Insurer uses data to highlight benefits of care management programs

Health insurance company Aetna recently highlighted the value of participating in a Health Quality Partners (HQP) care management program by demonstrating significant reductions in the number of inpatient hospital admissions, reports Healthcare IT News.

Officials at Aetna reviewed approximately 1,500 claims for coverage due to chronic illness. Of that figure, 942 individuals agreed to participate in the HQP program. Risk profiles were developed for each of these individuals, and electronic health records for each patient were created that included data on factors such as hospital admissions visits, lab results and claims data. Data management professionals at the insurance company then created prioritized risk assessments based on this information.

During the first year of the program, 97 individuals identified as being at high-risk participated in the HQP initiative, meaning that they would receive more individualized care based on the results of Aetna’s risk assessments. During that same time period, the insurance company reports that more than 12,000 interventions were performed based on healthcare monitoring, assessments, educational programs and counseling initiatives.

“We’re very encouraged by the first-year results,” Mike Ungvary, senior vice president of Medicare operations for Aetna’s Northeast Region, told the news source. “HQP has had a major positive impact on Medicare beneficiaries for several years, improving outcomes, addressing the root causes of high cost and poor quality. Its approach is a valuable tool for members.”

A contributing factor in the success of the Aetna/HQP collaboration was the availability of patient health information through existing clinical informatics systems. In addition to demonstrating the value of care management programs, such uses of patient health data highlight growing trends in the healthcare industry in terms of the implementation of medical informatics networks.

According to recent data from the Department of Health and Human Services, adoption of clinical informatics technology is set to increase throughout next year, with growth in the number of healthcare facilities utilizing fully functional clinical informatics networks increasing by more than 46 percent from 2009 to 2010.

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