1. PLEASE VIEW IN PRESENTATION MODE
Quality health plans & benefits
Healthier living
Financial well-being
Intelligent solutions
PLEASE VIEW IN PRESENTATION MODE
Aetna Whole Health℠ – INTEGRIS Health Partners Network Health care focused on you
Presenter Name
September 21, 2018
©2015 Aetna Inc.
OK (8/15)

2. What does the ideal health care plan look like?
Better health
Better care
Think about your ideal health plan. What does it look like? Is it the cheapest? Is it the most comprehensive coverage you can get? Or is it something more? Something that goes beyond your encounters with doctors and hospitals only when you’re sick?
You can get something more with Aetna Whole Health.
A new insurance plan option focused on you and designed to provide:
Better attention to your health and not just your illness
Better quality of care
Better cost by helping you get the right care, at the right place, at the right time.
Better cost

3. Introducing 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
Led by your primary care doctor, the INTEGRIS Health Partners Network works hard to improve your health with better coordinated care at a lower cost to you. Powered by technology and data-sharing, you have a team of doctors, nurses and other health professionals looking out for your health, spotting problems and reaching out to you to take action.

4. Selecting a primary care doctor
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 health
Better care
Better cost
*Recommended, but not required.

5. Section 1 About INTEGRIS Health Partners Network

6. Aetna Whole Health – INTEGRIS Health Partners Network coverage area
To participate in this plan, you can live or work in Canadian, Oklahoma or Cleveland counties.
There are over 250 primary care physicians in the network and over 2,000 specialists.
The network has 12 urgent care centers called Access Medical Centers.
Hospitals
Primary care provider offices
Urgent care facilities

7. Aetna Whole Health – INTEGRIS Health Partners Network hospitals
City
Address
ZIP
INTEGRIS Health Edmond
Edmond
4801 INTEGRIS Pkwy.
73034
Lakeside Women’s Hospital
Oklahoma City
11200 N Portland Ave.
73120
Northwest Surgical Hospital
9204 N May Ave.
INTEGRIS Baptist Medical Center
3300 NW Expy.
73112
INTEGRIS Southwest Medical Center
4401 SW Ave.
73109
Community Hospital
3100 SW 89th St.
73159
INTEGRIS Canadian Valley Hospital
Yukon
1201 Health Center Pkwy.
73099

8. What makes Aetna Whole Health – INTEGRIS Health Partners Network different?
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
There are a team of INTEGRIS nurses dedicated to Aetna Whole Health members. They support the primary care doctors and specialists in coordinating the care you receive, identifying patients that need attention, and proactively reaching out to you to help you navigate the system, understand your care plans, and alert you if you’re due for a follow up.
You will have direct access to these nurses with a dedicated phone number to call with questions about your health, your care plan, or just who to see if you’re not sure where to go.

9. Section 3 Aetna Whole Health – INTEGRIS Health Partners Network plan design

10. 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

11. Aetna Whole Health – INTEGRIS Health Partners Network HMO plan design
Annual OOP maximum (Individual/family)
$3,000/$4,500
Deductible/family deductible
None
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
Inpatient - 100% after $250 copay/per day, up to 3 day max copay = $750

12. Aetna Whole Health – INTEGRIS Health Partners Network HMO plan design
In-patient hospital
100% after $250 copay/per day, up to 3 day max copay = $750
Outpatient hospital
100% after $250 copay
Emergency (waived if hospitalized)
100% after $200 copay
Urgent care
100% after $50 copay
X-ray and lab services
100%
Home health services
Prescription coverage
Retail
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

13. How it works Tier 1: INTEGRIS Health Partners Network
INTEGRIS Health Partners Network clinically integrated physicians & facilities
Other providers necessary to meet access standards (e.g., mental health)
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
Check Docfind for in-network providers.
Emergency care is covered in-network when needed. 13

14. Section 4 Member tools

15. Building your care team
Visit and:
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
Tip: You’ll save money and get the most coordinated care when you stay in-network and use Aetna Whole Health doctors and hospitals.

16. Resources at your fingertips
Register for your secure member website at Then you can:
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

17. Know before you go
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.

18. Aetna Whole Connections℠ condition management programs
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.

19. Can’t see your doctor? Use Teledoc®
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

20. Can’t see your doctor? Schedule a Virtual Visit
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

21. Post-enrollment member materials
Gold Aetna Whole Health ID card
Visit for helpful tips and your:
New member e-guide
New member video

22. Thank you

23. 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 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.
©2015 Aetna Inc.
OK (8/15)

24. Appendix

25. A better member experience
See what it’s like to be an Aetna Whole Health member
BEVERLY has congestive heart failure
CHARLES
falls and hurts his knee
ALEX
learns he’s a diabetic
ANGELA
ruptures her spleen in a car accident
For illustrative purposes only. Does not reflect events experienced by an actual participant.

26. A better member experience
See what it’s like to be an Aetna Whole Health member
MEET ALEX
He’s in his late 40s, is married and has three teenage daughters. He’s a manager at a manufacturing company and a type 2 diabetic.
Let’s see how being an Aetna Whole Health member makes a difference for him.
For illustrative purposes only. Does not reflect events experienced by an actual participant.

27. A better member experience
OPTIONAL /ALTERNATE SLIDE
Alex’s story shows how Aetna Whole Health can deliver an improved patient experience
Alex’s doctor has additional resources to help support him and alert him to potential problems.
Better health
Alex receives proactive outreach to prevent a major health crisis.
Better care
Alex avoids duplicate tests and the expense of a potential major health crisis.
Better cost
Alex’s doctor is rewarded for keeping patients healthy.
Better Care
Clinical, Claim, Rx and EHR data are integrated within the care management platform which helps identify at-risk members sooner and provides a 360 view of the patient’s heath
ACO caregivers are provided a complete patient registry to better coordinate care across the entire health system
Doctors are alerted when data indicates gaps in care
This allows for proactive outreach to get patients into care before a crisis occurs. It also identifies needed preventive care – such as cancer screenings – and other services that can keep patients healthy
Better Health
The influence of the doctor and care team increases patient participation in existing care management programs.
The embedded care team constantly monitors at-risk patients so they get the right care quickly before health deteriorates. The team also facilitates access to specialists and other services to prevent gaps in care
Better Cost
Waste is reduced from fewer duplicate and avoidable tests
Ultimately the patient is healthier and less likely to have a health crisis that requires the ER or hospital inpatient care - the biggest drivers of medical costs
A critical driver is that ACO doctors are rewarded for improved efficiency and quality. In this way, goals are aligned and sustained improvements can be made.

28. INTEGRIS Health Partners Network awards and honors
#1 Hospital in OKC and Oklahoma
US News & World Report
INTEGRIS Baptist Medical Center
“Baby-Friendly” designation
Baby-Friendly USA
Consumers Choice Award Winner for 18 consecutive years
“One of America’s best hospitals for: Obstetrics, Heart care, Emergency care”
Women’s Choice
Award®
“Leading performer in patient experience”
Recognition
VHA Inc.
Leader in transparency award
Press Ganey®

29. INTEGRIS has re-structured to focus on accountable care
INTEGRIS Health Partners Clinically Integrated Network - governed by a board of directors comprised of 18 physicians
President: Carl Raczkowski, M.D. – Independent Gastroenterologist
Chairman of the Board, Matt Britt, M.D. – Independent Pulmonologist/Intensivist
Vice President of Operations: Jeff M. Brown, FACHE
Main Goals
Improve the Patient Experience – “Patient is in the Center”
Focus on Population Health
Prevention
Education
Control Cost
Efficiency
Evidenced Based Care
Improve Outcomes

30. Early results with INTEGRIS’s own population are extremely encouraging
64%
Improved Colon Cancer screening of patients aged from 2012 to 2014
73%
Improved Breast Cancer screening of women aged from 2012 to 2014
68%
Improved Cervical Cancer screening of women aged from 2012 to 2014 7%
Increase in generic drug prescribing from 2013 to 2014
31%
Reduction to inpatient stays from 2012 to 2014 4%
Fewer emergency room visits resulting in admission from 2012 to 2014
Reduction in CT scan use from 2012 to 2014
14%
Fewer emergency room visits from 2012 to 2014
While this is the first Product ACO in the Oklahoma City area, this collaboration benefits greatly from the focus INTEGRIS has already brought and the work it has done on its own employee population. Reflects population of 7,300 covered lives.
INTEGRIS has used its diverse and broad employee base as an excellent beta test population to “move the needle” on the inter-related concepts of better heath, better quality and better cost.
In 2013, overall plan expenditures were reduced by 14% … representing savings of over $6.5 million. 30
Sources: INTEGRIS Health Partners

31. Collaboration creates more value than either entity can deliver alone
Focus on those who need them most in the 1:1 setting
Information on all patients and resources to support between visits
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
One-on-one patient engagement and clinical credibility
Data analytics, leading technology and care management programs 31

32. Preventive screening rates Chronic condition (diabetes) management
We jointly focus on measures to improve quality and increase efficiency
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
Preventive screening rates
Breast cancer screening
Cervical cancer screening
Colorectal cancer screening
Generic drug prescribing rates
Chronic condition (diabetes) management
Retinal eye exam rates
Hemoglobin A1c testing
Medical attention for nephropathy
Avoidable emergency department visits