Quality Management & Improvement Efforts

One way we’re improving health care quality is by measuring how well we and others are doing. For example, we work with groups of doctors and other health professionals to make health care better.

Our clinical activities and programs are based on proven guidelines. We also give you and your doctors information and tools that may help you make decisions.

We aim to:

• Meet members’ health care needs 

• Measure, monitor and improve clinical care and quality of service

• Launch company-wide initiatives to improve the safety of our members and communities 

• Make sure we obey all the rules, whether they come from plan sponsors, federal and state regulators, or accrediting groups

We work to make your health care better by:

• Developing policies and procedures that meet clinical practice standards

• Reviewing preventive and behavioral health services and how care is coordinated 

• Addressing racial and ethnic disparities in health care that could negatively impact quality health care

• Monitoring the effectiveness of our programs 

• Studying the accessibility and availability of our network providers

• Monitoring the overuse and underuse of services for our Medicare members 

• Performing credentialing and recredentialing activities

• Assessing member and provider satisfaction 

Each year, we check to see how close we are to meeting our goals. Here's what we did in 2023:

• We collected data on a set of clinical measures called Healthcare Effectiveness Data and Information Set (HEDIS®), as applicable. We shared the results with the National Committee for Quality Assurance (NCQA) Quality Compass®. The NCQA makes the results public. Each year, we use the results to set new goals and improve selected measures. We improved performance on many measures.

• We asked members and providers how satisfied they are with Aetna®. To improve satisfaction, we:
  
  

  • Enhanced the Aetna.com website and online tools

  • Improved the accuracy of our provider directory information 

  • Improved online self-service options for members and providers

• We surveyed members in the Aetna Case Management program.* Satisfaction remained high, and members are likely to recommend the program. Members also told us the program's info helped. It has helped members prevent problems and better manage their health. And has improved their quality of life.

• We surveyed members in the Aetna Disease Management program.*  Satisfaction remained high, and members are likely to recommend the program. Members also told us the program has helped them learn more about how to keep and improve their health.

• More people are using telehealth. We updated our app and provider directory to help members easily find providers who offer telehealth.

We also: 

• Improved our patient safety program to help members make informed health choices

• Used social media to share patient safety information

• Provided patient safety resources to physicians on the secure provider website

Enhancing health and mental well-being leads to a better quality of life. Our quality improvement program helps improve the behavioral health care we provide to you. Hear about our goals, the progress we’re making and how we’re tracking our efforts. 

Here are some highlights from 2023:

• Behavioral Health Commercial member and caregiver case management satisfaction surveys were launched in January 2023. Surveys have been created and approved for use for the Behavioral Health Condition Management, Aetna 360, Autism Care Team and Guardian Angel programs. As of September 2023, satisfaction scores are 95% for caregiver surveys and 94% for member surveys.

• Behavioral Health Quality Management collaborated with Health Equity teams to develop equity initiatives related to depression screening for both underrepresented ethnicities and women’s health.

• As of October 31, 2023, Aetna has seen a 16% decrease in suicide attempts among our commercially insured adult members (25+) as compared to a 2019 baseline. Aetna has also seen a 20% reduction in our commercially insured young adult population (18–25) as compared to our 2019 baseline.

• Updated searchable provider directory to locate providers who have expertise in evidence-based, risk-reducing suicide care practices. This also includes Vita Health practitioners.

• Multiple suicide prevention strategies were launched in 2023, with a focus on prevention of suicide attempts for our adult commercial population.

• Aetna continued working with SafeSide, an organization dedicated to mental health education, to train primary care physicians, medical practices and their staff in identification and early intervention for patients at risk of suicide.

• CVS Health® is aiming to increase access to mental health care for historically marginalized communities. At more than 1,000 MinuteClinic® locations in the U.S., patients can access depression screening services. At select MinuteClinic locations, patient can receive in-person and virtual mental health counseling services for depression, stress and anxiety from licensed mental health providers. MinuteClinic also offers virtual mental health services to provide easy, effective and often less-stigmatized access to mental health care.

   

  • Since the launch of MinuteClinic behavioral health services in 2021, 99% of new MinuteClinic patients have been able to see a mental health provider within seven days. 80% reported a reduction in depression symptoms.

• Behavioral Health Commercial and Medicare plans saw an improvement in Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) scores. Members who initially presented with moderate depression or anxiety demonstrated a 35–36% decrease on average in subjective symptoms during participation in Complex Case Management.

• Aetna 360™ Behavioral Health partnered with Vita Health to provide education about Vita via on-site training to 360 facilities in NJ, CT, PA, FL CO and OH. This education not only contributes to the goal of reducing suicide attempts by 20% by 2025 but may also increase timely post discharge appointments for members.

• Launched mental health services at 6 southern California locations, bringing the total number of states where mental health counseling is available at MinuteClinic locations to 16.

Our plans for 2024:

• Focus on behavioral health network expansion with the goals of increased provider availability and reduced appointment wait times.

• Continue to use and refine predictive modeling to proactively identify members who may benefit from Medicare Behavioral Health Case Management.

• Continue to administer member and caregiver case management satisfaction surveys, with a satisfaction score goal of greater than or equal to 90%.

• Continue to develop robotics expertise and continue to work towards the creation of automated solutions to reduce manual work and data entry.

• Implement the 2024 suicide prevention roadmap to meet/exceed our bold goal for suicide prevention. Improve adolescent suicide prevention outcomes.

• Improve quality of care, achieve strong clinical outcomes and drive patient safety.

• Promote care coordination between medical and behavioral health providers.

• Behavioral Health Quality Management will continue to work on newly identified member service improvement opportunities and interventions.

View our behavioral health site

We take our NCQA accreditation seriously. It's how we show our commitment to improving your quality of care, access to care and member satisfaction.

Learn about NCQA accreditation