Glenn A. MacFarlane is Chief Executive Officer of Aetna Better Health of New Jersey.
You became CEO of Aetna Better Health of New Jersey just last year. The plan started in 2015 and now has 40,000 members. What makes the plan different from others?
Aetna started on January 1, 2015. We initially went live in eight counties. Since then, we’ve been expanding and in August we received statewide approval from CMS. We’re in NJ Family Care, which includes Medicaid, Child Health Plus and Managed Long Term Services and Supports.
What makes Aetna different is that we have an integrated approach to managed care. We have a team of nurses who go out to the members’ homes and manage their care. They attend visits to the doctors and sometimes to the pharmacy. Our nurses are a group of amazing people who take great care of our members. We’re improving access to care for our members. By that I mean we are making sure all the top hospitals and specialists and primary care doctors are in our network.
So you have Aetna nurses who actually go out to your members’ homes? How does that work?
It’s our Integrated Care Management Program. If a member has two or more chronic illnesses, say congestive heart failure and diabetes, they are assigned one of our nurses, though anyone can get it. But the member has to opt in. When we have a willing member it works best. Our nurses help manage the person more holistically, providing case and care management. Our job is to make sure they get the care to help them stay well.
Do you have any evidence that the program improves outcomes or reduces costs?
We try to reduce utilization of the ER while enhancing the member-primary care physician/specialist relationship. We’ve noticed the program reduces the likelihood members will go to the ER. They will call first and talk to their care manager and perhaps come up with a better plan. Of course if it’s a serious problem, we tell them to go to the ER.
We have noticed that our members in the program experience better quality of life. Currently, we have 850 members in the program and about 10 nurses. A team member becomes like a part of the family and a critical part of the health care experience. We get thank you notes — sometimes from children of members — that are really heartwarming. We’re reminded of why we’re here doing this work.
What else is innovative?
One of the things I’ve taken personal pride in is building a relationship any time a member has a grievance or appeal or any experience that was not the way it should have been. They tell me what their issue is and I try to get it resolved. They are surprised when they get a call from me, but I return every call.
I send a personal letter and an Aetna mug. The letter acknowledges that I have learned about their issue. Maybe they could not get into to see a doctor. I can get them an appointment. I can’t tell you how many times a member has emailed to thank me and has contacted me again.
Where can we find you on an afternoon when you are not working?
I have three kids, and even though they are older, 18, 21 and 23, they keep me busy. One of the reasons I wanted to join Aetna — I joined in June 2016 — was to be active in the communities across the state. My previous job was a very long commute to New York. I live in Freehold and now my office is in Princeton. I can be involved in state and community organizations. I go to health fairs, galas, and provider orientations — things the CEO does not usually show up for. I have the opportunity to become more involved and get to know our provider network and, to the extent I can, our members. Living and working nearby gives you the opportunity to give back.