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©2015 Aetna Inc. 51.25.910.1-OK (8/15) Quality health plans & benefits Healthier living Financial well-being Intelligent solutions Aetna Whole Health℠ – INTEGRIS Health Partners Network Health care focused on you
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What does the ideal health care plan look like? 2 Better health Better care Better cost
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Aetna Whole Health – INTEGRIS Health Partners Network Led by your primary care doctor, your care team’s goal is to: Help keep you healthy or improve your health Better coordinate your care Spot problems and build personalized care plans to treat you Encourage you to play an active and informed role 3
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Selecting a primary care doctor 4 Why it matters Every team needs a leader. And the primary care doctor you pick will lead your Aetna Whole Health – INTEGRIS Health Partners Network care team* and: Treat you when you're sick See you for your annual wellness exam Direct your care with other doctors and specialists Advise you and help you find care programs Better healthBetter careBetter cost *Recommended, but not required.
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Section 1 About INTEGRIS Health Partners Network
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Aetna Whole Health – INTEGRIS Health Partners Network coverage area 6 Hospitals Urgent care facilities Primary care provider offices
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HospitalCityAddressZIP INTEGRIS Health EdmondEdmond4801 INTEGRIS Pkwy.73034 Lakeside Women’s HospitalOklahoma City11200 N Portland Ave.73120 Northwest Surgical HospitalOklahoma City9204 N May Ave.73120 INTEGRIS Baptist Medical CenterOklahoma City3300 NW Expy.73112 INTEGRIS Southwest Medical CenterOklahoma City4401 SW Ave.73109 Community HospitalOklahoma City3100 SW 89 th St.73159 INTEGRIS Canadian Valley HospitalYukon1201 Health Center Pkwy.73099 Aetna Whole Health – INTEGRIS Health Partners Network hospitals 7
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What makes Aetna Whole Health – INTEGRIS Health Partners Network different? 8 Care Coordination Identifying patients at risk Educate each patient on their course of treatment Engage each patient in the management of their disease state Population Health Management Aggregate patient data across multiple health information technology resources Developing patient-specific action plans Data Sharing Combining claims and clinical data for use by physicians and clinical providers Used to develop evidence-based prototcols Physician Engagement Physicians incentivized to improve quality, improve outcomes, and decrease cost Physicians at the table in the formation of the Health Plan Wellness and Health Promotion
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Section 3 Aetna Whole Health – INTEGRIS Health Partners Network plan design
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An important decision, a better choice With Aetna Whole Health – INTEGRIS Health Partners Network, you’ll get: Better benefits for an affordable price A plan focused on wellness, not just sickness Dedicated INTEGRIS Health nurses reaching out to help improve your health Doctors and staff who communicate with you and each other A larger local provider network Better care for chronic conditions with direct access to INTEGRIS Health Care Coordinators A dedicated service line to speak to INTEGRIS Health Care Coordinators 10
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Aetna Whole Health – INTEGRIS Health Partners Network HMO plan design 11 Annual OOP maximum (Individual/family)$3,000/$4,500 Deductible/family deductibleNone Preventive health services Hearing Screening (One (1) visit per year) Immunizations for Children (Ages birth - 18) Immunizations for Adults (Ages 19 and over) Contraceptive services Consultation Surgical Procedure Periodic Health Examinations Well-Baby Care Covered at 100% Doctor visit$25 copay Specialist visit$50 copay Maternity/OB visits $25 copay Inpatient - 100% after $250 copay/per day, up to 3 day max copay = $750
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Aetna Whole Health – INTEGRIS Health Partners Network HMO plan design 12 In-patient hospital100% after $250 copay/per day, up to 3 day max copay = $750 Outpatient hospital100% after $250 copay Emergency (waived if hospitalized)100% after $200 copay Urgent care100% after $50 copay X-ray and lab services100% for routine. 250$ copay for complex. Home health services100% Prescription coverageRetail Tier 1a (select list of preferred generics and some brand OTCs) - $4 Tier 1 (all other generics) - $10 Tier 2 (preferred brands) - $30; Tier 3 (non-preferred brands) - $60 Mail Order 2x the retail copays Specialty Tier 4 - $100 for preferred drugs Tier 5 - $200 for non-preferred drugs
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INTEGRIS Health Partners Network clinically integrated physicians & facilities Other providers necessary to meet access standards (e.g., mental health ) Tier 1: INTEGRIS Health Partners Network 13 How it works Members must seek care within the INTEGRIS Health Partners Network Simple and easy to understand. Generally, no claims to file. A flexible prescription drug plan which includes local and national chains An optional mail-order program is available for convenient home delivery PCP changes are effective immediately Emergency coverage anywhere – worldwide
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Section 4 Member tools
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Building your care team 15 Tip: You’ll save money and get the most coordinated care when you stay in-network and use Aetna Whole Health doctors and hospitals. Visit www.aetna.com/docfind and:www.aetna.com/docfind Type a name, specialty, procedure or condition in the “Who or what are you looking for?” box Enter your zip code in the “Where?” box Choose (OK) Aetna Whole Health – INTEGRIS Health Partners Network from the “Select a Plan” drop down menu Pick a primary care doctor to lead your care team Take note of his or her Provider ID
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Resources at your fingertips 16 Register for your secure member website at www.myaetnawholehealth.com. Then you can: www.myaetnawholehealth.com Search for doctors, hospitals and more Check your personal health record and see reminders for important preventive screenings Use helpful member tools and enroll in special programs Review your claims and pay your bills Get discounts on over-the-counter vitamins, herbal and nutritional supplements, massage therapy and more
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17 Member Payment Estimator See how much an MRI, PET scan or medical procedure will cost. And where to go for the lowest price. Price-A-Drug See how much your prescriptions will cost at retail pharmacies or through Aetna Rx Home Delivery. And learn more about less expensive bioequivalent or therapeutic alternatives. Know before you go
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Aetna Whole Connections℠ condition management programs 18 Learn more about your condition and work closely with your doctor to improve your health and quality of life. If you’re high risk, we’ll connect you with a registered nurse “health coach.” And you can also talk to a caring registered nurse when you’re: Planning for or coming home from a hospital stay Managing a medical condition, like asthma or diabetes Coordinating complex medical treatments among different doctors, hospitals, labs and other health care providers Beginning Right ℠ maternity program Learn what’s best for a healthy pregnancy. And get personal case management to help lower your risks if your pregnancy needs special attention. Your conversations are private Rest assured that everything you discuss is confidential. So be sure to answer the phone when Aetna calls.
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19 24/7/365 access to a doctor at Teladoc.com/Aetna Helps members and their families seek care when their PCP is not available Increased convenience for general medical needs Less expensive than seeking routine care at Urgent Care Center or Emergency Room Services covered include general medical care, behavioral health and dermatology Can’t see your doctor? Use Teledoc®
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20 Members can have a face-to-face video consultation with a provider. Board certified physicians and nurse practitioners Available 24/7/365; average wait time of 30 minutes or less Prescriptions written is clinically appropriate Convenient care for these common conditions: colds and flu, bronchitis, eye inflammation, sinus infection, urinary tract infection Can’t see your doctor? Schedule a Virtual Visit
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21 Gold Aetna Whole Health ID card Post-enrollment member materials Visit www.myaetnawholehealth.com for helpful tips and your:www.myaetnawholehealth.com New member e-guide New member video
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Thank you
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Health benefits and health insurance plans are offered, administered or underwritten by Aetna Health Inc., Aetna Health Insurance Company and/or Aetna Life Insurance Company (Aetna). Each insurer has sole financial responsibility for its own products. This material is for information only. Health benefits and health insurance plans contain exclusions and limitations. Not all health services are covered. See plan documents for a complete description of benefits, exclusions, limitations and conditions of coverage. Plan features and availability may vary by location and are subject to change. Under your Aetna Whole Health plan, if your primary care doctor is part of an integrated delivery system, your doctor and other integrated delivery system providers will generally refer you to specialists and hospitals that are affiliated with that delivery system. However, Aetna Whole Health providers that aren’t part of the integrated network may not coordinate your care and the data may not be shared in the matter described. Health information programs provide general health information and are not a substitute for diagnosis or treatment by a physician or other health care professional. Aetna Rx Home Delivery refers to Aetna Rx Home Delivery, LLC, a subsidiary of Aetna Inc., which is a licensed pharmacy providing prescription services by mail. Providers are independent contractors and are not agents of Aetna. Provider participation may change without notice. Aetna does not provide care or guarantee access to health care services. The Aetna Personal Health Record should not be used as the sole source of information about the member’s medical history. Information is believed to be accurate as of the production date; however, it is subject to change. For more information about Aetna plans, refer to www.aetna.com. Policy forms issued in OK include: HMO OK COC-5 09/07, HMO/OK GA-3 11/01, HMO OK POS RIDER 08/07, GR-23 and/or GR-29/GR-29N. 23 ©2015 Aetna Inc. 51.25.910.1-OK (8/15)
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Appendix
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INTEGRIS Health Partners Network awards and honors 25 “ One of America’s best hospitals for: Obstetrics, Heart care, Emergency care” Women’s Choice Award® Consumers Choice Award Winner for 18 consecutive years “Leading performer in patient experience” Recognition VHA Inc. INTEGRIS Baptist Medical Center “Baby-Friendly” designation Baby-Friendly USA #1 Hospital in OKC and Oklahoma US News & World Report Leader in transparency award Press Ganey®
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Collaboration creates more value than either entity can deliver alone 26 Data analytics, leading technology and care management programs Together we: FIND AND ENGAGE MORE patients with Aetna technology plus provider records HELP MORE members have a streamlined experience SAVE MORE with efficient care across the entire care team Focus on those who need them most in the 1:1 setting Information on all patients and resources to support between visits One-on-one patient engagement and clinical credibility
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We jointly focus on measures to improve quality and increase efficiency 27 Breast cancer screening Cervical cancer screening Colorectal cancer screening Retinal eye exam rates Hemoglobin A1c testing Medical attention for nephropathy Chronic condition (diabetes) management Quality measurements: We monitor and work to increase: Efficiency goals: We also share data to jointly focus on: Medical bed days and admits per 1K Surgical bed days and admits per 1K Generic drug prescribing rates Avoidable emergency department visits Preventive screening rates
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