Aetna Member Story

Collaboration Between Utilization Management (UM) And Care Management (CM)

Mary, an Aetna Better Health® of Illinois member, was admitted to Substance Abuse Residential Treatment at Cornell Interventions in October 2021 due to daily heroin and cocaine abuse. A below-knee left her wheelchair bound, and a recent diagnosis of Multiple Sclerosis requires close observation and monthly infusions. Mary has an extensive history of attempted sobriety through treatment, with five years of sober time from 2009 to 2013. She also had five attempts of RTC treatment in 2020, along with medical admissions due to necrotic wounds on her arms from IV heroin use.

During her residential treatment, the team recommended specialized aftercare due to Mary’s medical diagnoses. The Behavioral Health Utilization Management team reached out to Aetna Better Health of Illinois Care Mangers Olga and Marlene for help with placement options.  Together, they helped get Mary placed at The Boulevard, a medical respite option in Chicago that specializes in both physical and behavioral health support.

*Names changed to protect privacy