September 22, 2025 | 4 minute read time
Americans face millions of health challenges every year. For many people, dealing with the health care system while managing their health needs can feel overwhelming. This can be especially hard for those with long-term health problems who might not know where to turn for help.
Aetna® offers personalized support through our care management programs. These programs help members identify and manage their holistic health needs in a way that works for them.
What is care management in health care?
Care management programs often offer personal guidance from health experts who can help coordinate your care. Different health plans have different care management programs, so what you get may vary. Aetna provides care management services based on the health plan and state and federal rules.
Care management programs may offer to coordinate your care and navigate the health care system. This can happen when you:
- Have long-term or high-risk health problems
- Leave the hospital or emergency room
- Receive a referral from your doctor or health program
The care management team
Your care management journey starts with a care manager. This is your main point of contact for both physical and mental health needs. They listen to your health issues and goals before developing a plan made just for you.
Care managers, who are usually nurses, can help you deal with long-term health problems by:
- Explaining your medications
- Helping you follow your treatment plan
- Talking with your doctors when needed
- Making sure you understand your care options and are using all the health benefits available to you
- Helping you find specialists when needed
You and your care manager may be supported by an even bigger team including social workers, behavioral health specialists, pharmacists, dieticians and community health workers. They can help you with:
- Answering health questions
- Making healthy eating plans
- Helping you manage your medication
- Finding mental health treatments
- Connecting to local community resources
Care management teams can offer long-term guidance or provide extra support during key health moments. For example, after a hospital stay, care managers can help prevent you from going back by:
- Making sure you understand the instructions before leaving the hospital
- Helping with prescription refills and any medical equipment you may need at home
- Setting up follow-up appointments
- Checking in on your recovery progress
- Helping you understand and manage any new medications
How care management programs work
Care managers work closely with your doctors to give you a smooth health care experience. They help you understand your benefits and find the best care options. At Aetna, our care managers also receive special training to help people who speak different languages or have different backgrounds.
For some plans, you get the same care manager over time. This helps build trust and make care more consistent. This "clinician for life" model means your family can talk to the same person whenever health issues come up.
Getting extra help when needed
Care managers can also connect you with community resources for needs beyond medical care, such as:
- Food assistance programs
- Transportation to medical appointments
- Housing support services
- Financial help for medical costs
- Support groups for your health concerns
They can also help schedule tests, make calls to pharmacies and doctors for you and find out if more affordable care options are available.
The value of care management
By managing health needs early, care management improves health and reduces costs. Our data shows that Aetna members in care management programs:
- Take medications more regularly
- Choose more affordable places to get care
- Go to the emergency room less often
- Get preventive care more often
- Follow treatment plans
Types of care management programs
- Commercial plans: Our three-tiered Aetna One program (Essentials, Flex or Choice) provides personalized support, appointment scheduling and resource connections.
- Medicare: The Community Care program offers goal-based health management with flexible support and coaching for chronic conditions.
- Medicaid/dual-eligible: We offer person-centered care coordination with dedicated teams, integrating Medicare and Medicaid benefits.
- Behavioral health: Specialized support connects mental health and physical health services across all plan types.
- Complex conditions: Our Aetna One® Advocate and Aetna One Advisor™ programs are our premier, high-touch offerings. Members with complex or chronic conditions, regardless of plan type, can benefit from this deeper engagement.
How care management brings real results for real people
Care management helps real people every day. For example, one of our Aetna members with cancer got help finding a new doctor, understanding treatment options and connecting with mental health support. Their care manager was the first person to ask how she was feeling emotionally since her diagnosis, making her feel truly heard and supported.
Evolving our approach to coordinated care
When health challenges arise, we make sure you're not alone on your journey. Through personalized guidance and coordinated care options, we strive to deliver compassionate and efficient support for all members.
We are always strengthening our care management services through:
- Focused development of our nursing staff
- Further investment in technology to find at-risk members and help our nurses work smarter
- Expanded local offerings
- Support teams with multiple specialties
Our commitment to personalized member care and continuous improvement keeps us focused on delivering smooth, effortless experiences for members at every stage of their health journey.
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.