Member Compliance and Monitoring

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Member Compliance and Monitoring

• eValue8 Users Conference
• July 18, 2006
• Dr. Louis Dickey
• Aetna

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Member Compliance Initiatives

• Plan Design
• Chronic Drug Coverage
• Preventive Care Coverage
• Incentives
• Wellness/Behavior Modification
• Program Participation
• Consumer Focused Tools
• Engagement Index
• Readiness to Change Assessment Training
  (Prochaska's Transtheoretical Model for Behavior
  Change)
• Informed Care Decisions Tool
• Personal Health Records
• eVisits/Minute Clinics
• Disparity Initiatives
• Training for Aetna Clinical Staff
• Targeted Outreach Programs for Members
• Physician and Member Intervention
• Post Discharge Phone Calls
• MedQuery
• RxCheck

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MedQuery
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What is MedQuery?

• Targets quality of care issues AND rising cost of
  health care
• Provides treating physicians with actionable,
  targeted, patient-specific considerations
• Complements other quality of care and cost
  management programs
• Conducts holistic review of patients data,
  including multiple types and sources of data and
  patient demographics
• Protects and fosters doctor-patient relationship
  and encourages appropriate patient-specific
  courses of action

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It All Starts With the CareEngine
MedQuery Powered by the CareEngine System
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CareEngineCategories of Care Considerations
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Care Considerations Communication
Since the programs inception in October 2002,
MedQuery has generated more than 1,000,000 Care
Considerations that break down into the following
levels and physician communication methods
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MedQuery Member Messaging

• In addition to physician communication, MedQuery
  can, as an option, also communicate directly to
  the member
• Engages members to become informed health care
  consumers
• Supports employee wellness, improves health care
  services and reduces cost due to erroneous
  medical treatments

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MedQuery Member MessagingProgram Description

• Care Considerations communicated directly to
  the member by letter
• Triggered if no information is received from
  physician after two weeks or if physician
  indicates member is noncompliant with treatment
  recommendations
• Letter is in easy-to-understand language
• Encourages member to speak with his/her doctor

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Complementary Programs

• MedQuery is an integral part of a comprehensive
• cost management and patient quality strategy

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RxCheck
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Aetna Rx CheckRapid Retrospective Drug
Utilization Review

• Acute Frequency
• prescriptions for a multiple daily dose of a
  medication when a once-daily dosing may be
  indicated
• High Utilization
• Multiple RX and or Docs for medications with
  potential for misuse
• Brand to Generic
• Identifies members who have filled RX for brand
  name that has an A-rate generic equivalent
  available
• Drug Interaction
• Identifies members receiving two drugs at the
  same time that are known to cause clinically
  significant reaction
• Retail to Mail
• Opportunity to notify members in selected plans
  with mail order benefit when they can save money
  by filling maintenance RX at MOD
• Therapeutic Duplication
• Certain RX that may duplicate another Rxs effect