Ms. James speaking at microphone

Innovative Care Delivery Models Deliver Results, Says Humana Official in U.S. Senate Hearing

Humana was one of a select few “private sector innovators” on Capitol Hill offering expert testimony at a hearing focused on reforming the health-care delivery system.

Humana was the only health insurance provider invited to testify before the Senate Health, Education, Labor and Pensions Committee, and representing the company was Marcia Guida James, Director of Network Relations and Provider Engagement.

Guida James was asked to appear before the committee to, as Sen. Sheldon Whitehouse, D-R.I., put it, “show how delivery innovations have resulted in real improvements in quality… patient outcomes… and cost savings.”

Whitehouse explained that while the government is moving toward delivery system reform, “the movement has been driven by dedicated providers, payers, employers and some states that have worked for years to improve the quality, safety and effectiveness of care.”

In her remarks to the committee, Guida James outlined several of Humana’s provider engagement initiatives, all of which “center on the robust exchange of clinical and financial information with provider partners in a variety of flexible reimbursement models.”

As an example of these initiatives, Guida James highlighted Humana’s Provider Quality Rewards Program, which last year resulted in a 2 percent improvement in colorectal screenings, a 4 percent increase in lung function testing and a 7 percent increase in breast cancer screenings.

Guida James also discussed Humana’s Accountable Care Organization (ACO) pilot collaboration with Norton Healthcare in Louisville – part of the Brookings Institution-Dartmouth Institute for Health Policy and Clinical Practice ACO pilot project. The partnership led to a 9.1 percent decrease in unnecessary antibiotic treatment for adults with bronchitis; a 6.1 percent improvement in diabetic testing; and an 8.6 percent improvement in cholesterol management in diabetics.

Additional witnesses at the hearing included Dr. Al Kurose, President and CEO of Coastal Medical, Inc., and James Capretta, a fellow with the American Enterprise Institute.

To watch the hearing and read Guida James’ full statement to the committee, click here.

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