Medical management

Our care management 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 case manager performs a health risk assessment to determine the member’s medical, behavioral health and bio-psychosocial status.

Care managers 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. Care management 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.

Care management 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 1-866-827-2710 and ask for the care management department.

Our disease 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 1-866-827-2710 and ask for the care management department. You can refer your patients to our disease management programs anytime.

Aetna Better Health of Maryland^®^ is dedicated to providing high quality care for our members.  To do that, we monitor and evaluate our performance on a regular basis. This is the responsibility of the Quality Management (QM) department. QM is always making sure that we are doing the right thing for the right reasons.

2018 was our first full year in operation.  We received a score of 95% on our first External Quality Review Organization (EQRO) audit for 2018.  We are excited about becoming even better in the future.  We also completed the accreditation process for the National Committee for Quality Assurance (NCQA) and became officially accredited in January of 2019.

As a new plan we did not qualify for the 2018 annual Healthcare Effectiveness Data Information Set (HEDIS) assessment.  Nor did we qualify for the Maryland Department of Health’s provider and member satisfaction surveys in 2018.  In the meantime, Aetna Better Health of Maryland focused on engaging members in new and exciting ways and working more closely with our providers. We did complete our own, limited member satisfaction survey and our own provider satisfaction survey.  Aetna Better Health of Maryland^®^ did fairly well with opportunities for improvement in network expansion and customer service.

Our goals for 2019:

  • Improve health outcomes for our members, especially for our members with diabetes and hypertension
  • Improve provider and member satisfaction
  • Help members get preventative screenings and flu vaccines
  • Reduce hospital readmissions
  • Expand our provider network