A pair of data-driven quality improvement initiatives are helping Aetna improve care in two different areas. One involves improving oral hygiene to reduce infections; another helps reduce opioid-related deaths by contacting patients after an overdose.

Data collected by the insurer indicated that good oral health could help fight hospital-acquired pneumonia (HAP), the most common hospital-acquired infection, with more than a 30% mortality rate for patients, says Dan Knecht, MD, MBA, vice president of health strategy and innovation at Aetna.

“We had clinical insight that good oral health in the post-operative period could reduce the chance of infection, particularly with pneumonia,” he says. “The clinical insight was combined with the available data, and the point of intersection was the patient. Clinical insight with thoughtful intervention can really positively influence the health of our insured and ultimately reduce costs.”

Knecht and colleagues assessed the data available on Aetna’s insured patients, focusing on which patients contracted HAP after surgery. They examined the top 25 procedures in which patients contracted HAP, then studied the factors common to those patients.

A one-year study performed by an Aetna research partner in Salem, VA, found there was a 93% reduction in the incidence of HAP with enhanced postoperative oral care, Knecht says. That spurred Aetna’s Rush to Brush campaign.1 The campaign addresses the fact that surgery patients receive little oral care while hospitalized, which sets up perfect conditions for an infection, Knecht says.

These patients often lie on their backs for hours or days, sometimes heavily medicated, without eating, drinking, or brushing their teeth. Even when conscious, postoperative patients often neglect their oral hygiene because they are out of their normal routines and may not have supplies, Knecht explains.

This allows bacterial overgrowth that can lead to medical complications elsewhere in the body, including the lungs, Knecht explains. Research has shown that improving oral hygiene in postsurgical patients can significantly reduce the risk of pneumonia, he says.

Aetna identifies members facing inpatient surgery through precertification data and mails them oral hygiene kits before the procedure, Knecht says. The kits include a soft-bristled toothbrush, toothpaste, and alcohol-free mouthwash packaged in a travel pouch, as well as a personalized “Get Well Soon” card with oral hygiene tips, he says.

“The timing works out quite well. Patients generally receive the kit up to 15 days prior to the scheduled procedure. We launched the program in January 2019 and sent out about 1,000 of these kits,” Knecht says. “We then did patient surveys on their experience with the program, and they were very positive. About 95% of those responding to the survey had a very positive response. One very good result was that about 70% of those who received the kits brought them to the hospital, which is much higher than we expected.”

About 55% of the respondents said the kits improved their hospital experience, and more than 80% said they would recommend the kit to others.

An ongoing clinical study is assessing the effects on HAP, and the early results suggest that the dental health initiative may reduce HAP among Aetna members by 30%. Knecht notes that figure is preliminary but still says it is very encouraging.

Aetna also has been tracking metrics related to opioids. They found that each month, a few hundred members would suffer an opioid overdose. Aetna’s data indicated that patients who go to the ED for an opioid overdose frequently do not engage in post-discharge planning, so the insurer wanted to encourage intervention after the overdose, Knecht says.

The result was the Guardian Angels program, which seeks to engage with these patients soon after the overdose, when they are the most receptive to help, Knecht explains.2

“We look at claims data from members who have had an opioid-related overdose resulting in an ED visit. The data team pulls a list of those folks every month. We have three full-time clinicians who are really dedicated to this program, social workers and nurses with extensive backgrounds in helping people with substance use disorder,” Knecht reports.

“They call these patients to engage with them telephonically, try to understand what happened and how we can help them,” Knecht continues. “We launched this program about a year ago and have learned so much anecdotally about the opioid crisis and people who are struggling with this disorder.”

The clinicians can facilitate the patients seeking additional care to help with the disorder, including medication-assisted therapy. “One of the problems people run into is that there are not enough clinicians to treat addiction. The Guardian Angels can look for local providers within the Aetna network who treat addiction, make appointments, and sort of hand-hold, if needed, to make sure they get the necessary treatment,” Knecht says.

The connection rate with the Guardian Angels is higher than with most other efforts to reach out to patients, Knecht says. The program reaches 40% of the people they try to contact, which Knecht says is about three times higher than Aetna’s typical success rate for phone-based care management programs.

“Data are insufficient to make an impact. You have to look at these things through a practical clinical lens to know what will work in these settings and what won’t,” Knecht observes. “You need physicians who understand the real world implications of some of these data trends, along with the right intervention that is individualized to what the patient needs.”


  1. CVS Health. Fighting pneumonia with a toothbrush: New program is yielding results, Nov. 19, 2019. Available at: http://bit.ly/2LgBut3. Accessed Dec. 2, 2019.
  2. CVS Health. Guardian Angel opioids program reaching members at critical time, June 13, 2018. Available at: http://bit.ly/2RdVHmW. Accessed Dec. 2, 2019.


  • Dan Knecht, MD, MBA, Vice President, Health Strategy and Innovation, Aetna, Hartford, CT. Phone: (860) 273-0123.