Medicare Advantage

Ten thousand people are aging into Medicare every day, and many of them are dealing with chronic conditions. To serve them best, health care has to evolve away from fee-for-service transactions and toward holistic, integrated, value-based care, Humana leaders say in a new video.

And that care has to extend beyond the doctor’s office, taking into account a person’s community and the many social determinants of health.

“If we are going to actually improve the health of these elderly patients, who will be us in not too distant future, looking at outcomes and being paid based on quality is something that we should all be motivated to do,” said Dr. Roy Beveridge, Humana’s Chief Medical Officer.

According to the Centers for Disease Control and Prevention, chronic conditions cause “7 of 10 deaths each year” and account for “86% of our nation’s health care costs.”

Addressing that will require a more integrated approach and more high-quality engagement between physicians and patients.

“I lost my father when I was young because he had a heart attack and previous to that, he had a stroke… and he didn’t know how to navigate the health care system,” Said Dr. Jimmy Fernandez, Chief Medical Officer, MCCI. “We thought by him going to the emergency room – him getting the care, he’d get the resources and help he needed and truth be told, it was one piece of the puzzle. He didn’t follow up with anyone, and in a short period of time, he died. I’m here to prevent that from happening to my patients.”

Focusing on value, rather than tracking only services rendered, can go a long way.

“Here at Humana we’re making really great progress on our value-based work,” said Mike Funk, Vice President in Humana’s Provider Development Center of Excellence. Results for 2015 “showed a 19% improvement in our quality…and a 20% overall improvement in cost compared to traditional Medicare.”

Watch the full video here.

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It’s common for people to look at New Year’s Day or birthdays as a chance to start a healthy behavior. But do those behaviors last? Humana recently conducted a study to test if these “fresh start days” were an opportunity to help people improve their medication adherence.

We partnered with researchers from Washington University in St. Louis and the University of Pennsylvania for the first-ever randomized controlled trial to test whether sending medication reminders around the time of fresh-start dates could boost their effectiveness.

Contrary to our expectations, the study found that reminder letters sent near fresh-start dates did not increase medication adherence. Even framing the fresh-start dates as an opportunity for positive changes did not increase reminder effectiveness, according to the study, which was published in the medical journal JAMA Cardiology.

“Medication adherence is a crucial issue when it comes to population health,” said William Fleming, president of Humana Pharmacy Solutions. “Finding what doesn’t work, can help us make progress towards finding what does work to improve medication adherence.”

The researchers, led by Hengchen Dai, PhD, of the Olin Business School at Washington University in St. Louis, contacted more than 15,000 Humana members to encourage them to take their cholesterol, diabetes, or blood pressure medications. These people were under commercial or Medicare Advantage programs and has 40-80 percent medication adherence during the previous 12 months. Some were sent reminder letters the week of their birthdays. Others were sent reminder letters three weeks after New Year’s Day. A control group was sent the reminder letters on a random day.

Researchers used pharmacy refill history to see how frequently people filled their prescriptions in the 90 days following the reminder. Contrary to our initial hypothesis, the people who received the Fresh Start reminder letters didn’t show a statistically significant improvement in their adherence compared to a control population. The timing of the reminder made no difference.

The study authors encourage further study be undertaken on how the psychology of fresh starts relates to medication adherence.

“Finding effective ways to improve members’ ability to take medication as prescribed has the potential to dramatically improve the health of individuals and communities,” said Laura Happe, director of Research and Publications at Humana. “Research like this is crucial to helping Humana serve its members while also contributing to the larger body of knowledge regarding population health.”

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Health plans and providers should work together because “the emerging winners in the healthcare space will be those who collaborate and engage in the nudge toward value-based care,” according to an article in Managed Healthcare Executive.

Humana Chief Medical Officer Roy Beveridge, M.D., and Oak Street Health CMO Griffin Meyers, M.D., spoke with the publication about navigating the transition.

“As the health industry transitions toward value-based care, Humana is collaborating with organizations such as Oak Street Health to provide quality care for members,” Dr. Beveridge said. “Value-based care generates improved clinical results, quality care and impressive patient engagement. Health plan and provider collaboration fundamentally supports high-quality value-based care, and creates a beneficial partnership.”

You can read the full Q & A here.

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Humana Chief Medical Officer Roy Beveridge, M.D., and Oak Street Health CMO Griffin Meyers, M.D., recently spoke to FierceHealthPayer about how both companies are working together to bring the benefits of value-based care directly to members.

“These days, value-based arrangements are common between traditionally adversarial entities like providers and payers,” the article said. “But making these partnerships successful requires a lot more than just signing a risk-sharing contract.

“Health insurer Humana and Oak Street Health, which operates primary care centers, think they have the puzzle figured out. The organizations forged a value-based arrangement in June 2015, combining Humana’s pay-for-value expertise with Oak Street’s holistic, population-health-focused approach to serving Medicare patients in the greater Chicago area.

“Now more than a year later, leaders from Humana and Oak Street are encouraged by the partnership’s early results, saying the use of robust data, open communication between payer and provider, and a focus on quality before cost are all helping drive success.”

You can read the Q&A with Dr. Beveridge and Dr. Meyers here.

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Sometimes you need a little help when it comes to taking charge of your own health, making healthy choices and simply getting things done.

Humana offers a service called Humana At Home that is provided by Care Managers, nurses, nurse practitioners, home health aides, and other professionals to help people live safely at home, even when faced with medical, functional and behavioral health challenges.

The Humana At Home service includes in-home visits, telephonic advice, clinical care and in-home technologies that offer remote monitoring and other solutions. There’s even an Online Points of Care portal that helps members learn about and manage their health conditions, share updates with family caregivers and professionals, and access a national directory of vetted community resources for elder care and caregiving. Humana At Home professionals specialize in caring for older adults with multiple chronic conditions and functional, behavioral and/or cognitive limitations.

People who receive Humana At Home services live longer and go to the hospital less.

Eighty-nine percent of Americans over 65 want to live out their lives in their own homes. But a majority of members cite health problems as the No. 1 threat to their independence.

Many people are vulnerable not just because they are sick, but because they struggle with their daily activities. They might have trouble reaching for things in the pantry or bending to pick up a newspaper. The might have trouble preparing a meal, shopping or doing housework. Many suffer from short-term memory loss and have difficulty managing money or their medications. They might have trouble standing, walking or bathing.

These are real risks that make people more vulnerable to falls, accidents and hospitalizations. These seniors are more prone to malnutrition, infection and abuse. There’s a high degree of stress and anxiety about how to navigate the healthcare system.

In a fragmented health system, Humana care professionals offer a unique, holistic approach to wellness. Humana nurses and care managers can offer:

Medication management
Nutritional counseling
Home safety and falls prevention
Mental health support
Care coordination

A Care Manger might, for example, identify a community resource to help someone pay unpaid utility bills that otherwise could lead to a nonfunctioning refrigerator, spoiling insulin and limiting the person’s access to fresh food.

Field care managers visit Humana’s most vulnerable members to understand and address any factors that impact their ability to remain independent at home and avoid unnecessary hospital visits.

Our services are tailored to meet individual needs and circumstances:

Short-term after a hospital stay (Transitions)
Ongoing care (Telephonic and/or face-to-face)
Technology-enabled (Remote monitoring)
Preventive (Stay Healthy)
Community outreach (finding people who do not have phones)
Skilled care (Home health and nurse practitioner home visits)
Non-Humana members (Private pay)

It’s all designed to help us provide the right intervention, at the right time, in the right way, in the right place.

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