Aetna Better Health of Florida aims to bend the cost curve for Medicaid patients living with chronic and complex conditions.
Aetna Better Health of Florida is bringing a different cost-saving approach to its Medicaid members through a combination of in-home care with telemedicine and remote monitoring.
Earlier this month, the insurer announced it is collaborating with Emcara Health, the value-based medical group of PopHealthCare, to deliver this approach to members.
Starting in the Tampa Bay, Orlando, and Miami-Dade areas, Emcara Health will deploy physician-led multidisciplinary teams to ramp up integrated, person-centered primary care for members in their homes, or wherever they call home, the two companies announced.
Chief Executive Officer Jennifer Sweet is leading this initiative at Aetna Better Health of Florida. After a decade in the Florida Medicaid industry, including a stint at PopHealthCare, she joined the company in February 2020.
Jennifer Sweet, chief executive officer of Aetna Better Health of Florida. Photo courtesy Aetna Better Health of Florida.
As a CVS Health company, Aetna Medicaid operates Aetna Better Health Medicaid plans in 16 states: Arizona, California, Florida, Illinois, Kansas, Kentucky, Louisiana, Maryland, Michigan, New Jersey, New York, Ohio, Pennsylvania, Texas, Virginia, and West Virginia.
During the pandemic, which began weeks after Sweet's arrival in February 2020, Aetna Better Health of Florida employees quickly pivoted to working from home. But even so, Sweet says, the business was changing rapidly.
"The state eventually changed a lot of the policies required in our Medicaid contract, so we were reorganizing our operations tremendously," she says. "Things are largely back to normal, but we're in a new normal. As utilization went down, telemedicine went up, and it has stayed up in the behavioral space."
What the pandemic didn't change was the health plan's aggressive pursuit of value-based care, Sweet says.
"We've continued to have more and more of our members getting care under providers who are in value-based contracts with us," she says.
The partnership with Emcara Health represents "a big step forward for us," Sweet says. "It combines much more hands-on direct care, that we are comanaging with them in many ways, than under a standard value-based agreement."
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A huge component of that co-management is the sharing of data between Emcara Health and Aetna Better Health of Florida, Sweet says.
"We start with the medical conditions that our members have," she says. "That would qualify them as good candidates for the Emcara program."
There were some false starts, due to stringent security protocols that protect each entity's data. Sweet says that challenge was overcome by building appropriate data-sharing infrastructure and staffing to manage it.
"It can be a slow process, a very resource-rich proposition," she says.
Part of that process was automating data transfers.
"It was tactical," she says. "The setup can be complex--not to the IT people who do it, but to those of us asking for something to happen, making sure we have the right resources to actually deliver on building those processes."
After building a set of baseline data, the partners began moving toward sharing data in near real time, Sweet says. Governance also consists of leaders from both organizations meeting quarterly.
"The evidence is there," she says. "Nobody is saying, I saw 10 of your members. It's all right there. We can pull it up, slice and dice, and see what services are administered. On our end, we are adding the care [members] are receiving from non-Emcara providers, to paint the full picture for us both to discuss. The real time exchange of status is very important to this program."
Although the Medicaid plan does have numerous children under its care, the cohort selected by the health plan for the Emcara Health program consists of only adults, all of whom have chronic or complex conditions that improve with close management of their medical conditions.
"We believe that with the kind of activities the Emcara team delivers to members, all of that can be used to create better outcomes for the members, to give them a better quality of life, and a more positive experience of being in the healthcare world," Sweet says. "Probably because of their conditions, many of them are likely to have a lifetime ahead of being in the healthcare world. Teaching them at the same time how to lead their own healthcare journey, it's pretty well-proven from studies everywhere that this is an effective way to reduce the total cost of care. That's the approach we're taking with the Emcara program."
The initiative will also address social determinants of health.
"We have a social team, feet on the street, out there meeting with community-based organizations and other resources, maintaining and updating the database that CVS has established of community resources," Sweet says.
The partnership announcement followed by days the arrival of Hurricane Ian in southwest Florida, but this program has not been impacted by Ian, Sweet says.
"I'm in Tampa, and the devastation south of me was enormous," she says. "We're still out on the street, delivering supplies, doing everything we can with our community partners. We had always intended to expand the program over time, but we will cross that bridge when we get to it in those areas."
“It combines much more hands-on direct care, that we are co-managing with them in many ways, than under a standard value-based agreement.”
— Jennifer Sweet, chief executive officer, Aetna Better Health of Florida.
Scott Mace is a contributing writer for HealthLeaders.
The new program was initiated in the Tampa Bay, Orlando, and Miami-Dade areas.
Some false starts in the program had to be overcome, keeping the security of data foremost while establishing complex, near-real time data exchange with home care provider Emcara Health.
The program is also addressing social determinants of health.