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 can 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 2021:

• 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. And 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
  • Surveyed members in the Aetna Case Management program. Satisfaction remained high, and members are likely to recommend the program. Members also told us the assistance they received helped them better manage their health*.
  • Surveyed members in the Aetna Disease Management program. Satisfaction remained high, and members are likely to recommend the program.  Members also told us the information they learned from the program had a positive effect on their lives, and their health improved because of the program**.
  • Updated our app and provider directory to help members easily find providers who offer telemedicine. (More people are using telemedicine.)

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 2021:

• Our provider network increased 6% in 2021.
• We’ve improved every year from 2017 through 2021 in our Healthcare Effectiveness Data and Information Set HEDIS measures and follow-up care for children prescribed ADHD medication (ADD). 
• We launched CVS® HealthHUB™ pilots across four states to demonstrate the CVS Health® commitment to mental health and access to mental health services and resources.
• We created social media campaigns for LGBTQ and BIPOC youth. We worked with BrandWatch to get social media analysis of mental health findings for adolescents and LGBTQ/BIPOC youth.
• We piloted new programs to help members manage addiction, depression, anxiety and eating disorders. 
• We developed “Second Curve,” “Here4You” and other suicide prevention campaigns to move beyond awareness and drive change. 
• We launched an evidence-based 12-week pilot program with OUI Therapeutics/Vita Health for adults 18+ — delivered virtually by clinical specialists — to help lower suicide risk.
• We expanded support to youth ages 12 to 25 through OUI Therapeutics/Vita Health. This evidence-based program provided psychoeducational coaching from clinical specialists to adult mentors.  
• We launched our Caring Contacts program to provide resources and support to Aetna members discharged from an inpatient setting after a suicide attempt. 
• We’ve partnered with Psych Hub to offer a customized suicide prevention training and certification program to all contracted network behavioral health and EAP providers at no cost. Over 1,350 providers have enrolled with a 61% course completion rate. (The industry standard is 10 to 20%.)
• Together with Autism Comprehensive Educational Services (ACES), we’ve created the first Aetna Institute of Quality (IOQ) for autism. The IOQ will help service more individuals and families affected by autism and expand access to quality autism care. 

Our plans for 2022:

• Work with HealthHUB, MinuteClinic® and network to bring licensed clinical social workers in to stores and offer new services, such as life coaching.  
• Engage members through pre-clinical coaching to address mental health issues before they become a crisis. 
• Develop robotics expertise and automated solutions for manual work and data entry. 
• Update educational materials and articles on the provider website to ensure that information is accurate.
• Improve our behavioral health HEDIS measure results.
• Continue to encourage providers to screen for co-existing mental health and substance use disorders.
• Promote care coordination between medical and behavioral health providers. 
• Find opportunities to ensure equitable access to health care.
• Collaborate with Network to access telehealth use analytics and its impact on accessibility and availability.

Visit 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