Aetna hopes to reduce medication-related hospital readmissions through a pilot program in collaboration with CVS Caremark and Dovetail Health, according to AIS Health.
In the program, Aetna targets members who take multiple medications and have recently been released from a hospital, nursing home or rehab facility. Members can receive consults with pharmacists either in their homes or on the phone. Dovetail Health provides the home-visit services, and CVS Caremark handles the telephonic outreach.
"Our review showed that better discharge planning and medical reconciliation and optimization of pre- and post-hospital medications could improve the overall continuum of member care and prevent a return trip to the hospital," Aetna spokesperson Katelyn Morgan told AIS Health.
When Aetna identifies members as at-risk for readmission, through its proprietary algorithm, an Aetna case manager contacts the members about enrolling the program. A pharmacist then reaches out to the members to schedule either an in-home visit or a phone call. During that initial outreach, the pharmacist will review all medications, help create a care plan for the member, address potential medication-related issues, identify gaps in care and educate members about their medicines. Plus, the pharmacist will consider certain risk factors, including chronic conditions and home safety, and then help arrange follow-up visits with the member's physician to rectify any identified problems.
All participating members receive ongoing phone call support for 30 days, after which they will be discharged from the pilot program and placed into Aetna's case management for follow-up and care. The company's case management program serves as the "cornerstone" of medical management.
"Case managers are uniquely positioned to make that strong connection between helping individuals navigate [insurance choices], as well as assisting them in understanding whatever circumstance or condition brought them to need those services in the first place," Susan Kosman, Aetna's chief nursing officer, told FierceHealthPayer in a June interview.
To learn more:
- read the AIS Health article