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CMS and Aetna Invite Chicago Area Medicare Beneficiaries to Join the Medicare Health Support Pilot.

CHICAGO -- Please replace the release with the following corrected version due to multiple revisions.

The corrected release reads:


Aetna (NYSE: AET) together with the Centers for Medicare & Medicaid Services (CMS) has invited 20,000 Chicago area Medicare beneficiaries, enrolled in the traditional Medicare fee-for-service program to join the Medicare Health Support pilot. Medicare Health Support will provide these beneficiaries, who were selected because they live with congestive heart failure and/or diabetes, with free access to nurses and case managers who can help them understand and follow their physician's prescribed treatment.

The program, which is voluntary and free of charge, will provide personal guidance and support to help beneficiaries adhere to medication schedules, properly use medical equipment, regularly monitor their weight and blood pressures, and promptly inform their physicians of significant changes. Participants will receive help with diet and lifestyle changes, tips on communicating with their doctors, workbooks that explain their medical condition, and information on local resources.

"Medicare Health Support is a tremendous advance in Medicare," stated John W. Rowe, M.D., Aetna Chairman and CEO. "It represents a shift in emphasis from simply waiting to treat costly complications and emergencies once they arise, to investing in helping Medicare beneficiaries with chronic disease stay well."

"Medicare has long paid for costly complications and emergency care related to chronic disease and we will continue to do that," stated Mark McClellan, MD., Ph.D., administrator of CMS. "But with modern medicine we understand better than ever how medications can help manage chronic disease; we know more than ever about the early warning signs and how to respond to head off costly complications. By investing in health, we can reduce spending on preventable complications and avoidable health care costs, and get more for our health care dollar."

CMS awarded Aetna the Medicare Health Support pilot for the Chicago region. Administered by CMS, the three-year pilot involves Aetna applying the benefits of its disease and case management services to traditional fee-for-service Medicare beneficiaries with congestive heart failure and/or chronic diabetes. In addition to the Chicago pilot, CMS is conducting similar pilots in eight additional regions across the United States. At the end of three years, CMS will compare the health outcomes of those invited to participate, along with the cost of providing their care, to randomly selected comparison groups. If, as expected, beneficiaries in the Medicare Health Support program have fewer complications and enjoy better health outcomes overall, leading to cost savings for Medicare, the federal government will consider expanding the program to provide similar support to more beneficiaries with chronic conditions nationwide.

"This program gives us an opportunity to convincingly demonstrate that we can improve medical results for patients with chronic illness," explained Randall Krakauer, M.D., national medical director for Aetna's Retiree Markets. "With this population, the goal of disease management and case management is to support patients wherever they are - not just when they are in a hospital or doctor's office. We can help people on a large scale and demonstrate our services can have a real impact on people's lives."

Medicare beneficiaries in the greater Chicago area who receive a letter from CMS inviting them to participate in the pilot have the option of calling Aetna to join or opt out. Those who think they might be interested will then receive a phone call from case managers working with Aetna who will further explain the program and begin working with beneficiaries to understand and address their health care needs. Beneficiaries who cannot participate by phone, or would benefit from a one-on-one visit, may receive visits by an advanced practice nurse at their home. Participants' physicians will also be contacted so that they can advise Aetna what information about their patients they would like help tracking in support of their treatment plan. For example, physicians may indicate that they want to be notified immediately once a patient gains a certain amount of weight, or has blood sugar levels that exceed a pre-determined level.

Case managers from Aetna and LifeMasters, a leading provider of disease management services working with Aetna on the pilot, will help beneficiaries schedule and keep regular doctors appointments, comply with medication schedules, and monitor their weight and blood pressure in order to notify their doctors of any significant changes. Should participants have questions or issues that arise between calls, case managers are available 24/7 to offer advice and support. Case managers will also offer help with any barriers to care, such as lack of transportation, language difficulties, or financial concerns. "On any given day at the local pharmacy, you can see women of a certain age emptying out their pocketbook to pay for diabetes test strips not knowing that these are covered under Medicare," said Allyn Webert, R.N., Aetna's health services manager for Medicare Health Support in Chicago. "People with chronic conditions can feel they've been sent off on a road trip without directional signs. We're here to help show them the way."

The Medicare Health Support initiative was designed to help improve health outcomes for Medicare beneficiaries, reduce medical costs, and improve participant and physician satisfaction with Medicare. The Medicare Health Support pilot is not a new type of Medicare HMO or private insurance health plan. Medicare beneficiaries invited to participate in the Medicare Health Support pilot do not have to change their current Medicare coverage to participate. They will keep their same physicians, and their Medicare claims will continue to be processed in the same manner. Participation in Medicare Health Support is voluntary. All services will be provided to participants free of charge.
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Publication:Business Wire
Geographic Code:1USA
Date:Sep 21, 2005
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