Aetna Medicare CMO Outlines Aging-in-Place Agenda – Home Health Care News

America’s biggest health care companies continue to focus on home-based care and aging in place as 2022 approaches. That includes CVS Health Corporation (NYSE: CVS) subsidiary Aetna.

Among its home- and community-based care initiatives, Aetna is doubling down on the use of telehealth and leaning into the CVS HealthHUB network, which offers seniors a range of services, from preventative care all the way to acute care. The insurer is likewise investing in “cost-effective care management programs” and expanding its relationships with home-centric partners like Papa and Contessa Health, according to Dr. Jamie Sharp, chief medical officer for Aetna Medicare.

“We’re kind of assuming a new landscape for the delivery of health care and moving away from acute,” Sharp told Home Health Care News. “I think it’s important to focus on aging in place.”

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As of June 30, Aetna served about ​​9.8 million Medicare members nationwide. Aetna Medicare’s overall footprint stretches across 46 states, with plans for dually eligible individuals available in over two dozen states.

As CMO of Aetna Medicare, Sharp is tasked with improving the care experience and outcomes for seniors. Along with her team, she additionally supports Aetna’s value-based provider relationships.

“We also have a real focus on driving health equity across the Medicare Advantage (MA) space for our members,” Sharp, an internal medicine physician who spent her early career working in the hospital setting, said.

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One of Aetna’s aging-in-place initiatives is its Healthy Aging support program, which launched over a year ago. The interactive program is designed to support Aetna’s members with chronic diseases by giving them tools to better self-manage their conditions.

As part of the program, members participate in a series of virtual sessions, either as part of a group or on an individual basis, Sharp explained.

“[Session] topics could be about nutrition or maybe understanding your medications,” she said. “It could be the impact of stress on your disease process or a variety of different topics. We’ve had really positive feedback from our members about this.”

Other home-focused care management initiatives include its readmission prevention programs. Those are focused on giving high-risk members and their families “all the resources they need” to avoid costly re-hospitalizations.

“After they have an acute event and end up in a hospital, how do you transition them back home, helping them stay at home while getting back to their previous life?” Sharp said. “That might be making sure they have the food they need. Do they need transportation to pick up their medication? Have they made their follow-up appointments with their providers and their specialists?”

Aetna’s aging-in-place agenda

CVS has made turning more of its stores into health care centers a serious priority. Doing so makes a lot of sense for the company, which seeks to create more synergy between its brick-and-mortar locations and its insurance arm.

HealthHubs play a major role in that mission, and CVS expects to have 1,500 hubs in operation by the end of the year. As it invests in the network, it will simultaneously close hundreds of stores that aren’t core to its health care strategy, CVS executives recently explained.

“We have HealthHubs spread across the United States,” Sharp said. “They’re right now redefining what services they’re delivering, so they make sure they have a full plate of services to deliver to our seniors as a covered benefit.”

Inside each HealthHubs is a care counselor who can help coordinate services for seniors, including in-home care if it’s needed.

“That’s what those care counselors are about,” Sharp said. “They’re delivering that one-on-one service for our members, understanding what their needs are.”

Aetna’s aging-in-place agenda, in particular, includes a relationship with Papa, the in-home companionship startup that has raised more than $240 million since launching. Several other major insurers have similarly struck partnership agreements with Papa, recognizing the value of addressing social determinants of health.

“Companionship support, decreasing that social isolation that’s really been present during the pandemic is a reason we’ve expanded that relationship with Papa,” Sharp said. “[We can] bring in those companions, make sure that they can meet with a member, take them grocery shopping, go on a walk with them. Do that maybe 10 hours a month, giving members the support they need so they can stay at home, stay safe.”

Meanwhile, on the telehealth front, all Aetna MA plans will cover telehealth for primary care, urgent care, speciality care and mental health in 2022. That coverage is also aimed at enabling aging-in-place.

“As the pandemic came up, we all realized that telehealth had to be a priority — and also quickly realized that seniors were more than willing to take advantage of it,” Sharp said. “We saw those claims go up, and we were happy to see that they were able to tap into that opportunity.”

In addition to using its HealthHub connections, covering telehealth and teaming up with Papa, Aetna is working with innovative home-based care players such as Contessa Health, an Amedisys Inc. (Nasdaq: AMED) company.

Contessa has built its entire business around shifting acute and complex care into the home, and that creates exciting opportunities for Aetna, Sharp suggested.

“Nothing is off the books,” she said. “One of our JVs coming up for 2022 is with Contessa and Prisma Health in South Carolina for hospital at home. And I don’t think any of us were thinking about that, you know, five years ago.”

Landmark Health is another Aetna home-based care partner.

“I think health care is at a new time, where we have to be inventive and have to put forward all those options,” Sharp said. “We have to break down barriers of traditional health care to make sure that our members don’t delay care and that they can stay as healthy as possible in their home.”

Post-acute care trends

When it comes to post-acute care trends with Aetna’s MA members, COVID-19 has been “a learning experience,” Sharp said.

Initially, Aetna members “froze,” with many not accessing care across the board, whether the setting was a nursing home, in-patient rehab facility or something else.

“All of it just — boom, went down,” Sharp said. “We still have not come back up to those pre-pandemic levels.”

Post-acute care utilization is starting to creep back up toward normal, apart from regular holiday dips. While utilization of skilled nursing facilities (SNFs) has been noticeably down, Aetna has not seen a corresponding uptick in home health utilization.

“​​We have not seen a material trend increase in home health to offset that, which is kind of interesting,” Sharp said. “And I don’t know that I clearly have the answers for that.”

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