Aetna Guardian Angel Program

A program implemented by a health insurer in North Carolina that uses claims data to identify nonfatal overdoses and a case manager to reach out to these individuals to provide linkage to treatment and other social services

The time immediately following a nonfatal opioid overdose can be an opportunity to link high-risk individuals to treatment, harm reduction, and other services. A health insurer, Aetna, implemented the Guardian Angel Program (GAP) to identify nonfatal overdoses among its members and link them to evidence-based and life-saving services. Although the program is present in several states, a special initiative that combines the GAP with a program to address social determinants of health has recently been implemented in North Carolina. 

The health insurer uses claims data to identify recent nonfatal opioid overdoses among its members. Once identified, a clinical case manager reaches out to these individuals via telephone and provides:

  • Guidance to members in finding in-network behavioral health and addiction service providers
  • Information on obtaining naloxone and other harm reduction strategies
  • Coordinating care with primary care and other community services
  • After an understanding of the member's psychosocial needs, connects them with Unite Us, a partnership to address social determinants of health 

There is a special component of this program that addresses nonfatal overdoses among college students. More information on this program can be found in the news article here and here and the presentation here. A comprehensive overview of Aetna's response to the opioid crisis can be found here

Provided meaningful support for more than 1,000 opioid overdose survivors...engagement rate of 50%.

Continuum of Care
Treatment
Harm Reduction
Type of Evidence
Implemented
Response Approach
Housing, Education, and Employment
Medications for Opioid Use Disorder
Post-overdose response

Evidence of Program Effectiveness

This program has not been formally evaluated, although it does self-report that case managers have connected with nearly 1,000 Aetna beneficiaries since the program began in 2018. Aetna also self-reports an engagement rate of 50%.