Special Needs Unit
Special Needs Unit
At Aetna Better Health, we manage the care of members with special health care needs through a Special Needs Unit within our Case Management department. The Case Management department operates under the direction of our chief medical officer and special needs coordinator. The Special Needs Unit’s primary responsibility is to work aggressively to identify and assess special needs members prior to the onset of an adverse event.
Our Special Needs Unit staff has direct access to the plan medical director, a behavioral health coordinator and case managers with specialized expertise in the diverse and complex needs of members with chronic and/or complex health conditions.
You can directly contact our Special Needs Unit to discuss their diversity practices. We’ll help you respond to the diverse needs of our members by providing training and information through a variety of channels. Just call our Special Needs Unit line at 1‑855‑346‑9828.
Click here to view and download our Special Needs provider brochure.
Our case management department consists of licensed clinical (nurses, social workers and counselors) and non-clinical professionals. They assess and give support to members based on their risks and unmet needs. We use a bio-psycho-social model (BPS) to identify and address the member’s behavioral and physical health, as well as the member’s psycho-social complexity. The case manager performs a health risk assessment to determine the member’s medical, behavioral health and bio-psychosocial status.
Case managers work with the member, the member’s family, PCP, psychiatrist, substance abuse counselor or any other health care team member to achieve a quality-focused, cost effective care plan. Case management educates members on their specific disease and preventing illness or complications while maintaining, promoting or improving their health status.
Case management programs include but are not limited to:
- Pregnancy outreach and high-risk OB
- Special health care needs
- Behavioral health/substance abuse
Call 1-866-638-1232 or TTY 7-1-1 and ask for the case management department if you'd like more information. You can also refer one of your patients to case management.
Our DM program assists you in managing members diagnosed with targeted chronic illnesses. The illnesses targeted are those that have been shown to respond to coordinated management strategies. They’ve also shown to frequently result in exacerbations and hospitalizations (high-risk) that require high usage of certain resources and that incur high costs. Our Disease Management Program has six components:
- Population identification processes
- Evidence-based practice guidelines
- Collaborative practice models that include physician and support-service providers
- Patient self-management education
- Process and outcomes measurement, evaluation and management
- Routine reporting/feedback loop (including communication with members, physicians, ancillary providers and provider profiling)
We identify members as candidates for the Disease Management Programs through a stratification process using claims data and ICD-9 codes through our predictive modeling program.
DM Programs available to members include:
- Asthma (children and adults)
- Congestive Heart Failure (CHF)/Coronary Artery Disease (CAD)
- Chronic Obstructive Pulmonary Disease (COPD)
If you have a member who has one of the above listed chronic conditions, i.e. Asthma, Diabetes, CHF or COPD, you or your staff can make a referral to our Disease Management Program at any time. To make a referral, call 1-866-638-1232 and ask for disease management.
Member Care Information Portal
You can connect to your patients and their care teams with Member Care Information. This secure, online portal gives you the ability to complete the ONAF online. You can also access:
- A real-time listing of your patients
- Information on your practice
- Email capability with Care Managers
The Department of Human Services (DHS) is moving towards an electronic submission of the ONAF. You can complete the ONAF through the secure site. You can also update information for a specific member that you previously submitted.
Already registered? Log in to Member Care Information Portal.
For more information, contact your Provider Services representative at 1-866-638-1232.