Helping our members stay healthy — and keeping their costs down

Great healthcare is personal. Because each person’s health is unique, each member needs something different from their care. Sometimes that’s as simple as having an easy process in place to keep different treatments organized and coordinated. Sometimes that means having a caring person to talk through options during a difficult time. But every time, great healthcare means helping people live more healthy days, providing high quality care, and keeping costs down—so members can focus on living their best lives.

Humana works with this single goal in mind: helping our members get, and stay, healthy.

That’s why we’ve set a bold goal: to improve the health of the communities we serve 20 percent by 2020. And we’re making steady progress with an early focus on communities like San Antonio, Texas, and Tampa Bay, Florida … places where Humana has large member populations.

Here are just some of the ways we’re getting there.

Our efforts to save you money

At Humana, we want to keep costs down so our members can focus on living healthy lives. We work hard to make sure we’re succeeding. Here’s what we do to help our Medicare Advantage and Prescription Drug Plan members save almost $500 in prescription drug premiums this year:*

•  We check that the drugs we cover are prescribed and used according to clinical guidelines. We help people choose less expensive but clinically equivalent drugs including generics or OTC. We choose drugs for our formularies that are effective and provide value to consumers.

•  We monitor new drugs entering the market and forecast when drug patents will expire and generic drugs will enter the market.

•  We negotiate drug prices with drug manufacturers and work with them to get better clinical outcomes.

•  We help members take their drugs as prescribed and not miss doses, and warn members of possible harmful drug effects such as drug to drug interactions, high risk drugs, or duplicate therapies.

•  We use clinical research and analyze data to compare drugs and clinical outcomes to help us place the most clinically and cost effective drugs on our formularies. We also try to predict and detect possible risks or overutilization of certain drugs.

Innovating to keep you healthy

You can’t always measure what a healthy day feels like. But at Humana, the measurements of our innovative technologies tell us we’re on the right track:

1.9 million Humana members had high health risks. Humana used predictive modeling to find them and connected them to their doctors to close potential gaps in their care.

In one study, we saw an average 8.7 percent reduction in body weight using digital health tools—and we’re planning more.

Promoting integrated care

Humana helps doctors spend their time keeping members healthy, rather than just treating them when they get sick. We’re doing it in a few key ways:

•  We’re emphasizing primary care and working to slow the progress of chronic conditions. By closing gaps in care, we’re making life a little better for members and helping them keep their costs low.

•  We’re rewarding doctors and other healthcare providers for great results—like our 42,000 primary care partners in integrated care arrangements. When we conducted a national survey of our partners, 87 percent of those medical providers were pleased with our partnerships.

•  We’re identifying chronic conditions before they develop using predictive models and data analysis to connect the dots between early symptoms … before they turn into long-term issues.

•  We’re making it easier for people to achieve their best health with in-home care and technology that encourages them to stay healthy on their own time.

We believe in a simple premise: Doctors should be able to keep you healthy, not just focus on treating you when you get sick. And doctors agree.

But in many cases, doctors are reimbursed for the procedures they perform, not health outcomes they help influence. That’s why we’re partnering with doctors across the country to move toward accountable, integrated care. It means we’re focusing on the quality of care you receive and how healthy you are.

And that model is working: In 2013, we compared Humana’s Medicare Advantage members who received care from doctors whose reimbursement focused on health outcomes to those members who received care from doctors reimbursed for the procedures they perform. The members who saw providers with health outcome focused reimbursement had seven percent fewer emergency room visits per thousand and four percent fewer inpatient admissions, too.

Healthy behaviors, healthy living

At Humana, we’re committed to helping our members achieve their best health. HumanaVitality, which now has 3.9 million members, gives members rewards for making healthier, active choices—and that helps lower their health costs. People engaged in the HumanaVitality program had 6 percent lower healthcare costs than those outside the program after one year.

Keeping costs in check

 

Keeping people healthy saves money. It’s as simple as that. By helping Humana members live their best, healthiest lives, each of these programs contributes to keeping their costs down.


*How we calculate our cost-savings for members:

February 2016 Internal Humana calculation of total projected premium value from Humana’s drug rebates, management, and quality programs divided by [projected 2016] Humana Medicare Advantage or Prescription Drug Plan membership, as applicable.

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