Aetna creating new system for managing migraines

The insurer wants physicians and patients to discuss less costly ways of treating headaches.

By Robert Kazel, AMNews staff. Sept. 13, 2004.

In the latest effort by a major insurer to use disease management to stem the costs of treating a chronic condition, Aetna is reaching out to migraine patients and their doctors.

The Hartford, Conn.-based insurer this summer launched a migraine management program that distributes written materials on the causes and treatment of headaches to both patients and physicians, asking them to work together to identify pain triggers. Aetna says it spends about $70 million a year to treat migraines.

Aetna is encouraging doctors to consider less costly medication alternatives, particularly preventive drugs, and to think twice about ordering brain imaging tests, which Aetna says usually provide little useful information about headache causes.

Aetna invited into the new program 2,500 patients who, based on claims data, appeared to be failing to get chronic headaches treated effectively, said Mark Rubino, chief pharmacy officer at the health plan. This represents a small portion of the 80,000 members that Aetna believes get migraines regularly.

"The idea is, let's try to prevent the episode," Rubino said. "Let's try to get them to use medications [for acute attacks] as infrequently as possible."

Patients opting into Aetna's program are sent a headache diary in which symptoms, medication use, therapy response and side effects are to be recorded for three months.

The program is the latest disease management initiative at Aetna, which also has programs for patients with asthma, coronary artery disease, congestive heart failure, diabetes, end-stage renal disease and lower back pain. Aetna and other major managed care firms have rolled out these programs to save money by pinpointing chronic users of health care services, supplying them with information on illnesses and in many cases offering regular contact with a specialized case manager by telephone. The migraine program does not now use case managers, Rubino said.