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Healthcare Plan Information

Aetna Health

Activity Activity Goal or Expected Outcome Tools Used to Evaluate the Results
Drug to Drug Interactions (DDI) Goal: To identify potential DDI at time of filling a prescription.

Process: When the pharmacist enters a prescription into the pharmacy database, the system will compare it with all others that the member is receiving and if there is a potential for life-threatening complications or permanent damage to be done by a combination of drugs, the pharmacist will receive a message denying the claim until s/he takes an action to confirm with the physician to proceed. The pharmacist must enter a code describing the action s/he took prior to allowing the prescription to be filled.
A variety of tracking and trending reports will be evaluated such as:
  • % of DDI captured
  • ID of most frequent DDI
  • ID of physicians with frequent prescribing of DDI drugs
Provider Recognition Programs Goal: To highlight physicians who have been recognized by NCQA as providing exceptional care in their specialty.

Process: Include a listing of these physicians on the DocFind home page. Place an icon identifying their recognition on applicable physicians's web page.
  • Diabetes Provider Recognition Program - currently in place.
  • Heart/Stroke Physician Recognition Program - scheduled for July 2003.
Provided as a service to our members, no evaluations planned.
Welcome Home Calls Goal: Promote timely access to and coordination of post discharge services.

Process: Targeted medical and surgical admissions are followed up after discharge with a call from a nurse to determine understanding of discharge instructions, whether prescriptions have been filled and are understood, scheduling follow up visits, or ordering home health care or equipment, if indicated to complete a course of treatment.
Tracking % responses of discharged members to several questions asked regarding post-discharge activities.
Hospital Comparison Tool Goal: Provide members with publicly available, evidence-based hospital outcomes information to help them make informed decisions about their healthcare.

Process: Available on Aetna Navigator secure web-site, this tool provides Aetna subscribers with access to procedure and diagnosis-specific comparisons of hospitals in their area according to factors the subscriber selects as important for their analysis, including mortality rates, patient volume, unfavorable outcomes and average length of stay. The tool also includes the hospital's results of The Leapfrog Group's Hospital Survey.
Provided as a service to our members. Process measures of visits to the site are monitored.
Med Query Goal: Assist physicians who are treating members with information based on current evidenced-based medical research to improve clinical outcomes and reduce medical errors.

Process: Identifies potential medical errors and opportunities for enhanced care by analyzing pharmacy and lab data matched against evidenced based research.to generate patient-specific treatment improvement suggestions. Physicians and nurses oversee all treatment suggestions, which are then communicated to treating physicians. This program has been in effect for FEHB Program members in the New England and MidAtlantic regions since October 2002.
Measure number and type of adverse events identified and number of changes that occurred post-MedQuery intervention
InteliHealth Goal: Provide member friendly messages to Intelihealth users about patient safety issues in various clinic settings

Process: InteliHealth users click on information articles about patient safety
Provided as a service to our members and others who visit the InteliHealth website

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