Aetna Medicaid

Aetna MedicaidOverview

Long Term Services and SupportsAugust 2013

Aetna Medicaid

Medicaid Overview

Core business is serving TANF/ CHIP/ ABD/LTSS with a focus on serving high acuity populations

Post Coventry acquisition we have grown to ~2.2 million members across 16 states

Recent awards validate the strength of our integrated care expertise and ability to effectively manage high acuity populations Duals programs in Ohio, Illinois and New York LTSS programs in Illinois, Delaware and New York Behavioral Health/SMI award in Arizona

Aetna and Coventry Existing Medicaid Markets

Populations Served TANF: Temporary Assistance for Needy Families CHIP: Children’s Health Insurance Program ABD: Aged Blind Disabled LTSS: Long Term Services and Supports Duals: Members eligible for both Medicaid and Medicare BH/ SMI: Behavioral Health/ Seriously Mentally Ill

(Recently awarded Arizona contract)

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Aetna is a leader in managing medically complex populations at the local, community-based level by integrating physical health, behavioral health and social economic status of members

Aetna States

Coventry States

Shared States

Aetna Medicaid

Introducing a Key Issue…

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Aetna Medicaid

Aetna Medicaid Model of Care and Capabilities

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Aetna Medicaid

Aetna’s Model of Care - Integrated Care Management

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Received “recognized” 96.4% of 100% score

Focuses on members with a lower complexity profile with less risk for future utilization but with an immediate presenting issue

low risk profiled members and specific contractually-required populations

RISK

High

Low

IntensiveCare

Manageme

nt

StandardCare

Management

Service Coordination & Support

Population Health Services

Member centered approach & focus on community relationships integrating physical health, behavioral health and social economic status of members

Focuses on high-risk vulnerable members characterized by bio-psycho-social complexity. Care managers address the root causes that drive poor health, within the context of a longer term working relationship with the member

Aetna Medicaid

Goal: Decrease Fragmentation and Improve Coordination of Care

Working with Members All members assigned to CM, member centered approach CM assess members in multiple settings including home, assisted living

facility and nursing facilities -- helps drive quality Responsible for managing entire member through integration and

coordination of care Medical: Hospital Discharge, PCP Visits, DME, PharmacyFunctional: In-home Care, Assisted Living, Nursing FacilityBehavioral Health: Full array of BH services carved in

Special Care Management teams for behavioral health and medically complex recipients

Drive member action – vaccinations, PCP visits

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Aetna Medicaid

Local Integrated Support of Members in their Community

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Aetna Medicaid

Effective Use of Home and Community Based CareALTCS Trend HCBS Utilization

'89 '91 '93 '95 '97 '99 '01 '03 '05 '07 '080

102030405060708090

100

HCBS

SNF

MCP LTC HCBS

Governor’s Report to Senate

Perc

enta

ges

%

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Aetna Medicaid

Medicaid LTSS Users Accounted for Nearly Half of Medicaid Spending, 2010

NOTE: Individuals who used both institutional and community-based services in the same year are classified as using institutional services in this figure. SOURCE: KCMU and Urban Institute estimates based on data from FY 2010 Medicaid Statistical Information System (MSIS). Because 2010 data was unavailable, 2009 data was used for Colorado, Idaho, Missouri, and West Virginia.

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Aetna Medicaid 10

Capitated Medicaid Managed LTSS: An Emerging TrendCMS reports that more than half the states are expected to be operating capitated

Medicaid managed LTSS programs by January 2014, including:

Expansion of current Medicaid capitated managed LTSS programs under § 1115 or § 1915(b)/(c)

19 states with waivers implemented or approved as of 2012 (AZ, CA, DE, FL, HI, KS, MA, MI, MN, NH, NJ, NM, NY, NC, PA, TN, TX, WA, and WI)

Establishment of new Medicaid capitated managed LTSS programs under § 1115 or § 1915(b)/(c)

3 states with proposals pending (CA, IL, and NV)

Implementation of Medicare/Medicaid financial alignment demonstrations for dual eligible beneficiaries under § 1115A combined with § 1115 or § 1915(b)/(c)

5 states with capitated proposals approved (CA, IL, MA, OH, and VA); 10 states with capitated proposals pending (HI, ID, MI, NY, OK, RI, SC, TX, VT, and WA)

SOURCES: P. Saucier, J. Kasten, B. Burwell, and L. Gold, The Growth of Managed Long-Term Services and Supports (MLTSS) Programs: A 2012 Update, July 2012, available at: http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Delivery-Systems/Downloads/MLTSSP_White_paper_combined.pdf; M. Musumeci, Financial Alignment Demonstrations for Dual Eligible Beneficiaries Compared: California, Illinois, Massachusetts, Ohio, and Washington, The Henry J. Kaiser Family Foundation’s Commission on Medicaid and the Uninsured, May 2013, available at http://www.kff.org/medicaid/issue-brief/illinois-massachusetts-ohio-and-washington-financial-alignment-demonstrations-for-dual-eligible-beneficiaries-compared/.

Aetna Medicaid

The New Health Care Landscape is Emerging…

New and Innovative Relationships Increased focus on innovative care management models for high-risk

populations across the community care continuum

Value-Based Payment Models Demand for value-based purchasing arrangements focused on

achieving quality outcomes: pay for performance, shared savings, bundled payments, alignment of quality incentives

Health Information Technology Alignment Intense focus on health information technology as key driver for care

coordination and point-of-care delivery optimization

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Aetna Medicaid

Home Care or Nursing Facility

Care Coordination of the Future

Care Coordinat

or

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Aetna Medicaid

Aetna Solutions: The Role of Technology

Clinical Data Integration Secure Data Exchange

Real time provider interface Application Store Rapid Distribution

Population based clinical intelligence Decision support Care management

Popular mobile based application User (symptom) to provider link Appointments, registration, alerts, cost

Health Information Technology Alignment - focus on health information technology as key driver for care coordination and point-of-care delivery optimization

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Aetna Medicaid

A Partnership for the Future…

An Integrated System

The Right Experience

The Right Perspective

The Right Technology

The Right Results

High Quality

High Satisfaction

Aligned Stakeholders

Future Focused

Cost Savings

Thank You!14