Health plans

Aetna and Optima are two of Virginia’s best performing health plans – State of Reform

Aetna Life Insurance Company (Virginia) and Optima Health Plan both achieved four out of five stars and “accredited” status from the National Quality Assurance Committee (NCQA) annual review, which was updated this month. The NCQA review evaluated 77 health plans in the Virginia market based on patient experience, prevention services, and treatment.

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Both plans exclusively serve members in Virginia. Aetna is a Medicare Preferred Provider (PPO) organization, while Optima is a combined health maintenance organization (HMO) and point of service (POS) business plan.

Optimal health, the plan operated by vertically integrated carrier Sentara Healthcare, represents more than 70% of the market in Virginia Beach, with more than 195,000 registered members, according to the report. Out of the three measures in the review, Optima scored the best for prevention service coverage, scoring 3.5 out of five stars. Preventive service measures included a high number of childhood vaccinations, pregnancy care, cancer screening, flu shots and STD screening.

On March 6, 2020, as the COVID-19 pandemic began in the United States, Optima announcement it would cover COVID-19 testing and treatment for its members. Denis matheis, president of Optima Health Plan and executive vice president of Sentara Healthcare, spoke about the impact of the pandemic on the organization.

“We want to do our part to remove barriers to care and provide safe options for our members who may be concerned about their health based on their symptoms and travel history. Our team takes the COVID-19 virus seriously and engages our members to help them protect themselves and the community as a whole. “

Etna, an entity under CVS Health, also achieved the best results in the coverage of prevention services, obtaining four out of five stars. According to the report, most members aged 50 to 75 were able to benefit from cancer screenings and adults 65 and older had been vaccinated against the flu as of June 30, 2021.

Aetna received three out of five stars for the report’s behavioral health measures in the treatment category, which include follow-up after hospitalization for mental illness or addiction, member’s adherence to depression medication, and outpatient care services. for drug addiction.

Cara mcnulty, chair of the Aetna Behavioral Health and Employee Assistance Program, discussed the importance of integrating behavioral health specialists into the community during the pandemic in a video for CVS health.

“What we do is place licensed social workers in specific locations who can help you do an assessment, understand what it means if you are suffering from anxiety, depression or other issues. How to navigate the system, how to use your health care benefits, and how to get the care and support you and your family need. We normalize that it is important to take care of our mental well-being.

Three plans that serve the Virginia-DC area, the Kaiser Foundation Health Plan for Mid-Atlantic States, Inc. (Commercial HMO), the Kaiser Foundation Health Plan for Mid-Atlantic States, Inc. Atlantic, Inc. (Medicare HMO) and Johns Hopkins US Family Health Plan (Commercial HMO), scored 4.5 out of five stars or higher in the report.

Forty of the plans evaluated obtained the status “accredited”, which means that they obtained “at least 80% of the applicable points in each category of standards”. Plans that did not provide any or partial data to the NCQA were marked as “unaccredited”.


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