Aetna Behavioral Health continually adds new and innovative tools and products to our existing suite of services. This is one way we fulfill our commitment to you, a valued member of our health care team.

To help you better care for your patients, we integrated our products and leveraged our data across multiple health services, including medical, dental, pharmacy, behavioral health, disability, long-term care, life insurance, and wellness and prevention programs

Here are just a few of our decision-support tools and dedicated programs:

• DocFind® Referral Directory
• Medical Psychiatric Case Management
• Aetna Depression Management
• Depression Disease Management Program
• The Trigger Diagnosis Program
• Level of Care Assessment Tool (LOCAT)

DocFind® Referral Directory

DocFind for Physicians, our online directory, lists physicians, hospitals and other health care professionals participating in Aetna's networks, along with their PINs. Specifically formatted to make it easy for physicians to use in the referral process, DocFind is refreshed three times each week, providing the most up-to-date information available on participating health care professionals.

We invite you to check your own listing in the DocFind Referral Directory to ensure that the information presented to members about you is accurate.

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Medical Psychiatric Case Management

To help providers address the needs of members with comorbid medical and behavioral health conditions, we established the Medical Psychiatric Case Management program. The program supports and enhances member and treating practitioner efforts in working together to improve the possibility of successful treatment.

Referrals to the program may come directly from health care professionals, as well as Aetna medical management units. Aetna Patient Management and specialty units screen members with medical conditions for behavioral health issues. If a member screens positive and agrees to a referral to Behavioral Health, Aetna will provide member information to a medical psychiatric case manager.

Medical psychiatric case managers assess the member's needs, arrange treatment services, and develop and implement a medical psychiatric management plan for any member who meets the program's admission criteria. This case management plan includes the integration of behavioral health services, as well as coordination with medical care.

Examples of members who may benefit from the program include an alcohol-dependent member with diabetes who is currently drinking; a member with multiple medical problems, including depression, who is overwhelmed and not able to comply with treatment regimens; or a disabled member who is in psychological distress but cannot get to therapy appointments.

Medical Psychiatric Case Management is available for both fully insured and self-insured HMO members. Starting Jan.1, 2005, the program expanded its offering to self-insured PPO members whose employers include the program in their benefits plans.

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Aetna Depression Management

Depression is a common illness that affects up to 10 percent of the population and can last weeks, months or even years if not treated properly. To help manage this condition, Aetna Depression Management provides a dedicated care planner to coordinate the efforts of primary care physicians and mental health specialists in identifying and treating depression. Once identified and enrolled in the program, members receive educational materials and individualized care management, with an emphasis on appropriate treatment and adherence.

The program:

• Provides a turnkey depression treatment program for primary care physicians based on the clinically proven Three Component Model (3CM™) program designed by the MacArthur Foundation and further developed through trials run by Dartmouth Medical School and Duke University.
• Integrates medical and behavior benefit plans to help improve treatment so that a member’s quality of life and personal productivity can be increased. Aetna has been monitoring its efforts to integrate depression programs during the past year, and early results show integrating behavioral health and medical management can also reduce overall medical costs.
• Includes an Aetna-developed web-based continuing medical education program for the primary care physicians to bring information and educational materials to the doctors who first see patients.
• Provides training for office staff of participating primary care physicians who also work and interact with the patients.
• Gives access to Aetna case planners and psychiatrists who are on call throughout the day to answer questions and provide guidance for treatment that is needed outside the primary care office.
• Distributes member-targeted communications materials for use by the primary care physicians.
• Changes Aetna's reimbursement policy to encourage primary care physicians to more closely screen patients for depression. Many believe that screening and counseling for depression is not reimbursable, and the Aetna initiative will make it clear that benefit plans include that coverage.

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Depression Disease Management Program

Aetna's Depression Disease Management Program facilitates the application of evidence-based treatment intervention and enhances the utilization of pharmacy benefits to maximize responses to antidepressant medication.

The program integrates care from pharmacy, primary care physicians and behavioral health professionals. It offers outreach, in that clinicians are available to enrollees via the telephone. Other tools, such as self-assessments and online psycho-educational information, are also available to members, who can be recruited through several different referral streams:

• Inpatient psychiatric admission for a diagnosis of major depression, dysthymia, depression not otherwise specified or bipolar depression.
• Outpatient treatment for one of the above diagnoses.
• Pharmacy data indicating suboptimal use of antidepressants.
• Referral by a primary care physician.

The Depression Disease Management Program is currently available for fully insured and self-insured HMO-based members when covered by both Aetna medical and behavioral health benefits. Starting Jan. 1, 2005, the program will also be available for those self-insured PPO-based members covered by employers who include it in their benefits offerings. Programs will be available to members in two situations: (1) when the member is covered by both Aetna’s medical and behavioral health benefits, and (2) when the member is covered only by Aetna’s behavioral health benefits (“stand-alone”). The program will be expanding to manage alcohol use disorders and anxiety disorders.

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The Trigger Diagnosis Program

The Trigger Diagnosis Program was designed to help Aetna Precertification staff and Patient Management nurses obtain appropriate behavioral health intervention for Aetna members in the hospital. Members must have one of six pre-identified "trigger" diagnoses:

1. Poisoning/overdose
2. Change in mental status
3. Dementia
4. Any alcohol or drug withdrawal syndromes
5. Any suicide attempt
6. Any eating disorder

In addition, the attending physician must indicate that behavioral health services would be beneficial.

This process concerns the continuity and coordination of care that members receive and facilities timely access for treatment and follow-up for individuals with coexisting medical and behavioral disorders.

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Level of Care Assessment Tool (LOCAT)

The Aetna Level of Care Assessment Tool, or LOCAT, helps participating behavioral health professionals make a determination regarding the appropriate levels and types of care for patients that they determine are in need of treatment for behavioral health conditions, as well as diagnoses for patients in need of placement in specialized behavioral health care facilities or units.

LOCAT does not replace medical judgment. Behavioral health professionals must exercise their own clinical judgment and are solely responsible for medical advice and treatment of members.

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Member satisfaction with the physicians in Aetna's network is very important in determining how well our members' expectations are being met. Our goal is to provide you with the tools you need to deliver appropriate and effective care.

We're here to help.