Aetna Behavioral Health Insights™ Behavioral health newsletter

aetna.com 48.22.800.1 Q (11/18)

Inside this issue Changes to our precertification list . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

New stats open up treatment discussion for ADHD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

2018 Behavioral Health Summit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

Don’t let your network status change — complete your FDR attestation today. . . . . . . . . . . 6

2018 Treatment Record Review (TRR) results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

Resources for better health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

For more information, or if you need to contact us . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

Aetna is the brand name used for products and services provided by one or more of the Aetna group of subsidiary companies (Aetna). Aetna Behavioral Health refers to an internal business unit of Aetna. The EAP is administered by Aetna Behavioral Health, LLC. In California for Knox-Keene plans, Aetna Health of California, Inc. and Health and Human Resources Center, Inc.

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Changes to our precertification list

Starting January 1, 2019, the following services will no longer require preauthorization:

• Outpatient detoxification(ambulatory withdrawal management)

• Psychological/neuropsychological testing

• Intensive outpatient

If you have questions:

• For HMO plans and Medicare Advantage plans, call1-800-624-0756 (TTY: 711).

• For all other plans, call 1-888-MDAetna (1-888-632-3862)(TTY: 711).

• You can also reach us online.

Visit aetna.com for more information on services requiring precertification and for electronic precertification information.

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New stats open up treatment discussion for ADHD Each year, a large number of children and teens are diagnosed with attention-deficit/hyperactivity disorder (ADHD). It’s important for our providers to monitor and treat this condition according to evidence-based guidelines. We’ve adopted the American Academy of Pediatrics (AAP) clinical practice guidelines. These guidelines focus on the diagnosis, evaluation and treatment of ADHD in children and teens.

For children taking ADHD medicine, the guideline recommends regular visits with a prescribing provider, including follow-up:

Within 30 days of the first prescription fill

Two more times within nine months of the first visit

One of these visits can be a telephone or televideo visit.

Children with ADHD need more care

A 2018 Journal of Clinical Child & Adolescent Psychology study found that in the United States, about 6.1 million children from ages 2 to 17 were diagnosed with ADHD in 2016. About 30 percent were not taking their medicine. Almost half had not received any behavioral health treatment. Many also had a co-occurring disorder.

6.1M

children from ages 2 to 17 were diagnosed with ADHD in 2016.

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2x

Help kids get the treatment they need:

• Caring for Children with ADHD: A Resource Toolkit for Clinicians

• Centers for Disease Control and Prevention (CDC) ADHD data and statistics page

• CDC ADHD resources

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2018 Behavioral Health Summit Role of the health company in suicide prevention On June 7, 2018, we held our eighth annual summit, which focused on suicide prevention. Our expert speakers shared engaging and relevant information on the role of the health company in suicide prevention.

Speaker and position Discussion points

Mark Friedlander, MD, MBA Chief medical officer of Aetna® Behavioral Health

• Suicide prevention needs to be a focus for Aetna.

• Suicide is a top ten cause of death and is likely in the top two for Aetna Student Health.

Christine Moutier, MD Chief medical officer of American Foundation for Suicide Prevention

• Suicide rates have been climbing since 1999, with about 45,000 suicides annually in the U.S.

• Individual, social and cultural factors can create risk for or protection against suicide.

• Formal suicide risk assessments will be helpful in meeting the goals of assessing risk.

Michael F. Hogan, PhD Operates Hogan Health Solutions, a consulting practice in health and behavioral health care

• In suicide care, people don’t slip through the gaps; they weave through the holes in our system.

• There are about two years between the first ideation and the ability to actually make an attempt.

• Screening helps us look at who has high risk and what we can do to reduce that risk.

Brian K. Ahmedani, PhD Director of psychiatry research at Henry Ford Health System

• Zero suicide begins with identifying who is most at risk in health care systems.

• We need high-intensity interventions for those at highest risk, coupled with a focus on those at lower risk, to attain goal of zero suicide.

Richard McKeon, PhD, MPH Current chief, Suicide Prevention Branch, Substance Abuse and Mental Health Services Administration (SAMHSA)

• The two main reasons the health system is unable to do better for this population: organization and reimbursement.

• There’s diffusion of responsibility — many providers don’t feel responsible for care that doesn’t occur in their setting.

• Transition from ER or inpatient is the most at risk, so connecting to outpatient care needs to occur rapidly.

Michael Schoenbaum, PhD Senior adviser for mental health services, epidemiology and economics for National Institute of Mental Health

• To be better at finding those needing help, consider tracking mortality and adapt protocols to manage suicide risk.

• Parity means we should treat behavioral health conditions the same way we treat medical problems, report data and measure outcomes.

Hilary P. Blumberg, MD Professor of psychiatry, radiology and biomedical imaging in the Child Study Center, and director, Mood Disorders Research Program, at Yale School of Medicine

• The future is hopeful as we learn more about the brain and the connection to suicidality.

• Brains can change very quickly; we’re seeking to understand those changes and how to interrupt the change toward suicide.

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Don’t let your network status change — complete your FDR attestation today If you provide services to our Medicare and/or Medicare-Medicaid plan (MMP) members, you must meet the Centers for Medicare & Medicaid Services compliance program requirements for first tier, downstream and related (FDR) entities. You also have to confirm your compliance with these requirements through an annual attestation.

How to complete your attestation

You’ll find the resources you need to ensure your compliance on the Medicare Compliance FDR Attestation page of aetna.com.

1 Once on the page, click “See our Medicare compliance FDR program guide” or “See our office manual” under “Need more information on the Medicare FDR program?”

2 Once you review and ensure you’ve met the requirements, you’re ready to complete your attestation. Simply click the 2018 Medicare Compliance FDR Attestation link on the page and follow the instructions.

A single annual attestation meets all of your Aetna, Coventry and/or MMP compliance obligations.

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Where to get more information

If you have compliance-related questions not addressed in our guide, just call us at 1-800-624-0756 (TTY: 711) or review the FAQs. If you’re an MMP-only provider, you can email us at medicaidmmpfdr@aetna.com.

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2018 Treatment Record Review (TRR) results Aetna Quality Management performs the annual TRR to provide feedback about outpatient behavioral health practitioner performance. We also use the TRR process as a quality review. Our goal is to help facilitate practitioner communication, collaboration and education.

National results improve from last year

In 2018, we conducted TRR audits on 71 records from across the country. Our target in 2018 was 85 percent. This year, the average score was 87 percent — 3 percentage points above the 84 percent average score in 2017.

Results show room for improvement

In 2018, the following questions fell below the 85 percent target:

Audit question Result

Is there documentation to reflect that the provider requested the member’s permission to communicate with the primary medical practitioner?

43%

If the member did grant permission, is there documentation that the provider communicated with the primary medical practitioner?

59%

If there is documentation about other behavioral health specialists or consultants treating the member, is there documentation to reflect the provider requested the patient’s permission to communicate with the other behavioral health specialist or consultant?

37%

Does the documentation include a discharge plan? 61%

Is there documentation of member education regarding the risks and benefits of the prescribed medications and of the member’s understanding of information?

56%

Is there a substance abuse assessment for all those over 12 years of age and a history, including substances used, amount, frequency and prior treatment history?

84%

For children and adolescents, is there a developmental history that could include prenatal and perinatal events, physical, psychological, social, intellectual, academic and educational history?

81%

Next steps

We sent result letters in August 2018 to practitioners who participated

in the TRR process.

Check out our TRR best practices

Review the Behavioral Health Provider Manual for our TRR best practices. Or you can request a provider sample form

via email at qualityimprovement2@aetna.com.

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Resources for better health We offer several online tools to help your patients feel better and be more productive.

MindCheck® tool: Getting a quick read on

emotional health and learning the five signs of suffering is easy.

Patients can also download the app at no cost. It’s available for AndroidTM

and iPhone® mobile devices.*

Patient care programs and quality assurance:

Programs and care services that support total health —

mind, body and spirit.

Assess Wellbeing website: Patients can take short depression

and anxiety self-assessments. Quick tips can also help to

boost their mood.

*Android is a registered trademark of Google LLC. iPhone is a trademark of Apple Inc., registered in the U.S. and other countries.

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For more information, or if you need to contact us Online

Access our provider website on NaviNet® through our public website. Once there, select “Providers,” then “Login.” Already registered? Go to connect.navinet.net.

To access the Aetna Behavioral Health and employee assistance program page:

• Log in to NaviNet®.

• Go to “Workflows” in the upper left menu and select a health plan.

• Select “Aetna Benefits Product guide” on the right under “Resources.”

By phone

• For general questions about Aetna Behavioral Health, call 1-888-632-3862 (TTY: 711).

• For HMO-based and Medicare Advantage plan claims, benefits, eligibility, precertification, case management or demographic changes, call 1-800-624-0756 (TTY: 711).

• For all other plan claims, benefits, eligibility, precertification, case management or demographic changes, call 1-888-MDAetna (1-888-632-3862) (TTY: 711).

• If you have questions about joining our Aetna Behavioral Health network, call 1-800-999-5698 (TTY: 711).

• For the employee assistance program call center, call 1-888-238-6232 (TTY: 711).

By mail

Aetna Behavioral Health 1425 Union Meeting Road PO Box 5 Blue Bell, PA 19422

Learn more about our behavioral health programs today. Or call us at 1-888-632-3862 (TTY: 711).

This material is for informational purposes only and is not medical advice. Health benefits and health insurance plans contain exclusions and limitations. Information is believed to be accurate as of the production date; however, it is subject to change.

aetna.com ©2018 Aetna Inc. 48.22.800.1 Q (11/18)