Transcript: Aetna Story Healthier Care

Shawn Franklin

Value based care is about improving quality and lowering costs.

Kenneth Homer

Rather than concentrating on a system that’s focused on reimbursement based on volume, we’re now focusing on what we should be focusing on and that’s keeping patients well.

Brigitte Nettesheim

It’s about outcomes; it’s about the experience of patients.

Kenneth

Patients will note that it’s more of a team concept than it used to be. That team might consist of the physician as the foundation, care manager nurses, pharmacists, case managers, social workers.

Doreen Smiley

I am a care manager, I call patients to make sure that they have a primary care doctor; I call them to check on their health.

Kenneth

We’re able to navigate them more efficiently through the healthcare system to get them better, more timely care.

Simonne

About a week after I had surgery I developed a fever and I had to be admitted to the hospital. I had a pelvic abscess and a couple of different infections as well as I had been diagnosed with ? .

Doreen

When I called Simonne, she was still recovering at her parents’ house on the west coast.

Simonne

I was at the point where I was like okay, I need to go to the ER and just tell them that I need this strain pulled and I need this pickline pulled, and at that point Doreen said, “hold on a second, don’t do that.”

Doreen

A lot of surgeons don’t want to touch anybody else’s work, so it was very important for me to help her collaborate her care.

Simonne

She was actually calling doctors on my behalf, and trying to get surgery scheduled.

Kenneth

We developed a communication system so that we could all communicate and share information about the same patient which is extremely important and which has been a gap in healthcare for a long time.

Brigitte

That’s the power of the information that we can pull together in working with providers collaboratively.

Doreen

We collaborated with the medical director and we were able to set her up with a surgeon here.

Simonne

Doreen was instrumental at making sure that I got things done and move appointments up and spoke with doctors.

Doreen

Simonne had one person on her side that she could call when she needed help getting into any place, and that was me. I love what I do. I love being able to speak to the patients, and to help educate them.

Kenneth

As a primary care doctor and an internist, I believe in this change from volume to value, I believe it’s long overdue.

Simonne

On a scale of 1 to 10 I would say that my experience with Doreen has been 11. It goes outside of the scale.