It is projected that, on average, a company with 3,000 employees could experience a medical cost savings of $460,000 per year for its covered members; while a company with 10,000 employees could experience a medical cost savings of $1.5 million per year for its covered members. Aetna is providing self-funded National Accounts customers with medical claim reduction estimates of 2.7 percent when they initially migrate from a stand alone medical program to integrated medical and pharmacy, including Aetna Health ConnectionsSM and MedQuery®.
"The analysis provides evidence suggesting that integrated Aetna medical and pharmacy benefits may promote better health and lower medical costs," said Edmund J. Pezalla, MD, MPH, national medical director for Aetna Pharmacy Management. "For example, we're able to identify members who have chronic conditions and provide physicians, pharmacists and plan members with access to information that can help them identify instances where plan members may not be taking essential medications that help manage their conditions."
The medical cost differences between members with and without Aetna pharmacy coverage appear to be driven by lower rates of use of each category of health care services, including 10 percent fewer inpatient days, four percent fewer emergency visits, six percent fewer specialist visits and five percent fewer primary care physician visits.
"Aetna is in a unique position to promote appropriate, cost-effective health care because of our ability to integrate our medical benefits with pharmacy and other types of coverage," said Laurie Brubaker, head of Integrated Health and Productivity Solutions for Aetna. "The results of this analysis support our overall commitment to help members, employers and providers identify opportunities for better outcomes through a holistic approach to managing health care benefits."
*Aetna Informatics conducted the analysis of a random sample of members in PPO plans that had more than 3,000 employees. It compared medical costs and utilization in 2005 and 2006 for members with Aetna's medical and pharmacy benefits to members with Aetna's medical benefit but not Aetna's pharmacy benefit. The Aetna medical members that did not have Aetna's pharmacy benefit may have had pharmacy coverage issued or administered by a competitor or had no pharmacy coverage at all.
Aetna is one of the nation's leading diversified health care benefits companies, serving approximately 37.2 million people with information and resources to help them make better informed decisions about their health care. Aetna offers a broad range of traditional and consumer-directed health insurance products and related services, including medical, pharmacy, dental, behavioral health, group life and disability plans, and medical management capabilities and health care management services for Medicaid plans. Our customers include employer groups, individuals, college students, part-time and hourly workers, health plans, governmental units, government-sponsored plans, labor groups and expatriates. www.aetna.com