SH (Clip)
I really think that this space needs more investment in order to ensure that we have the adequate number of trained behavioural health specialists in place.
SH (Clip)
The freedom of having dialysis at home while being able to participate in other activities. You know, from a mental health point of view, it means having the comfort of family and being in familiar surroundings.
SH (Clip)
Things like using cost comparison tools when researching elective care, for example, and utilising those preventive health benefits to keep your health in check. We're also working to push back against over utilisation for things like unnecessary testing.
LN
Hi, and welcome to the latest episode of the Fit for Duty podcast, brought to you by Aetna International. It's that time of year again when we ask Aetna's healthcare experts to provide a view on emerging or persisting healthcare trends for the year ahead. And today we're speaking with Seeta Hammer, the Senior Director of Clinical Health Services at Aetna International.
So, stay with us to find out what 2023 has in store as far as healthcare trends are concerned, and how organisations can use this insight to support the wellbeing of their people and also manage their corporate healthcare costs. We'll also be diving into the investments that Aetna international is making into solutions to improve the health and wellbeing experiences of the people it serves.
So hi, Seeta, how are you?
SH
Hi, Lorien. Thanks so much for having me join you in this podcast.
LN
Oh, well thank you so much for being here. I know it's a really busy time of year for you. So, I'm just delighted that you could make time for me. So welcome to the podcast. And first of all, could I please ask you to introduce yourself and also give us a bit more information about your role at Aetna?
SH
Yes, absolutely. So again, my name is Seeta Hammer, and I'm the Senior Director of our Clinical Health Services here at Aetna International. I've been a registered nurse and a board-certified case manager for over two decades. I've actually been with Aetna for the past 20 years. And prior to that, I worked as a bedside nurse specialising in medical surgical care, intensive care and as a circulating room nurse in the operating room.
So, in my current role, my team and I are responsible for coordinating and ensuring access to care for our members, both stateside and abroad. I've got a team of clinicians who walk side-by-side in each of our member's healthcare journey to facilitate access to care, you know, whether it's in a remote part of the world or navigating complex care in large metropolitan areas.
LN
That's a really fantastic summary. Thank you so much. And the length of tenure at Aetna that you have is incredible. And also you mentioned, you know, obviously your experience with stateside and abroad and looking at that access to care piece. So that has been so important moreso than ever over the last couple of years, obviously given the Coronavirus pandemic. And I was wondering with that, and also with other operational challenges and clinical challenges that you might have come across. What are some of the biggest lessons that you have learned from, let's say, just the last 12 months, let's say 2022?
SH
Yeah, absolutely. I think the biggest realisation for me for 2022 was that healthcare was not going to return to what we knew of it prior to the pandemic. We found that our members want better access to care through a variety of channels. It's really about offering them the ability to meet with their provider from the comfort and safety of their home, through telehealth apps and being able to access non-emergent care from the nearby CVS MinuteClinic when their providers are unavailable. Secondly, medical consumers want inclusive and equitable care when it comes to their race or their personal lifestyle choices. And, you know, thirdly, for me, I found that our members want holistic care where their mental healthcare is equal to that of their medical needs.
LN
Yeah, absolutely. There's so much more that I'd like to get into out of those three specific areas that you've mentioned. But I think first of all, I'd really like to set the scene for our discussion today with some observations about you know, economic forecasting for next year and some of the challenges that employers and providers and also brokers will need to contend with. So, we have economists, leaders at the World Bank, the United Nations, and many, many global CEOs are really predicting that the economic climate in 2023 will be challenging the world over and the healthcare industry, as you well know, is not immune to staff shortages, to employee restless. You know the same rising energy prices and broken supply chains and general inflation that other industries are susceptible to. So really, you know, organisations must be and we know that they are scrutinising their spend on health and wellness more than ever. They really have to walk a tightrope, don't they between employee health and happiness and productivity and balancing those tighter budgets. And as that capital tightens, health and wellbeing budgets are going to follow suit. So it's safe to assume that not only are organisations looking to understand and harness costs, saving advances and health management technology, but they're also looking for ways to keep abreast of medical trends, to accelerate that preventative healthcare strategizing to keep people as healthy as possible, upfront, to keep costs per hospital beds in mind, as they soar globally, and more besides. So, you know, there's a really big, big picture, there's a lot of challenges to contend with. But let's start to strip it back down again. Before I get too ahead of myself and build up this enormous, overwhelming picture. So, looking to 2023, what I've heard from various quarters is that wellness, not just condition management, is on the rise. So how does that statement correspond with your experience and your expectations for the coming year, Seeta?
SH
Yeah, absolutely. I think for me, it's really about understanding that the whole person, especially behavioural health, is really a critical approach to keeping our members and consumers healthy and well, and it's actually reached the mainstream. An example is the rise in behavioural health visits that we're seeing globally across telemedicine platforms. Mental healthcare is finally being destigmatised across the globe. Primary care is set to align more closely with the whole person when it comes to health, mental and physical health, ultimately evolving into more holistic care model. And I really think that this space needs more investment in order to ensure that we have the adequate numbers of trained behavioural health specialists in place, you know, working alongside primary care physicians. This is where comprehensive clinical programmes that integrate behavioural health services, and extended provider networks of primary and specialist care will come into its own. We'll continue to see advancements in this space as the year progresses. And with our deeper integration with CVS health, our clinical programme now works alongside our medical directors across our enterprise, as well as specialty programmes like behavioural healthcare, as we've been talking about, transgender care is a big one, and services and a host of other such programmes.
LN
Yeah, absolutely. Well, that brings us back to the equity, the inclusion and diversity piece that we were speaking about earlier. But before we get into that in more detail, Aetna International's, proprietary research found that there's an increasing degree of segmentation among employees, which requires more personalization and more drilling down into the needs of individuals and not just groups or cohorts. So it, you know, looking at the unique health goals, the unique health stories and the social determinants of health of individuals. And there's really there is an increasing degree of segmentation based on healthcare disparities. What can you tell me about what we can expect to see regarding customer segmentation or member segmentation in 2023?
SH
Yeah, absolutely. It's something that we're very attuned to. So, when it comes to healthcare disparities, we are continuing to advocate for the right care at the right time. As far as reducing disparities, what that means is providing broader services to our transgender community, serving all genders of all ages. It's really important for us to also consider the mental health support that we're offering to our LGBTQ members ahead of their scheduled procedures, for example. We also need to take a holistic view of an individual and their condition and work to reduce bias through education.
LN
Yeah, and I should imagine, that is why Fortune magazine has included Aetna on their 2022 Change the World list. You know, they've recognised that the organisation has put massive efforts into reducing suicide, for example, amongst members. So, you know, why has the organisation taken that particular cause to heart so much, and what's your team specifically doing to support the initiative as well?
SH
Yeah, that's a really great question. And we're really passionate about that at CVS Health. For example, my team, we have a behavioural health coach who spends a significant amount of her time with children, families and individuals who are in need of a broad range of support, whether it's from programmes that we offer, or those within the community, she bases her their unique care needs and tailors a treatment plan based on the resources that are specific to her member's needs. And in addition to that, we offer our case management support, which also includes outpatient members, and referrals to specialists. We have a large clinical tool, toolbox, if you will, to identify and outreach those that are risk for suicide, and we work with them to provide individualised support and education. Now, when they're inpatient, we're working closely with the case management team at the hospital to plan for a safe discharge to the next setting, and also provide the needed resources, again, whether it's in the programmes that we offer, or within the community. And what I'd like to say is that we remain in contact with that member for as long as they need us.
LN
That's incredible. And you'd hit upon your words such as individualised and earlier, you spoke about the convenience of that care, looking at people from all ages, all walks of life, really. And that support, you know, critically when they when they need it most for as long as they need that support. So, coming back to that convenient care in the home, really, what can you tell me about advanced in home-based care in the coming year? What can we expect there, Seeta?
SH
Yeah, from a US perspective, it's really about deeper integration with our broader CVS organisation, which means an increase in capabilities to deliver care in the home. It produces bigger savings, greater convenience, and greater time savings, which really equals a better quality of life through the ability to be at home while receiving care. For example, the freedom of having dialysis at home while being able to participate in other activities, rather than being off site and in a clinical setting. You know, from a mental health point of view, it means having the comfort of family and being in familiar surroundings. And then from an international point of view, we provide support through telemedicine and allow for greater access to healthcare, by leveraging the broad network of our overseas partners.
LN
And that support from family and being in the comfort of your own home is critical to the mental wellbeing of patients regardless of what they're going through, but particularly those that are obviously very much in need of suicide prevention, intervention and support with that. So, we know that the role of family is incredibly important there. And when it comes to whole person health and how we are looking at holistic, emotional, mental and physical wellbeing, what else can we expect that organisations or providers or payers can be doing to improve access to that whole person healthcare across the spectrum of health and also wellbeing and self-care needs,
SH
It really means offering preventive and personalised care using the predictive modelling that we have through our sophisticated algorithms to identify members in need, using a collaborative approach to engage members in their care, and helping them foster positive coping skills and behaviours. It's also about addressing their emotional, mental and physical needs, really of that individual from a care perspective and offering options for both professional services as well as self-serve apps.
LN
And how does this differ domestically versus internationally? What advice do you have for organisations who are looking to provide that access to that full spectrum for their employee base?
SH
We do offer a comprehensive suite of clinical services to our members. You know, while many clinics are available to our US members, it's not necessarily true for overseas members. But how we're bridging those gaps is by again leveraging the tools that we have, such as telemedicine, virtual health, and again, our rich network of partners across the globe.
LN
Fantastic. And then in terms of that rich network of partners, I wanted to talk to you a little bit about value-based care. So, the industry has placed a lot of hope a lot of emphasis in value-based care as solution to medical costs inflation. But as a concept, VBC - value-based care, is really open to interpretation, isn't it and perhaps hasn't always made the headway that we'd all hoped for. So, what does value-based care mean to you? What does it mean to Aetna? And do you think that the concept is losing its shine?
SH
Absolutely not. I think really being able to offer value-based care is key to controlling rising healthcare costs and decreasing the out of pocket spend for consumers. For us at CVS Health, it's about making sure that you're seeing the right specialists who are ordering the right tasks. Things like using cost comparison tools when researching elective care, for example, and utilising those preventive health benefits to keep your health in check. We're also working to push back against over utilisation for things like unnecessary testing, unnecessary levels of care or medications by offering our personalised services through our care team. And finally, it means access to nearby things like minute clinics, for example, where there's often no copay for non emerging care, rather than spending time more costly Urgent Care Centre, where the wait times are often much, much longer.
LN
Yeah, absolutely. That's a big one for organisations, isn't it? It's helping people, who aren't familiar with a US healthcare system who are inpats into the country, you know, on a year or two-year rotation, really understand how to get the best out of the system. And, as you said, make it as timely and effective for them, but also keeping an eye very much on the cost, making sure that the option that they choose is the most cost effective. And, and also, quite rightly, as you said, it's looking at that piece whereby, you know, some providers to say, "Well, now that you're here, we might as well screen you for this or test you for that" it's making sure that it's absolutely necessary and appropriate. So, I, just before we wrap up, I really wanted to focus on a little bit more of that sort of cost containment piece, Seeta. So, what key takeaways do you have for organisations who are looking to keep costs in check while their people are either away from home or in a domestic environment?
SH
Yeah, absolutely. So, I think we're moving in the right direction of truly looking at that individual's care from a holistic lens, you know, by offering supportive tools through an omni-channel approach, for example. And definitely by linking those in need with the right tools, and within community resources that are available to them. And finally, I know that this is a challenge for our organisations and consumers alike. You know, I really want to talk about our care management team and really conclude with noting that our most valuable offering is our care team, where we offer member-centric care by coordinating the needs that are both cost effective, and with proven quality outcomes. And our services are always available and free of cost to our members wherever they are in the world.
LN
And that brings me to one final question actually, if you don't mind. You mentioned earlier about inclusive and equitable care. So again, I'd just like to understand more about what that means to you and in an Aetna context.
SH
Sure. And really, we serve a broad spectrum of all races, individuals with unique needs that they have for themselves. And, you know, offering the respect and understanding their journey by walking with them in their shoes, and really pulling together those resources and those programmes that we're offering, and working to reduce those disparities that we come across as a clinical team. And by pulling in our medical directors, I come from a span of backgrounds ranging from behavioural health, to oncology, to transgender care. So, I think here, we are really aligned with our members and really serving them on their individualised needs.
LN
And just briefly, coming at this from an organization's perspective, you know, when you have that built into your benefits, services and offering that is really strong as far as your talent retention and employee engagement strategies are concerned and, and again, coming back to some of those challenges that we're going to be facing into 2023, keeping hold of skilled, talented employees is going to be a critical strategy for organisations as the year progresses. So, with that, I just wanted to say thank you so much and ask you if you have any final thoughts on what organisations should really be focusing on as far as employee health and wellbeing is concerned for 2023 Do you have any advice in a nutshell or any overriding guidance for employers that are listening?
SH
Yeah, absolutely. And so we offer a valuable programme called pre trip planning. And really this is for inpats and expats alike, where we are here as case managers helping those members that are coming into their host country by understanding the healthcare landscape. If they need a provider that specialises, say in autism, we can find those providers that may even speak their own language. And so taking advantage of what the insurance companies are offering and working with us collaboratively to really promote the services that your employees need. We're happy to do so. We're happy to meet them where they are and help get them to their next cure.
LN
That's incredible. So yeah, absolutely setting them up for success and helping to remove some of those stressful barriers as well that happen when you move abroad. Fantastic. And Seeta, thank you so much for your for your time and support today, and we really look forward to talking to you again before too long.
SH
Great being with you.
LN
We hope you've enjoyed this episode of the Fit for Duty podcast. Don't forget, you can subscribe on your preferred podcast platform. As part of CVS Health and Aetna, a Fortine Four company, our 165-year heritage of strength and expertise, positions us as a world leader in health and wellness benefits. We provide global benefits for medical, dental and vision to wellbeing support and emergency assistance. Serving more than 300,000 members across North Central and South America as well as the Caribbean, we deliver convenient and affordable access to quality care around the globe. For more information about us, you can visit Aetna international.com
As part of CVS Health and Aetna, a fortune four company, our 165-year heritage of strength and expertise positions us as a world leader in health and wellness benefits. We provide global benefits for medical, dental and vision to wellbeing support and emergency assistance. Serving more than 300,000 members across North, Central and South America, as well as the Caribbean, we deliver convenient and affordable access to quality care around the globe. For more information about us, you can visit aetnainternational.com
