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Quality management and improvement efforts

We’re working hard to improve the service, quality and safety of health care. Learn about our efforts and how far we’ve come.

One way we’re improving health care quality is by measuring how well we and others are doing. For example, we work with groups of doctors and other health professionals to make health care better.

 

Our clinical activities and programs are based on proven guidelines. We also give you and your doctors information and tools that may help you make decisions.

We aim to:

 

  • Meet members’ health care needs
  • Measure, monitor and improve clinical care and quality of service
  • Launch company-wide initiatives to improve the safety of our members and communities
  • Make sure we obey all the rules, whether they come from plan sponsors, federal and state regulators, or accrediting groups

We work to make your health care better by:

 

  • Developing policies and procedures that meet clinical practice standards
  • Reviewing preventive and behavioral health services and how care is coordinated
  • Addressing racial and ethnic disparities in health care that could negatively impact quality health care
  • Monitoring the effectiveness of our programs
  • Studying the accessibility and availability of our network providers
  • Monitoring the overuse and underuse of services for our Medicare members
  • Performing credentialing and recredentialing activities
  • Assessing member and provider satisfaction

Each year, we check to see how close we are to meeting our goals. Here's what we did in 2022:

 

  • We collected data on a set of clinical measures called Healthcare Effectiveness Data and Information Set (HEDIS®), as applicable. We shared the results with the National Committee for Quality Assurance (NCQA) Quality Compass®. The NCQA makes the results public. Each year, we use the results to set new goals and improve selected measures. And we improved performance on many measures.
  • We asked members and providers how satisfied they are with Aetna®. To improve satisfaction, we:

    • Enhanced the Aetna.com website and online tools
    • Improved the accuracy of our provider directory information
    • Improved online self-service options for members and providers
  • We surveyed members in the Aetna Case Management program.  Satisfaction remained high, and members are likely to recommend the program.  Members also told us they feel more actively involved in managing their health because of the program .*
  • We surveyed members in the Aetna Disease Management program. Satisfaction remained high, and members are likely to recommend the program.  Members also told us the program helps them meet their health care needs.*
  • More people are using telemedicine.  We updated our app and provider directory to help members easily find providers who offer telemedicine.

 

We also:
 

  • Improved our patient safety program to help members make informed health choices
  • Used social media to share patient safety information
  • Provided patient safety resources to physicians on the secure provider website

Enhancing health and mental well-being leads to a better quality of life. Our quality improvement program helps improve the behavioral health care we provide to you. Hear about our goals, the progress we’re making and how we’re tracking our efforts.
 

Here are some highlights from 2022:

 

  • Aetna Managed Behavioral Health Organization (MBHO) achieved full re-accreditation for Commercial, Medicare, and Exchange lines of business.
  • We continued our Caring Contacts program to provide resources and support to Aetna members discharged from an inpatient setting after a suicide attempt. Additionally, we saw a 17.3% decrease in suicide attempts for adult Aetna Commercial members through October 2022. Multiple suicide prevention strategies were launched in 2022, with a focus on prevention of adolescent suicide attempts.
  • Partnership with PsychHub to provide free provider education around suicide prevention was launched on time in March of 2022.
  • We expanded access to mental health services through partnerships such as Array and Brightline.
  • Aetna began working with SafeSide, an organization dedicated to mental health education, to train primary care physicians, medical practices and their staff in identification and early intervention for patients at risk of suicide.
  • Aetna CVS launched multiple initiatives dedicated to improving health equity. Targeted populations included members with disabilities, LGBTQ+ members, Black and Hispanic members, among others.
  • CVS Health Foundation supported expansion of equitable access to mental health care services in underserved communities via grant funding.
  • An educational campaign for members who received treatment for substance use disorder resulted in a 21.12% decrease in inpatient admissions for this group. We also launched informational campaigns for members taking mental health medications but not participating in therapy, dealing with depression in addition to long-term medical conditions, or searching for therapy options on our member website.
  • Aetna 360 Behavioral Health established an enhanced partnership with Array to increase quicker appointments for members after discharge.
  • CVS MinuteClinic hired over 60 providers of mental health counseling and opened new locations across 14 states, enabling broader access to mental health counseling services (virtually and in-person).
  • CVS MinuteClinic mental health providers completed over 19,000 counseling sessions.

 

Our plans for 2023:
 

  • Focus on behavioral health network expansion with the goals of increased provider availability and reduced appointment wait times.
  • Develop and use a new model to proactively identify members who may benefit from Medicare Behavioral Health Case Management.
  • Launch member and caregiver case management satisfaction surveys, with a satisfaction score goal of >85%
  • Continue to develop robotics expertise and continue to work towards the creation of automated solutions to reduce manual work and data entry.
  • Implement the 2023 suicide prevention roadmap to meet/exceed our bold goal for suicide prevention. Improve adolescent suicide prevention outcomes.
  • Improve quality of care, achieve strong clinical outcomes, and drive patient safety.
  • Promote care coordination between medical and behavioral health providers.
  • Improve provider network and charitable partnerships.

 

Visit our behavioral health site

We take our NCQA accreditation seriously. It's how we show our commitment to improving your quality of care, access to care and member satisfaction.

 

Learn about NCQA accreditation

Notes

 


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

 

*FOR CASE MANAGEMENT SATISFACTION SOURCE: Based on results from the 2022 Aetna® Case Management Member Satisfaction Analysis.

 

*FOR DISEASE MANAGEMENT SATISFACTION SOURCE: Based on results from the 2022 Aetna® Disease Management Member Satisfaction Analysis.

 

 

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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).

Health benefits and health insurance plans contain exclusions and limitations.

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