1 APA Annual Meeting 2011
Aetna’s Primary Care Based Behavioral Health Program
Hyong Un, M.D.Chief Psychiatric Officer
CHFA Annual Meeting 2011
2 APA Annual Meeting 2011
We Are in a Dynamic Time
Economic Conditions
Political Environment
Customer Needs
Health Care System
3 APA Annual Meeting 2011
Forces Driving Our Strategy
Industry Trends Legislation
•Well-being/Wellness
•Global Benefits and Talent Management Strategy
•Health Information Technologies
•Demographic Trends
•Unsustainable Cost Trends
•Global Competition
•Health Care Reform
•Mental Health Parity
3 EAP Master Strategy Plan Executive Summary
4 APA Annual Meeting 2011
Rising Health Care Costs
Health System Forces
Annual health care spending in the U.S. is estimated to surpass $4.2 trillion in 2018.1
4
1 Centers for Medicare & Medicaid Services, Office of the Actuary, National Health Statistics Group. http://www.cms.hhs.gov/NationalHealthExpendData/ ; Historical data from CY 1960-2008; Projected data from NHE projections 2009-2018.1 Centers for Medicare & Medicaid Services, Office of the Actuary, National Health Statistics Group. http://www.cms.hhs.gov/NationalHealthExpendData/ ; Historical data from CY 1960-2008; Projected data from NHE projections 2009-2018.
19701970 20092009 20182018
$75B$75B
$4.2T$4.2T
$2.5T$2.5T
Contributing Factors Opaque system
Bias toward new and expensive
Cost shifting
Provider payment challenges
Demographic challenges
Taxes, fees, compliance
Medical Liability
Unhealthy Lifestyles
Contributing Factors Opaque system
Bias toward new and expensive
Cost shifting
Provider payment challenges
Demographic challenges
Taxes, fees, compliance
Medical Liability
Unhealthy Lifestyles
5 APA Annual Meeting 2011
1% of population represents over 20% of spending
10% of population represents over 64% of spending
Chronic Health Conditions Underliethe Bulk of Health Care Costs in 2007
Top1%
Top5%
Top10%
Top15%
Top20%
Top50%
Bottom50%
% of Population Ranked by HC Spend
% o
f H
C S
pen
din
g
Diabetes Heart Failure Coronary
Artery Disease Depression
Chronic Pain Cancer Asthma
and COPD Dementia
Falls Obesity Co-morbidities
Chronic Conditions Are Costlier to Treat
and Control
(≥$39,688) (≥$13,387) (≥$7,509) (≥$5,191) (≥$3,733) (≥$724) (<$724)
Source: Kaiser Family Foundation calculations using data from U.S. Department of Health and Human Services, Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey (MEPS), 2004.
6 APA Annual Meeting 2011
Prevalence of Depression and Chronic Mental Illness
27%
45%
40%
40%
52%
Diabetes
Asthma
Stroke
MI
Chronic Pain
Pincus HA. J Clin Psychiatry. 2001;62 Suppl 6:5-9; Schatzberg AF. J Clin Psychiatry. 2004;65 Suppl 12;3-4.
Med
ical
Co
nd
itio
n
Percent With Depression
7 APA Annual Meeting 2011
Leading Driver of Reversible Cost at Worksite
0%
10%
20%
30%
40%
50%
60%
70%
80%
Depression High stress High bloodglucose
Overweight Currenttobacco
use
High bloodpressure % Increase in
Costs
Source: HERO Study. Goetzel et. al
8 APA Annual Meeting 2011
Behavioral Health in Primary Care
• Significant portion of primary care visits are associated with stress, lifestyle management or a psychological disorder
• Behavioral health disorders are often under-diagnosed
• Screening tool availability/reimbursement alone are insufficient
• Behavioral health support is required for optimal treatment
9 APA Annual Meeting 2011
Prescribing patterns by provider type
Mark, Tami et. al. Psychiatric Services September 2009 vol. 60 no. 9 1167
10 APA Annual Meeting 2011
Employee Assistance Program
Continuum of Behavioral Health Services
Specialized Behavioral Health Service
Counseling Worksite Consultation Work/Life Support Legal/Financial
Support Crisis Debriefing SBIRT
Network Care Management Integration with PCPs
Depression PediatricsSBIRTMed. Assisted RX
Intensive Case Management Med/Psych Case Management Eating Disorder Case Management Autism Advocacy Program Disease Management
− Depression− Alcohol Use Disorder− Anxiety Disorder− Bipolar disorder
Primary Prevention
Tertiary Prevention
Aetna Behavioral Health Strategy: Integrated Clinical Programs
11 APA Annual Meeting 2011
Integrated Primary Care Behavioral Health Program
• Integrates behavioral health clinicians in primary care
• Addresses behavioral health, health/wellness issues
• Facilitates access to behavioral health servicesBrief/problem-solution focused interventionMax of 3 sessions in PCP officeReferral /continued treatment outside PCP office if
needed
12 APA Annual Meeting 2011
Aetna Support
• Identify PCP practices Substantial Aetna membership Practice infrastructure Open to an integrated approach
• Identify behavioral health practices Geographic location Practice size Availability of psychiatrist
• Complete behavioral health clinician contract amendments Reimbursement combination coding: Diagnosis Code: V40.9
(Unspecified mental or behavioral problem) ; Procedure code: 99242 - Office consultation for a new or established patient
13 APA Annual Meeting 2011
Implemented Sites
Family practices• 7 sites in Philadelphia, PA area
Including Jefferson University & University of Pennsylvania primary care
Pediatric practices • 1 site in Columbus, OH area• 2 sites in Philadelphia, PA area
Including Children’s Hospital of Philadelphia location• Includes reimbursement for pediatrician screening and
pediatrician/psychiatrist telephonic consultations
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