Fw: Integrated Care Prgram - Aetna Better Health Webinars

[Guest guest]

FYI

Ellen

Registration

required

To register for any

of the scheduled web

sessions, please email

aetnabetterhealthillinois@

aetna.com or call Karis

Hill at 317-485-4905.

Once registered, you will

receive an email with the

call-in information and link

to use for log-in purposes.

IL-10-12-01

Join us online for our

new webinar series.

You know Aetna. We've been a part

of your community for decades.

Now get to know Aetna Better Health.

Aetna Better Health will be hosting multiple webinar sessions

to talk with you about our role in the Illinois Integrated Care

Program. During these online sessions, we will introduce ourselves

to you, talk about what we offer and how we want to partner

with you to provide quality health care in your community.

Sessions will cover:

n Program overview

n Integrated care management activities

n Home- and community-based services

n Question and answer period

Please join us:

n Friday, March 18, 12:30 to 2:30 pm

n Monday, March 21, 9 to 11 am

n Thursday, March 31, 3 to 5 pm

Miss our

community

meetings?

Q: The state claims that this program will save millions of dollars.

How can this happen unless your company is going to cut needed care?

A: We believe in being partners with our members. For those who want it, we use

a model

of care management that empowers our members to decide what their health goals

are,

and then we work with them, their providers and caregivers to achieve their

goals. This

benefit comes at no cost to the member. It pays off in increased quality of

care, a reduction

in duplicate services, and avoidable hospital admissions and readmissions.

By helping our members stay in their homes and/or in community-based settings

and out

of the hospital or nursing home, the cost of care is decreased dramatically.

Meanwhile,

quality of care and quality of life increases.

Q: What is integrated care?

A: Integrated care is a way to deliver health care benefits that improves

people's health by

assisting them in getting the right care, at the right time, in the right

setting. Members will

be able to choose a medical home/primary care provider (PCP) who will get to

know them

and their health history and can help the member get specialty care and other

services.

Other features of an integrated care health plan include integrated care teams

composed

of care managers who can help our members get other services they may need, such

as

wheelchairs, oxygen, or behavioral health care.

These teams are also dedicated to assisting our members in locating community

resources

for those services or needs not covered by the Integrated Care Program.

Q: What is a medical home?

A: A medical home is the place where a member's PCP is located. A medical home

also

includes a support team who works with the member's PCP to coordinate the

services and

care needed. The goal is to help our members stay as healthy as possible.

Having a medical home is important because it is the first place a member goes

to get the

care needed to stay healthy.

Having a medical home means:

n Members will have a personal PCP who gets to know them well.

n A member's PCP will work with other health care providers, such as specialists

and

hospitals, to coordinate their care.

n Members will receive better health care because the member's PCP knows their

health

care needs.

n A member will gain an understanding of their illnesses and how to care for

them.

n Members will understand how to get and take their medicine.

n Members only use the emergency room for health care emergencies.

n The PCP may use other team members to help members get better care.

Q: Who can be a medical home/primary care provider (PCP)?

A: A medical home/PCP may be one of the following:

n General practitioners n Internists

n Women's health care providers (WHCPs) n Family practitioners

n Federally qualified health centers n Rural health centers

n Nurse practitioners working with doctors

In some cases, a specialist may be a medical home/PCP.

Frequently asked

questions

Q: Will a member be able to

keep their current provider?

What will happen if he/she

can't keep his or her own

provider?

A: Aetna Better Health is building a

network of providers to treat people

enrolled in the Integrated Care

Program. If a member's provider is in

our network (which means he/she has

signed a contract with Aetna Better

Health), the member will be able to

continue to see his or her provider.

If a member's provider is not

currently in the Aetna Better Health

network, the member can let us

know. We will contact the provider

to see if they would like to join

our network.

If a member's provider does not

join Aetna Better Health's network,

the member can continue to see

that provider for the first 90 days

following the member's initial

enrollment in our health plan.

After that time, we will help our

member find a provider in our

network and will work with them

to help coordinate any transition

of care needs.

Q: Will pharmacy benefits be covered?

A: Pharmacy benefits are covered under the Integrated Care Program. Prescription

Formulary

information will be available at www.aetnabetterhealth.com/illinois by March 1,

2011.

Q: Will members have to go into a nursing home to receive the care

they need?

A: We know that most people prefer to remain at home and in their communities

while still receiving the health care they need. We have had great success with

assisting

our members to either stay in their home or transition from a nursing home

setting

back into their home. Aetna Better Health has an affiliate managed health care

plan in

Arizona, part of whose membership is similar to members enrolled in the

Integrated

Care Program. The Arizona managed care health care plan began with 70 percent of

its

members living in a skilled nursing home. The program, which is very similar to

Aetna

Better Health, was able to assist the state in moving more than 40 percent of

these

members back into the home or community setting of their choice.

We believe that those who wish to remain in a home or community setting should

be able

to do so. To accomplish this, we will work with our members, their family or

caregivers,

and their medical home/primary care provider.

Q: What is a care manager and how can they help?

A: An Aetna Better Health care manager is a nurse, a social worker or other

health care

professional. They will work with our members to coordinate their care and help

them get

covered services and other special services they may need.

For example, if a member has a disability, care managers can help provide the

member

access to the equipment he or she may need, such as a wheelchair, walker or

oxygen tank.

Care managers can also help by coordinating special services, such as meal

deliveries or

home attendant care.

Q: How do members give input about the program?

A: There are many ways for us to receive input from members about the program.

These include participating in:

n Member Advisory Council

n Focus groups

n Member satisfaction survey

Or by emailing us at aetnabetterhealthillinois@....

Applications for the Member Advisory Council will be available on our website:

www.aetnabetterhealth.com/illinois.

Q: Does the Integrated Care Program cost the member anything?

A: When members are enrolled in the Integrated Care Program they have already

met

the eligibility requirements. When seeking authorized, covered services there

will be no

copayments or extra costs to the member.

Q: How will members transition to their new managed care health plan?

A: Members will get to choose which managed care plan they want to join. The

Illinois

Client Enrollment Broker (ICEB) will send materials to help members make this

choice.

Members can call, mail or complete the enrollment form online to tell the

enrollment

broker which managed care plan they have picked. ICEB will then sign the member

up for

their new health plan. If the member has a primary care provider (PCP) that they

want to

use, the member can tell ICEB when they call.

Members must choose their health plan within 60 days or the enrollment broker

will assign

members to a managed care plan.

Whether the members pick their

health plan, or the enrollment broker

picks one for them, members can

change their health plan within the

first 90 days of enrollment. Members

can call ICEB at 1-877-912-8880

(TTY 1-866-565-8576) to make

this change.

Q: What if a member already

has services set up during this

time of change?

A: Aetna Better Health is committed

to providing continuity of care for

new members who are currently under

treatment for acute and chronic health

conditions. Our goal is to make sure

that our transition process is efficient,

timely and seamless with no disruption

in care for these new members.

During the initial transition period, we

will make maximum effort to maintain

the members with their current medical

home/primary care provider (PCP)

and continue courses of treatment with

their specialty providers. Our protocols

support a collaborative relationship

with non-participating providers for

prior authorization of the existing

course of treatment and attempt to

have the provider join our network.

We will honor all previous service

prior authorizations for up to 90 days

following initial enrollment.

Tell us how we're doing and what we need to know

regarding:

n What should we take into consideration when building our

health plan?

n What is the best method to communicate with members

and caregivers?

n How can we help advocates in the community work with

ICP members?

Additionally -

n Are you interested in becoming a member of our Member

Advisory Council?

n What else would you like us to know?

Aetna Better Health wants

to hear from you.

If you are a caregiver, advocate or provider

for someone enrolling in the Illinois

Integrated Care Program, we want to hear

from you!

Your input and feedback is

important to us.

n Attend a community meeting

n Email us at

aetnabetterhealthillinois@

aetna.com or

n Visit our website at

www.aetnabetterhealth.com/

Sent: Friday, March 18, 2011 12:17 PM

Subject: Re: Integrated Care Prgram - Aetna Better Health Webinars

Based on yesterdays network meeting, I'm sharing the following - see attached.

Also see http://www.hfs.illinois.gov/newsroom/090910.html

Karl Kopp

President/CEO

NorthPointe Resources

3441 Sheridan Road, Zion, Illinois 60099

Direct: 847.731.5706

Main: 847.872-1700 ext. 706

Fax: 847.872-0037

kkopp@...

www.NorthPointeResources.org

" Empowering individuals with disabilities to achieve their dreams. "