Aetna’s Disease Management Program pairs members with a nurse coach for ongoing conditions.
Aetna describes its Disease Management Program as personal attention for members who have a health condition or think they are at risk. The source is a general Aetna document, not one written for Michigan.
What the program is and what members do.
What the program is
Aetna describes the program as one that is about the member, not the condition, designed to help people control a condition in ways that work for them. Aetna says it covers conditions such as diabetes, heart disease, cancer, low back pain and digestive conditions.
How members use it
Aetna says a member can put in a request through the secure Aetna Navigator member website or call the number listed on the document. Aetna also says it may find members through medical or prescription claims, its patient management staff or a doctor referral, and that a member may get a call or letter.
What it includes
Aetna says members work one to one with a registered nurse who acts as a personal health coach. The document also lists online and community resources, medicine safety, preventive care reminders, drug interaction searches and a 24-hour disease management phone line. It states that only a doctor can decide on the best care.
Eligibility, funding and plan design.
Who can use it
The document speaks to members who have a condition or think they are at risk. It is a general Aetna document and does not say it is specific to Michigan or to any one line of business. It lists several Aetna legal entities and mentions California, New York, Florida, Maryland and Oklahoma in its notices. Confirm the program applies to the group’s plan.
How it is funded or sold
The document does not describe pricing, a fee or how an employer buys the program. It says the member’s employer can let members know if these programs are offered at the workplace. That suggests availability depends on the group, so we would not assume it is included.
Where it fits in plan design
It fits as a member support layer next to the medical plan, aimed at people already managing a condition. It does not change benefits or cost sharing based on this document. We would treat it as an engagement tool to communicate at open enrollment, not as a reason to pick a carrier.
What to settle before relying on it.
Is it included for our group?
The document says the employer can tell members whether these programs are offered. We would ask Aetna to confirm in writing that the program is part of the group’s medical plan, for which funding arrangement and from which effective date.
Which conditions and which programs apply in Michigan?
Because the document is general, we would ask Aetna for the current condition list and online program list that apply to Michigan members on this group’s plan. We want that in writing before we put it in any employee material.
How are members reached and what is reported back?
Aetna says it may identify members through claims, staff or referrals and may call or send a letter. We would ask how members are contacted, how a member opts out, and what, if anything, Aetna reports to the employer, with privacy limits made clear.
Common questions about this program.
Is this program specific to Michigan?
No. The source is a general Aetna document that does not say it is Michigan specific. Employers should ask Aetna what applies to their Michigan group.
Can members join on their own?
Aetna says members can put in a request through the Aetna Navigator member website or by phone. Aetna also says it may reach out based on claims, staff or a doctor referral.
Does the program replace a doctor?
No. Aetna states that only a doctor can decide on the best care and that its health information programs are general information. They are not a substitute for diagnosis or treatment.
Where these details come from.
This page summarizes what Aetna publishes. Programs change, so confirm current details with the carrier before relying on them.
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