Medical Management

Our Service Coordination department provides support to members based on each individual’s risks and unmet needs. These care needs are assessed by licensed nurses, social workers and counselors, as well as non-clinical professionals. We use a bio-psycho-social model (BPS) to help us identify what care our members need. Then, the integrated Service Coordinator performs a health risk assessment to determine the member’s medical, behavioral health and bio-psychosocial status.

Service Coordinators work with the member, member’s family, PCP, psychiatrist, substance abuse counselor or any other healthcare team member to achieve a quality-focused, cost-effective care plan. Service Coordination educates members on their specific disease and how to prevent worsening of their illness or any complications. The goal is to maintain or improve their health status.

Service Coordination programs include, but are not limited to:

  • Pregnancy outreach and high-risk OB
  • Special health care needs
  • Behavioral health/substance abuse

You may have concerns about one of your patients. We can help coordinate many needed services. Just, call 1-855-221-5656 and ask for the Service Coordination department.

Our chronic condition management programs help members manage specific conditions. We assist with regular communications, targeted outreach and support, and focused education.

The conditions in our program include diabetes, asthma, heart failure, sickle cell anemia, hepatitis C, obesity and HIV/AIDS.

To learn more, just call 1-855-221-5656 and ask for the Service Coordination department. You can refer your patients to our chronic condition management programs anytime.

Aetna Better Health of Kansas maintains quality management (QM) through a Quality Assessment and Performance Improvement (QAPI) program. This involves multiple organizational components and committees. The primary goal of the QM program is to improve the health status of members -- or maintain current health status when the member’s condition is not amenable to improvement.

Aetna Better Health of Kansas’ QM Program is a continuous quality improvement process that includes comprehensive quality assessment and performance improvement activities. These activities continuously and proactively review our clinical and operational programs and processes to identify opportunities for improvement.  This enables us to:

  • Assess current practices in both clinical and non-clinical areas
  • Identify opportunities for improvement
  • Select the most effective interventions
  • Evaluate and measure the success of implemented interventions, refining the interventions as necessary