AETNA BETTER HEALTH® Doing the right thing for the right reason AETNA

AETNA BETTER HEALTH Doing the right thing for the right reason AETNA BETTER HEALTH Aetna Inc.

About Aetna Better Health Medicaid business unit owned by Aetna, Inc. Twenty-three (23) years of experience as a Medicaid Managed Care leader nationally Serving Families and Children, Aged, Blind and Disabled, Long Term Care, Medicare/Medicaid Enrollees Manage services for more than 1.3 million Beneficiaries in twelve (12) states AETNA BETTER HEALTH Aetna Inc.

AETNA BETTER HEALTH Aetna Inc.

What is the Illinois Integrated Care Program (ICP)? A Medicaid program designed to link primary, specialty, institutional and community services focused on improving quality through coordination, pay for performance and creation of health homes Members choose or are automatically assigned a health plan with either Aetna Better Health or IlliniCare Health Plan and receive Medicaid services through those health plans Persons who are aged, blind and disabled (ABD) in suburban Cook (non-606 zip codes), Will, Dupage, Kane, Kankakee and Lake counties AETNA BETTER HEALTH Aetna Inc.

Integrated Care Service Packages Responsibilities of Aetna Better Health will include all covered services currently funded by Medicaid through the State Plan or waivers, and will be phased in as follows: Service Package I: All medical, pharmacy, dental and behavioral health services for the member. This includes all non-long term care services, mental health services, alcohol and substance abuse services and short term post-acute rehabilitation stays in nursing facilities. Service Package II: Nursing facility services and services provided through the Home and Community Based Services waivers, except those waivers serving individuals with developmental disabilities. Service Package III: Home and Community Base Services Waiver services for individuals with developmental disabilities and ICF/DD services AETNA BETTER HEALTH Aetna Inc.

Integrated Care Management Guiding Principles Focus on each individual member Work with members and providers to address medical, behavioral, social, and long-term care needs Partner with the member and/or caregiver to maximize the member’s self management ability Enhance quality of care outcomes Support member’s choice of community living AETNA BETTER HEALTH Aetna Inc.

CycleHealth of Care anagem ent Aetna Better of M Illinois Overview Cycle of Care AETNA BETTER HEALTH Working Relationship Recovery Autonomy Resiliency Aetna Inc.

Community-Based Integrated Care Team 35 out of 85 employees are responsible for direct care coordination 21 Care Coordinators - licensed clinicians; clinical social worker or RNs 14 Care Management Associates - individuals with medical or behavioral health experience; know the community 11 Provider Representatives – education and support for providers relative to all service issues 1 Community Liaison Manager – interact with advocates, community and supportive agencies AETNA BETTER HEALTH Aetna Inc.

Pay for Performance and Quality Measures Illinois Department of Healthcare and Family Services (HFS) will hold Aetna accountable for thirty (30) distinct quality measures including: Behavioral health assessment within 60 days of enrollment and 30 day follow up for patients with a finding 7 day follow up after hospitalization for mental illness Annual Influenza Immunization Increased use of Diabetes care therapies Increased use of Congestive Heart Failure therapies Increased use of Coronary Artery Disease therapies ER visits per 1,000 patients Hospital in-patient visits per 1,000 patients In-patient Hospital re-admission AETNA BETTER HEALTH Aetna Inc.

ICP Status as of April 2012 Aetna Better Health Members: 18,447 Total ICP enrollment: 35,518 Aetna Better Health Network Providers 56 Hospital and Specialty Hospitals 1,982 Primary Care Providers 3,569 Specialists 45 Community Mental Health Centers (CMHC) AETNA BETTER HEALTH Aetna Inc.

Provider Payment Direct Patient Care: .88 per ICP dollar must be spent on patient care. Timely Payment: 90% of all clean claims for covered services will be paid in 30 days; 99% of all clean claims for covered services to be paid within 90 days Reimbursement: no less than State Medicaid fee schedule AETNA BETTER HEALTH Aetna Inc.

Phase 2: Aetna’s Long-Term Care Principles Assist members and their families with the resources they need to live in the least restrictive setting Provide members their choice of settings and allow them to direct their own care to the greatest extent possible Create a long-term support program that offers access to community-based options Creates a long-term care system that is financially sustainable and better aligns incentives across the system AETNA BETTER HEALTH Aetna Inc.

The Member’s Voice in the Health Plan: Member Advisory Council Participants include members, family members, advocates and providers Quarterly meetings scheduled with three held on October 26, 2011, January 25, 2012 and April 18, 2012 Agenda: Council members draft agenda items; discuss and provide Aetna feedback on issues ranging from network adequacy to customer service AETNA BETTER HEALTH Aetna Inc.

Contact Information Robert Mendonsa Chief Executive Officer Aetna Better Health of Illinois 312.821.0502 office 312.235.9909 mobile [email protected] Jacqleen Musarra Community Liaison Manager Aetna Better Health of Illinois 312-821-0583 [email protected] AETNA BETTER HEALTH Aetna Inc.