Aetna was founded in 1853 and is a major player in the United States for life and health insurance and top expat solutions. Distribution and services through teams involving more than 2'000 employees. Aetna is a valued partner of the Swiss Life Network since 2013.
What is Population Health: Different people have different definitions of population health. At Aetna, we define Population Health as ‘the use of technology and data to enable health systems to provide quality care at a lower cost’.
Population health is being actively used to help insurers deal with the health and medical issues which are drivers of cost. Many P&C and Life insurers have health products in their portfolio, with difficult to manage loss ratios; they often turn to the expertise of Population Health organisations to help them manage their medical book better, controlling costs, attracting a larger client base, and improving the health of their members.
Population Health – Aetna's 3 tiered pyramid
Level 1 – Administrative services
We leverage Aetna’s 160 years of experience in managing core health insurance functions to help clients optimize their processes and establish robust cost control mechanisms. Health insurance is increasingly being offered / considered as an additional offering by P&C, life and general insurers who often have limited experience in the health sector.
We leverage our deep understanding of this segment to help them deliver value to their clients while keeping costs under control. The mechanisms we employ to this aim are
- Member management
- Claims management
- Pharmacy management
- Fraud, waste and abuse management
- Network management
- Clinical coding infrastructure to streamline payments and enable analytics on conditions
Level 2 – Data services
Data is at the centre of everything we do. We enable organizations to establish robust data infrastructures, help them organise, structure, cleanse and warehouse data. We also go one step further and help clients convert information into insight. We leverage the capabilities our companies HDMS and Active Health Management have developed in advanced data analytics to enable organizations to deliver data driven actionable intervention programmes aimed at improving their member's health and maintaining their wellness.
Level 3 – Care services
We help clients manage their members’ health throughout their health spectrum. Based on the information we can glean from all sorts of data, we concentrate on keeping them well, to helping them manage their disease to managing their last few months in life we work with members to enable them to have better quality of life. Our ethos is to enable better care at every stage of a person’s life.
Our virtual care solution is aimed at creating a virtual primary care infrastructure in countries that lack a robust primary care infrastructure. We leverage technology to enable access to quality medical care via text, voice and video consultations. Our physicians leverage our robust evidence based clinical protocols to drive the delivery of sound advice and treatment to patients. This solution not only enables access to care but also reduces costs in the system by ensuring proper resource utilization and helping avoid expensive and unnecessary secondary care utilization for primary care needs.
1. Delivering care with Active Health Management
Our company Active Health Management utilizes robust data analytics to analyse claims, pharmacy, clinical, EHR and primary care data to find gaps in care. The results are matched against evidence based clinical rules to identify gaps in care. Automatic notifications (called Care Considerations and Care Alerts) are sent to the patient and their physician to alert them of the gaps in care identified thereby avoiding expensive and potentially catastrophic emergency episodes.
2. Delivering disease management to our client in the Middle East
We deliver diabetes, maternity and ischaemic heart disease management programmes to a national health insurance company in the Middle East covering all their nationals. Below are some key statistics from the diabetes management programme:
3. Delivering cholesterol management in Europe to a large corporate client
We deliver wellness and cholesterol management to a large corporate client in Western Europe. The graphic below represents the results we achieved with our cholesterol management programme for their employees.