that “regional health plans continue to embrace DM and continue to use vendors.” HIRC found that disease management organizations, excluding insourced programs, will have about $2.3 billion in revenue this year. Those are the plans marketed di- NOVEMBER 2008 / MANAGED CARE 19

Table of Contents Feed for the Digital Edition of Managed Care - November 2008

Managed Care - November 2008 Editor’s Memo Contents News and Commentary Legislation & Regulation Letters Medication Management Compensation Monitor Do It Yourself for Less Biomarkers Promise, but Do They Deliver? Oncologists Complain About Drug Payment Consider Blood Pressure Self-Monitoring Q&A: Keep Industry in the Game Formulary Files Plan Watch Tomorrow’s Medicine Outlook Respiratory Syncytial Virus Managed Care Considerations Contents Continuing Education Objectives RSV Disease in the Pediatric Population In the Trenches RSV Infection in the Adult Population Health Plan Medical Director Health Plan Pharmacy Director RSV Issues and Solutions Assessment/Evaluation/Certificate Request Post-Test

Managed Care - November 2008

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