Aetna's Guardian Angel program helps opioid patients get the care they need

Sue Martin gets on the phone every day, calling her company's health insurance members who recently have been treated for opioid overdose or addiction.

"I'm craving a 10 out of 10. I need to use. What can we do?" one of them asks her.

Martin has a case manager call the member back within the hour, offering help from hotlines, rehabilitation centers or doctors who provide medication-assisted treatment, looking up locations by ZIP code, offering to listen and to bridge gaps.

Martin is a registered nurse and clinical program manager of the Guardian Angel program launched by the health insurer Aetna in March 2018. The program involves phone follow-up with Aetna members who recently have been discharged from a hospital for an opioid overdose or opioid use disorder, along with offers of transportation to appointments and coordination of care among providers.

These forms of follow-up encourage opioid patients to connect with their primary care provider and seek further treatment.

"We try to get to the root cause of how they got dependent on the opioids," Martin said. "I let them do the talking. I want to hear their story and see how I can best address their needs."

The program is part of a three-pronged strategy Aetna launched in 2016 to provide better prevention, intervention and support for members who are addicted to opioids, said Dr. Dan Knecht, vice president of clinical strategy and policy.

Officials noticed hospital aftercare is one area where they can increase assistance to hundreds of patients across the country who are discharged following an opioid issue each month.

"These are very vulnerable people," Martin said. "When they're struggling with addiction, they need help."

After leaving a hospital, opioid patients often don't know where to turn. Aetna executives say that's especially true after an overdose revival, which typically involves a stay of four to six hours in the emergency department, but little more.

While first responders and bystanders are frequently reviving users with a medication called naloxone, the antidote only allows users to breathe again. It is not an automatic lifesaver, as doctors and coroners say it increases risk for repeat overdose if the patient uses opioids again shortly after revival; and it is not a cure for addiction.

"We feel that naloxone is just the first step of a long journey to recovery," Knecht said. "After the overdose, once naloxone is administered, we need to be there with our provider partners to make sure there is that longitudinal care."

An insurance company is uniquely positioned to help members find care because insurance is often one of the hurdles that stands in the way. Patients say insurance plans can limit providers, treatment options and length of stay.

Aetna says its Guardian Angel Program can tell patients where their coverage will be accepted and help them seek treatment at those locations, as well as from their primary doctor.

"We can leverage our claims and pharmacy data to understand our network of participating providers," Knecht said.

The outreach is surprising those it reaches.

"I get this many times from families: 'I cannot believe that Aetna reaches out,'" Martin said. "They're very shocked. They said they've never heard of this."

The program reaches out to roughly 200 people each month, with roughly 80 of them engaging with further treatment, Knecht said. Aetna plans to keep the program going.

Since the launch last March, the Guardian Angel Program already has grown to include a social worker, more clinical staff members to oversee transportation and care coordination, and educational outreach by Martin to doctors about best practices for prescribing opioids. Martin said she knows it's making a difference.

She's helped the family of an Illinois college student find a facility for intensive outpatient treatment - far from the town where he formerly bought his heroin, so he feels less temptation. She's helped a father in New York begin to find help for his son, who had been using heavily and living on the streets.

Martin said she often deals with cases involving young adults, people 18 to 28 years old, who have much life ahead if they can transition from addiction to recovery. Her calls can last up to an hour, and she said she's working the phone daily, doing her best to respond at the odd and unscheduled times when opioid users or their families need her most.

"They have such a need to communicate with somebody and ask questions. They feel like they're abandoned, which a lot of them are," Martin said. "Individuals struggling with addiction need somebody to talk to who will listen and not judge."

Connections to Care: Part 2

Facing continuing issues with opioid overdoses and addiction, drug rehabilitation centers and health insurers are doing more to help people who are released from hospitals after initial treatment. Today, the Daily Herald examines one such program offered by the health insurer Aetna and how it's helping clients find long-term addiction treatment that fits within their insurance coverage.

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