The following is the Aetna MedQuery® Program Transcript:
The emergency room. It was the last place Mary expected to end up after a jog in the park. But when Mary's normally controlled asthma turned into a full-blown attack, she was treated in the emergency room by this doctor.
But neither the ER doctor nor Mary told Mary's personal physician about this serious event. And since he never knew about this incident, he never knew Mary needed something stronger than her current 'use-as-needed' inhaler.
As a result, Mary is at an increased risk of another attack and another hospitalization. And, Mary and her doctors don't even know it.
Today, people see multiple doctors for multiple treatments. The lack of communication between patients and their various doctors, as well as between the doctors themselves, can potentially lead to serious medical events and significant additional costs.
Until now. Thanks to Aetna's MedQuery program, millions of people have their medical care reviewed by a sophisticated health care technology called the CareEngine® System. A closer look at this technology reveals that every recorded medical claim, lab result, and filled prescription is seamlessly integrated into the CareEngine. It then compares this information against thousands of evidence-based algorithms that make up the foundation of the CareEngine. This comparison highlights medical best practices and reveals opportunities for better care, as well as potential ways to reduce medical errors and deviations from clinical guidelines.
The CareEngine constantly scans for new member information. At the same time, published medical findings are added to Aetna MedQuery's clinical rule set as they become available.
In Mary's case, the CareEngine identified an opportunity for better care when claims data revealed her visit to the emergency room. And, it led to what we call a 'Care Consideration'.
A Care Consideration, communicated by phone, fax or letter, depending on urgency, typically recommends: