HARTFORD, CN – Aetna is launching an Aetna Health Actions Rx-Savings incentive program for its self-funded employer groups.
After one year of adoption, its pilot customer, Marriott International, has shown that the program has paid for itself – the savings on the medical side offset the overall increased spend on pharmacy, which includes the co-pay and the increase in pharmacy utilization, says Ed Pezalla, MD, national medical director of Aetna Pharmacy Management.
The program is addressing companies’ interest in encouraging medication compliance, especially for those employees who take multiple medications for chronic health conditions. Under the program, employers will pay part of or the whole co-pay for qualified employees.
Pezalla said CFOs and CEOs – not just employee benefits personnel – are looking at programs to control the overall medical cost and the wellness of their workforce.
Through ActiveHealth Management’s CareEngine System technology, which is integrated with Aetna’s claims and medical management systems, Aetna can identify high clinical risk members who currently use a drug covered under the program and members who aren’t using a drug in the program but should be.
In general, “CareEngine aggregates the data that relates to each individual member and compares it to the latest evidence-based medicine guidelines,” said Stephen Rosenberg, MD, senior vice president of Outcomes Research for ActiveHealth Management. “CareEngine identifies potential gaps in care, medical errors and opportunities to improve care.”
With 8 percent of Aetna’s commercial plan workforce having diabetes and diabetics taking between six and 12 drugs, Pezalla expects this area to experience significant savings by driving compliance.
Employer groups can expect to see impact on compliance within a year and ROI within two years, he said.
Pezalla expects the program to eventually be integrated with Aetna platforms that support its disease management (DM) initiatives.
Janice Young, program director of Health Industry Insights, an IDC company, said there is little integrated technology that links health and wellness programs to DM programs.
“There is a disconnect on overall health management,” she said. Predictive modeling tools, which can help identify candidates for DM, would also be a good application for compliance and treatment programs.