Overview and Evaluation of Aetna's Healthcare Consumer Education Initiative

Aetna, Inc. initiated a multi-dimensional healthcare consumer education strategy in 1995 to help employees and retirees become better consumers of healthcare and promote better use of medical services.

Goals of the initiative are to:

· Provide employees and retirees information about a variety of health topics to increase  awareness and understanding of important health issues.
· Empower employees and retirees to effectively communicate with their providers.
· Promote effective and efficient use of health services.

The strategy includes:

Aetna U.S. HealthCare's Informed Health Line (ML) program: IHL was incorporated as an add-on service to the Aetna benefits package for all employees and retirees regardless of their medical plan selection. IHL provides access to a toll-free, 24-hour telephone line staffed by experienced nurses. The nurses offer health information and decision support but do not diagnose, prescribe treatment or give medical advice. The IHL service is available 24 hours every day. TDD is available for hearing impaired.

An Informed Health Handbook: When the program was introduced, all Aetna employees (N= 41,000) and retirees (N= 15,000) received a health reference guide that helps identify common health problems and provides information on over 100 health topics. The guide is also mailed to all new hires and retirees quarterly throughout the year. The handbook is also available in Spanish upon request.

A Medical Information Fact sheet: An interactive, easy to read fact sheet was included in the introductory kit to help increase awareness of the program components and how to use them effectively. Handy program reminders such as refrigerator magnets, stickers for the phone or phone book were also included.

Ongoing employee communications help build program awareness and enhance knowledge and understanding of healthcare problems including internal newsletters, showcase displays, postcard mailings, promotional articles, flyers, e-mail announcements and click and print information from the Aenhance intranet website.

Creating a Partnership with Your Doctor: Self-directed Program to help employees improve medical consumer behaviors at their own pace. More than 2,100 employees completed the program. Follow up data suggests participants increased self-efficacy for several healthcare behaviors such as keeping a note of symptoms of a health problem (+31%), preparing for an office visit (+49%) and asking the doctor to explain tests and treatments (+38%). Medical self-care action campaigns featuring guest speaker events, videotape distribution to field office employees, on-site workshops, showcase displays and program incentives. On-site Flu Shot Program which provides flu shots and preventive health information at the
work place to help employees learn steps they can take to prevent the flu. Participation in 1998 = 3,230. The program helped reach high-risk populations. About 14% participants reported they were potentially at risk for serious side effects from the flu.

First Action: The "First action taken at the sign of a health problem" also changed significantly for survey respondents. In the pre-test, "Calling the doctor" was ranked first, followed by "Make a doctors appointment and "Look in the Informed Health handbook." I the post-test, "Look in the Informed health Handbook" was ranked first, followed by "Calling the doctor" and "Make a doctors appointment."

Three Year Follow Up: A similar follow-up survey was conducted three years after the initiation of the IHL program to a statistically random sample of Aetna employees (N= 4,110). Survey results suggest the program has continued to improve medical consumer behaviors and efficient use of healthcare resources. Of respondents(N= 700):  78% reported the program has increased their knowledge about their health problem or
question.  63% increased confidence for making healthcare decisions.
 65% improved ability to treat minor injuries at home, when appropriate.
 54% have improved ability to talk with their doctor about medical questions or concerns. By improving members understanding of healthcare issues and empowering them to actively and knowledgeably participate in their care, our program has resulted in effective and efficient use of healthcare resources. For example, the education information we provide
through Informed Health Line, the Handbook and other health benefit programs, help employees and retirees identify problems their physicians might otherwise ignore, leading to early treatment of potentially serious and costly health conditions.

Overview and Evaluation of Aenhance Fitness Programs
Aetna, Inc. has demonstrated a long-term commitment to fitness dating as far back as the 1940's. Over the years the Aenhance fitness program has evolved into a comprehensive, multi-dimensional strategy and highly valued benefit for Aetna employees. This summary provides an overview of core program components and evaluation results that have been documented. The fitness program includes:

On-site Fitness Centers: Aenhance manages two state-of-the-art fitness centers in Connecticut home office locations. The centers are staffed by exercise physiologists and provide a full range of fitness programs to help Aetna people improve fitness level and reduce health risks. Services include fitness assessment, personal exercise prescription, group exercise, individual wellness counseling, cardiovascular and strength conditioning and ancillary services such as physical therapy and chair massage. Annual membership rate is 35%. Program impact and cost effectiveness studies are described in detail below.

Get Active Aetna! A nationwide fitness incentive program was designed to motivate employees who do not belong or have access to a fitness facility to increase physical activity into their daily lifestyle. During the first year of the program, 9,327 employees participated and 44 percent completed the program. Pre-post test results suggest the program was effective for motivating inactive employees to start exercising and to increase the frequency of exercise for employees who were already active. Analysis of variance (ANOVA) was used to test for significant differences between participants who completed the program and those that did not. Level of physical activity for all participants increased by an average of one day
per week. Other statistically significant results reported were increases in sense of well being, energy level and stamina and endurance.

Fitness Programs "To Go": A variety of fitness education kits are available continuously throughout the year to help employees design their own fitness program to meet their needs at their own pace. Topics include Run for Fun and Fitness, Walk AWhile, First Steps to Fitness and Nutrition Fuels Fitness.

National Fitness Network: Employees have access to a national fitness provider network to offer discounts on membership fees and/or the best corporate rate.  The program also provides discounts on home exercise equipment and certificates for trial membership. Ongoing Fitness Awareness and Education: Employees receive weekly and monthly communications about fitness topics and events via internal newsletters, e-mail, postcard mailings, posters, flyers, showcase displays, and the Aenhance intranet web site.