Aetna PowerPoint Presentation


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  • Aetna members have access to a broad selection of experienced health care professionals, a high level of customer service and exceptional member resources. Our goal for today is to let you know all about the Aetna plan and the many innovative programs and resources available to Aetna members.
    Proven track record – site Dupont and other DE accounts.
  • Not everyone can be perfectly healthy. But, even with a chronic condition, you can reach your own best health.
    The Aetna Health Connections disease management program can help a member get there. We offer support for more than 30 chronic medical conditions – if yours is one of them, we will provide:
    Educational materials and online resources
    Nurse case management for members who have more complex needs
    State-of the art technology to help enhance quality of care and patient safety
    FINAL POINT – By coupling current patient data with current medical knowledge we are able to identify significant opportunities to improve care that can be caused by either a physician not knowing all the information about a patient (the patient is seeing multiple physicians who don’t know what each are doing/prescribing); the lack of a physician applying the latest evidenced knowledge to the patient at the point of time it could most help the patient; and patient non-compliance. As important as it is to identify these issues, they are communicated and tracked on an ongoing basis.
  • Aetna Navigator, our member and consumer web-based resource center, available today at,
    Secure Aetna Navigator is a password-protected website and requires the subscriber to register for access. The registration process authenticates the user as an Aetna member who is eligible to use the site. It also serves to promote the confidentiality and privacy of the information presented to the subscriber online.
    Registering for Aetna Navigator is quick and easy. Here’s how:
    Go to and select Aetna Navigator.
    Click on the "Register Now" link.
    Complete the requested information with the number on your member ID card to verify that you are an Aetna member.
    Select a user name, password and security phase. Once your registration is complete, your user name and password will give you access to all the features of Aetna Navigator.
  • Once you register, you can use Aetna Navigator to complete a variety of self-service transactions online… you can:
    Review your dependents.
    Check your claims status and view EOBs online.
    Hospital Comparison Tool
    Estimate the Cost of Care
    Through the price-a-drug feature, you can research the price of a drug and discover if there are less-costly alternatives.
    Send an e-mail to Aetna Member Services in English or Spanish.
    View credible health and wellness information by searching the HealthWise Knowledgebase or linking to Aetna Intelihealth
    Personal Health Record -
  • Aetna’s Personal Health Record: Helping members Make History with online access to their health information Aetna seeks to provide simple, relevant, personalized information that our members, in concert with their health care providers, can use to achieve their optimal health. In keeping with this goal, Aetna is launching a Personal Health Record to help members become better informed, organized and active with regard to their health, health information, and health care.
    Aetna’s Personal Health Record combines detailed, claims-driven information gathered from across the health care spectrum – such as physician offices and hospitals, labs, diagnostic treatment and pharmacies. It also makes it easy for members to add additional health information such as family history or allergies. The result is a comprehensive health profile that the member can view anytime online, and print to share with his or her doctor.
  • Aetna has been utilizing the Internet since 1995, when we first launched DocFind.
    We were the first national managed care carrier to offer an online directory of doctors and hospitals.
    DocFind, our online directory, is available 24 hours a day, 7 days a week.
    With DocFind, up-to-date listings of participating doctors, dentists, other medical professionals and facilities are available at your fingertips. Perform your searches in either English or Spanish, and search by name, location, or criteria such as specialty, gender, languages spoken and hospital affiliation.
    Log on to and click on "Find a Doctor, Dentist" for easy access to up-to-date participating health care professional information.Data refreshed 3x/week
    Spanish version available
  • Pregnancy brings a lot of joy... and a lot of questions! The Aetna Moms-to-Babies Maternity Management Program can help you become well-informed about your pregnancy and know what to expect before and after your new baby arrives.Moms-to-be receive:
    A voluntary pregnancy risk survey.
    Educational materials, available in English or Spanish, on topics like prenatal care, labor and delivery, newborn and baby care, postpartum depression and breastfeeding.
    Special information "For Dad or Partner."
    Web-based educational materials and access to certain program resources through Aetna Women’s Health Online.
    Access to obstetrically trained registered nurses, who provide case management, education and depression screening to high-risk members.
    If you have questions or would like to enroll in the Moms-to-Babies program, call 1-800-CRADLE-1 (1-800-272-3531) today. You can also enroll using Aetna NavigatorTM, our password-protected, secure member website at
  • Have a health question at 1:00 a.m.? Whether it’s the middle of the night, or the middle of your work day, you can call our toll-free Informed Health Line to learn more about health issues important to you.
    Our registered nurses have an average of 12 years of clinical experience and a broad range of backgrounds (pediatrics, oncology, nutrition, cardiology, geriatrics, women’s health)
  • The Aetna Natural Products and Services Program was developed several years ago in response to a growing trend towards an interest in complementary health care products and services; and to provide additional choices to members who want to take advantage of discounts on these types of products and services not traditionally covered by their health benefit plans.
    No enrollment is required. Members must have an Aetna ID card to participate.
  • Access to products: Members have access to discounts on health-related products including over-the-counter vitamins, herbal and nutritional supplements and natural products (i.e. including, but not limited to, aromatherapy, homeopathic remedies, natural body care products and yoga equipment, etc.) through special arrangements with two retailers: InterNatural and WebVitamins, Inc.
    The Aetna Natural Products and Services Program provides a minimum 20 percent discount off retail price on all products available through InterNatural; WebVitamins, Inc. offers a 12 percent discount off retail prices. Vendor information is available within the “Health Programs” section of secure Aetna Navigator.
  • Value:
    Dedicated clinical team with extensive case management experience in specialized care
    Provides member with single point of contact
    Individualized case management and support for members and families through all phases of treatment
    Access to nationally recognized network of specialty physicians and hospitals
    Transportation and lodging allowance available for member and companion when preauthorized
    Act as a member advocate
    NME handles case management, precertification and concurrent review.
  • Aetna PowerPoint Presentation

    1. 1. Aetna HMO for State of Delaware Employees and Pre-65 Pensioners
    2. 2. State of Delaware © 2006 Aetna Inc. Highlights  Outstanding customer service located in the Blue Hen Corporate Center - Dover, DE  Dedicated Customer Service # : 877-54-AETNA (877-542-3862)  Large local and national network  Tools to help members stay healthy and well informed  Personal Health Record  Aetna Health Connections  Aetna Navigator  Proven track record
    3. 3. State of Delaware © 2006 Aetna Inc. The Basics….  Member chooses primary care physician (PCP) from our large network of participating providers  Member visits PCP for routine care, injury or illness  PCP referral generally required for specialist care, except for direct access benefits  Member pays copay at time of service  Coverage for dependents living away from home
    4. 4. State of Delaware © 2006 Aetna Inc. Direct Access Benefits No referral needed for:  Routine and preventive care  Routine well-baby care  OB/GYN care  Routine eye exams
    5. 5. State of Delaware © 2006 Aetna Inc. Value Add Programs & Services  Aetna Health Connections  Aetna Navigator  Personal Health Record  DocFind  Moms-to-Babies  Informed Health ® Line  Aetna Natural Products & Services  National Medical Excellence Program®
    6. 6. State of Delaware © 2006 Aetna Inc. Aetna Health Connections  In house disease management monitors 30+ diseases/conditions  Single Aetna nurse manages all member’s conditions  State-of-the-art predictive modeling tools  Patient safety is an integral part of the program  Care considerations
    7. 7. State of Delaware © 2006 Aetna Inc.  Vascular − Peripheral Artery Disease (PAD) − Cerebrovascular Disease (CVA)/Stroke − Congestive Heart Failure (CHF) − Coronary Artery Disease CAD) − Diabetes – Adult and Pediatric − Hypertension (high blood pressure) − Hyperlipidemia (high cholesterol)  Pulmonary − Asthma – Adult and Pediatric − Chronic Obstructive Pulmonary Disease (COPD)  Gastrointestinal − Gastro Esophageal Reflux Disease (GERD) − Chronic Hepatitis − Peptic Ulcer Disease − Inflammatory Bowel Disease (Crohn’s Disease and Ulcerative Colitis)  Neuro-Geriatric − Seizure Disorder − Migraine − Parkinsonism − Geriatrics  Orthopedic − Rheumatoid Arthritis (RA) − Osteoporosis − Osteoarthritis (OA)*  Cancer − General Cancer − Breast Cancer − Lung Cancer − Lymphoma/Leukemia − Prostate Cancer − Colorectal Cancer  Renal − Chronic Kidney Disease − End Stage Renal Disease  Other − Cystic Fibrosis − HIV − Hypercoagulable State − Chronic Low Back Pain − Sickle Cell Disease - Adult and Pediatric − Weight Management Program Conditions/ Clinical Content
    8. 8. State of Delaware © 2006 Aetna Inc. Navigator™ Engaging Consumers Through Aetna
    9. 9. State of Delaware © 2006 Aetna Inc. Links to Related Resources  Personal Health Record  Find Health Care in DocFind®  Order a Member ID Card  Contact Member Services  Take Action On Your Health SM Member- Centered Design
    10. 10. State of Delaware © 2006 Aetna Inc. DRAFT
    11. 11. State of Delaware © 2006 Aetna Inc. What Is DocFind?  Aetna’s premier online directory of doctors and hospitals  Supports searches for network participating: – PCPs – Specialists – Dentists – Urgent Care Facilities – Pharmacies  Data refreshed three times per week − Hospitals − Institutes of Excellence™ − Transplant Facilities − Behavioral Health Specialists − Vision One® locations − Other Facilities (e.g., Labs)
    12. 12. State of Delaware © 2006 Aetna Inc. Moms-to-Babies Members:  Identified for participation by multiple means and encouraged to register and complete pregnancy risk survey  Risk stratified based on responses to pregnancy risk survey  At normal risk receive educational intervention and telephonic support when necessary  With high risk stratification assigned to OB nurse case managers to receive targeted outreach calls
    13. 13. State of Delaware © 2006 Aetna Inc. Informed Health ® Line  24/7, toll-free access to registered nurses for health information  Access to Audio Health Library  Access to Healthwise Knowledgebase  Ongoing communications  Personal follow-up  Consistent, coordinated service
    14. 14. State of Delaware © 2006 Aetna Inc. Natural Aetna Products and Services ProgramSM
    15. 15. State of Delaware © 2006 Aetna Inc. Health-Related Products  Purchase online for InterNatural and WebVitamins, Inc. – InterNatural  Minimum 20% discount off retail prices for: – Over-the-counter vitamins – Herbal and nutritional supplements – Health-related products – WebVitamins, Inc.  12% discount off retail prices for: – Over-the-counter vitamins – Herbal and nutritional supplements
    16. 16. State of Delaware © 2006 Aetna Inc. National Medical Excellence  Out-of-country care program – Supports members who need emergency medical care while temporarily traveling outside the United States  National special case program – Assists members with rare or complex conditions requiring specialized treatment in evaluating their options and obtaining appropriate care  National transplant program – Case management, centralized claims/member service, Institutes of ExcellenceTM (IOE) transplant network
    17. 17. State of Delaware © 2006 Aetna Inc. Our Customer Service Center Dover, DE Our Customers Our Site Our People  Serving 700,000 members  Focused exclusively on National Accounts customers and members  Over 195 service staff  Average 7.9 years Aetna experience  76% at Aetna over 5 years  High Quality Service Since 1987  Full Spectrum of Products  Dedicated Customer Service #: 877 54-AETNA (877-542-3862)
    18. 18. State of Delaware © 2006 Aetna Inc. Our Customers Are at the Center of Everything We Do We deliver results for you We organize our people around you We focus our service and technology on you