AETNA Better Health, IL: Patient and Physician Portal
The medical professionals and the patient are facing the introduction of new technologies in the healthcare in order to increase the access in healthcare, decrease the costs and improve the quality of the services provided. These technologies are changing and challenging the traditional health care. (Chaudhry B. et al., 2006). Implementing these technologies introduced new opportunities for transformation of the patient’s role. The patients become more informed and more autonomous, responsible and active in their own care. (Nagel G., 2005)
Aetna Medicaid follows the trends in the healthcare technology. One of the ways to ...view middle of the document...
Moreover, the user can obtain demographic information, send messages about members to the case managers and update the personal and contact information. (Aetna Medicaid, 2014b)
The expected outcomes of the portal were related with the better coordination of the care. As Ms. Yandell mentioned, the patients are able to insert information about the treatment and the surgery history. The coordinators interpret the data with the information offered by the provider. Other projected outcomes were related with the ease of access of getting information and the process of the claims by the providers online. Furthermore, the providers were expected to be able to access information related to prior authorization requirements. Although the outcomes were projected to benefit the patients and the providers and add value to the processes, the company observed a decrease in the time and an increase in the efficiency of claims processing.
The project faced some limitations. The two basic limitations were results of the low level on the providers’ adoption of the portal and the characteristics of the population served. More specifically, the population may face difficulties on access on Internet or a computer. Furthermore, the providers sometimes are not willing to use the portal in addition to the Electronic Health Records program they are using, as it was mentioned in the communication with Ms. Yandleen.
Aetna Medicaid Administrators LLC, that includes Aetna Better Health, IL, was acquired by Aetna in 2007 and has become the company’s national Medicaid subsidiary. Aetna Medicaid provides managed care to approximately 2 million people in 17 states under the Integrated Care Program (ICP). (Aetna Medicaid, 2014a) Aetna generated 44,397 in million dollars by Health Care, 2,341 in million dollars by Group Insurance and 556 in million dollars by Large Case Pensions in 2013. (U.S Securities and Exchange Commission, 2014).
Aetna Better Health, IL is one of the two companies operating the ICP in the state of Illinois. The program introduced on May, 2011. The plan creates a frame of communication for primary care providers, specialists, hospital, nursing home and other providers in order to organize the care of older adults and adults with disabilities, who are eligible for Medicaid, but not eligible for Medicare. (Illinois Department of Healthcare and Family Services, 2014). Moreover, an expansion of the program on January, 2014 increased the number of eligible members by adding the people who are eligible for Medicare and Medicaid. (Aetna Better Health of Illinois, 2014). The program is designed to provide better coordination of care, opportunity for beneficiary involvement of the patient in all healthcare decisions. Furthermore, the program intents to decrease the effects of the lack of care coordination because of the fragmented relationship between Medicaid and Medicare. The total number of full benefit Medicaid –Medicare...