Aetna Medicare CMO: Home-Based Care Now Critical Part of Health Care Ecosystem

When Aetna, a CVS Health company (NYSE: CVS), announced 2020 Medicare Advantage (MA) offerings, the company set out to go beyond simply offering its members a list of benefits. Instead, the company wanted to take a more holistic approach to health, stressing that individuals’ social and personal needs play key roles in keeping them healthy. 

Aetna isn’t the only MA player to adopt the strategy, as hundreds of plans will offer expanded benefits like in-home care and transportation services next year. The approach from payers has become so widespread that home care providers have spent the past several months trying to get a piece of the action.

Dr. Robert Mirsky leads Aetna Medicare as its chief medical officer. Home Health Care News recently caught up with Dr. Mirsky to discuss Aetna’s expanded MA portfolio for 2020, social determinants of health and what Aetna looks for when establishing provider partnerships.

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Below are highlights from HHCN’s conversation with Aetna’s Dr. Mirsky, edited for length and clarity.

HHCN: Aetna, which serves about 46 million people, has significantly expanded its MA product portfolio for 2020. The expansion includes fall-prevention, transportation assistance and in-home support for housekeeping, grooming and dressing. Why do this?

Dr. Mirsky: I think in the broadest sense, this should all be seen through the lens of helping our members age and thrive in place. This means providing all of the support, whether it’s medical, behavioral or social determinants of health so people can live in the least restrictive and most home-like setting possible.

We assess each individual on an annual basis by offering an in-home assessment — or what we call a healthy home visit. We have providers, including physicians or nurse practitioners, come into the home and do a complete review of medical history, physical exams, medication reconciliation and even take a look at what’s in the refrigerator. Those folks also look for fall risks in the home. They’re also looking for any sort of indication of social isolation because that’s equivalent to smoking almost a pack of cigarettes a day.

And to the extent that we can identify individuals who are isolated or at risk for future isolation, we begin to bring services to bear. 

It’s not just a list of things. It all kind of hangs together around that rubric of aging and thriving in the home. 

What makes this the right time to expand what Aetna is offering? Did the CMS guidance in 2018 and 2019 factor into the expansion? 

I think it does. But benefits are one thing — they get you part of the way there. Leveraging community resources is another thing, but it really is about bringing those together and bringing them to bear for the unique needs of each individual member.

CMS’s flexibility and the ability to offer [new] supplemental benefits was perfect for where we were headed in terms of evaluating the holistic needs of each of our members — not just medically but also through behavioral health and social determinants lenses. 

We start with the big picture and then try to understand how we can design benefits to help or how we can bring in existing community resources. We want to make sure that people aren’t just existing in their homes. Even if they’re safe, we want to make sure that they’re feeling like they’re a vital part of society.

Getting seniors out into the community, you help them feel like a vital part of society and not just like someone who needs to be taken care of. Although they may have needs, they also have a lot of wisdom and experience to offer. 

Housekeeping, help with grooming, companionship. These aren’t your standard health-related benefits. Why does Aetna see these areas as important?

People aren’t just medical diagnoses. Many seniors also have overlying or underlying or behavioral health issues. Making sure that we’re taking care of their social needs, their personal needs so that they can have a high quality of life is really important. It certainly will differentiate us as people select a health plan, not just by a list of things that we have, but by our approach to taking care of them.

It all fits together, it’s not just an array of what benefits we can offer. That’s a piece of the pie. It’s really looking holistically at, should we be offering this benefit? Should we be offering it as coordinated with community services? Should we be meshing them together?

One particular benefit that stands out about Aetna’s 2020 plans is the post-skilled nursing stay meal benefit. What kind of positive impact can something like that have?

When people get out of the hospital and come home … they didn’t generally leave their homes fully prepared for exactly what was going to occur when they got back. We want to make sure that when they come home, they’re not nutritionally challenged at a time when they’re healing and need to be recovering.

Offering those meals post-discharge will make sure that individuals have all the nutritional support they need. This is also a bridge to assess what their ongoing nutritional needs will be and connect them with other resources. 

Aetna isn’t the only one focusing on social determinants of health and going beyond traditional medical care. What’s your take on this paradigm shift?

Each health plan is coming at this from maybe a little bit of a different angle.

We see this more holistically. How can we support each individual on their journey, beginning with evaluating them in their homes, engaging them in care management programs, helping close gaps in care, evaluation of chronic conditions, etc.

Again, I think for us, the message we’re trying to get across is: It’s not a list of supplemental benefits. It’s our approach to helping you remain in your home and be an active member of society. It’s also about anticipating your needs in the next few years so that you design the rest of your life, and you’re not one hospital admission away from ending up in an assisted living facility or nursing home.

Speaking of paradigm shifts, can you just talk a little bit about your views on the U.S. health care system’s shift toward home and community-based care, generally?

I think the ability to offer care in the home is becoming important. I think that needs to be balanced with not having people be homebound and get them out to more community-based settings as well.

What do home care providers need to do for a chance to work with Aetna? What are you looking for from the provider organizations you form relationships with?

I think it’s seeing them as part of this ecosystem. It’s about making sure they understand the precious nature of a touch inside of someone’s home — and everything else that can be identified when you’re there.

As I mentioned, we do an in-home assessment on a large percentage of our members and get a really good sense of what the home environment looks like, but that’s usually annually.

Being able to capture that information and leverage what home care providers find in the home — and then collaboratively exchanging information — is important.  

I know one of the care organizations you’re working with is Papa. What made them so appealing? 

It’s having an intergenerational interaction between a senior and a young person. It’s having that mutually beneficial relationship between what that younger person can provide to the senior, in terms of errands and things around the house. It’s also realizing, in my opinion, that a young person can be deeply touched by the experience and wisdom of that senior. Both parties tend to get a lot out of that relationship. 

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