Skip to main content

Quality management and improvement efforts

We work hard to improve health care quality, service and safety. It’s our commitment to you.

How do we improve the quality of health care?

How do we improve the quality of health care?

One way is to measure how well we and others are doing. For example, we work with groups of doctors and other health providers to help make health care better.

 

We also base our clinical activities and programs on proven guidelines. And we give you and your doctors the tools and information to make informed decisions.

 

Program goals

  • Meet members’ health care needs.
  • Measure clinical care and quality of service.
  • Launch programs to improve the safety of our members and communities.
  • Obey all the rules, whether they come from plan sponsors, federal and state regulators or accrediting groups.

 

Program scope

  • Create policies and procedures that meet clinical standards.
  • Review preventive and behavioral health services and how members receive care.
  • Address racial and ethnic disparities that impact access to quality care.
  • Monitor the success of our programs.
  • Help ensure access and availability of our network providers.
  • Monitor the overuse and underuse of services for our Medicare members.
  • Perform credentialing and recredentialing activities.

Program outcomes

Learn how far we’ve come, and where we’re going

 

Helping make health care better for everyone

Each year, we survey our members and providers to help ensure we’re meeting our goals.

 

Clinical performance

We collected data on a set of clinical measures called Healthcare Effectiveness Data and Information Set (HEDIS®). We shared the results with the National Committee for Quality Assurance (NCQA) Quality Compass®. The NCQA makes the results public. Every year, we use the results to set new goals and improve chosen measures.

 

Member satisfaction

Aetna® website: We improved our website, member tools and provider search results. We also improved self-service options for members and providers.

 

Case management program: Satisfaction stayed high.* Members are likely to recommend the program. It helped them learn how to prevent health issues and manage their health. This helped improve their quality of life.

 

Disease management program: Satisfaction stayed high.* Members are likely to recommend the program. It helped them learn more about how to stay healthy or improve their health.

 

Telemedicine: We improved our mobile app and provider directory. This made it easier for members to find providers who offer telemedicine visits.

 

Patient safety

We improved our patient safety program to help members make informed health choices. We shared information with consumers on social media. We also added patient safety resources to our provider website. 

Helping members access quality mental health care

 

Member and caregiver satisfaction
  • In January 2023, we launched case management surveys for commercial members and caregivers. We also created surveys for behavioral health condition management, Aetna 360™, autism care and Guardian Angel programs.
  • By September 2023, satisfaction scores were 94% for members and 95% for caregivers.

 

Improving access to care
  • Behavioral health quality management worked with our health equity team on initiatives to increase depression screening for underrepresented ethnicities and women’s health.

 

CVS Health® is working to improve access to mental health care for historically marginalized communities. Some results:

 

  • Patients can access depression screening at more than 900 MinuteClinic® locations in the U.S. At select MinuteClinics, patients can get in-person and virtual counseling for depression, stress and anxiety from licensed mental health providers.
  • Since MinuteClinic behavioral services launched in 2021, 99% of new patients were able to visit a mental health provider within seven days. 80% reported fewer depression symptoms.
  • CVS Health launched mental health services at six MinuteClinics in southern California. MinuteClinic now offers mental health counseling in 16 states.

 

Suicide prevention
  • In 2023, we launched various suicide prevention strategies with a focus on our adult commercial members.
  • As of October 2023, there’s been a 16% decrease in suicide attempts among our adult commercial members ages 25 years and up. And a 20% decrease among those ages 18 to 25. (Compared to 2019)
  • We updated our directory to include providers who have expertise in evidence-based practices to reduce the risk of suicide.
  • We continued our work with SafeSide, an organization dedicated to mental health education. Together, we trained primary care physicians and medical practices on how to identify patients at risk of suicide and provide early intervention.
  • We updated our directory to include providers who have expertise in evidence-based practices to reduce the risk of suicide. This includes Vita Health practitioners. Vita Health is a telehealth provider that specializes in suicide care.
  • Aetna 360™ Behavioral Health partnered with Vita Health to offer on-site training at 360 facilities in Colorado, Connecticut, Florida, New Jersey, Pennsylvania and Ohio. This helps us reach our goal to reduce suicide attempts by 20% by 2025. It may also help members get timely appointments after discharge.

Mental health: Building on our success

 

Our goals for 2024:

 

  • Expand our network to improve provider availability and wait times.
  • Enhance predictive modeling to identify Medicare members who may benefit from behavioral health case management.
  • Continue to survey our members and caregivers. Aim to meet 90% satisfaction with our case management program.
  • Hone robotics expertise and develop automated solutions to reduce manual work and data entry.
  • Launch 2024 roadmap to achieve our goal for suicide prevention with a focus on improving adolescent suicide rates.
  • Continue to improve quality of care, clinical outcomes and patient safety.
  • Promote care coordination between medical and behavioral health providers.
  • Work on new ways to improve our members’ experience with us.  

To learn more, visit our mental health and well-being site.

 

Meeting quality standards for you

 

We take our NCQA accreditation to heart. It’s how we show our commitment to improve access to quality care and member satisfaction.

 

Learn about NCQA accreditation

Legal notices

Aetna is the brand name used for products and services provided by one or more of the Aetna group of companies, including Aetna Life Insurance Company and its affiliates (Aetna).

HEDIS is a registered trademark of the National Committee for Quality Assurance (NCQA). Quality Compass is a registered trademark of NCQA.

Health benefits and health insurance plans contain exclusions and limitations.

Also of interest: