The Louisiana Department of Health announced Mon., Aug. 5
that it has selected Humana to negotiate a contract with the state to participate
in its Medicaid Managed Care program to provide coverage to eligible children
and adults across the state beginning in January 2020.
“Humana has a long history in Louisiana of ensuring
high-quality care, health and well-being for families, seniors, employers and
our military servicemen and women,” said Humana Medicaid President John Barger,
“and we’re excited and honored to have been chosen by the state to serve
Louisiana’s Medicaid Managed Care recipients starting next year.
“We believe we can help enhance coverage provided through the
Medicaid program,” Barger said, “leveraging our innovative and integrated
health delivery platform; longstanding community presence; strong provider
partnerships; and unique commitment to population health.”
“We’re looking forward to expanding our reach in the
community to serve this important population,” said Tony Mollica, Humana’s
Louisiana-based Medicaid leader, “and partnering with the state of Louisiana to
improve health outcomes across the state.”
Medicaid managed care plans for Louisiana’s statewide program
were chosen through a competitive bid process.
The program is scheduled to begin enrolling eligible
Louisianans in January 2020 and the statewide program is expected to provide
health care to approximately 1.3 million Medicaid enrollees. The statewide
contract term is set to last through 2022, with the potential for an additional
two-year contract extension.
Integrating patient care and social determinants of health (SDoH)
— the conditions in which people are born, grow, live, work and age – is vital
to improving population health, according to a recent article in Managed
Healthcare Executive that uses Humana’s work as an example.
The author spoke with Humana’s Caraline Coats, MHSA, vice
president of Bold Goal and Population Health Strategy, and Andrew Renda, MD,
MPH, associate vice president of population health.
Humana “has made strides in incorporating SDoH into their
population health strategies with their Bold Goal initiative, a unique program
to help better care for patients with chronic medical conditions,” the article
said. “Humana aims to improve the health of the communities they serve by 20%
by 2020. Part of that strategy is considering SDoH factors like food insecurity
and social isolation in their population health programs.”
“We understand that food insecurity, social isolation,
transportation security, and housing are all directly related to health,” Andrew
said. “This program allows us to bring
those things into the mainstream of healthcare so we can start treating SDoH
for what they are—clinical gaps in care.”
Caraline said healthcare has been too medically focused for
too long. “Today, as an industry, we only spend 4% of every healthcare dollar
on social health. Everyone knows it’s important to health outcomes,
particularly the clinicians. But we needed to find a way to provide the data
and resources providers needed so they could treat social health factors too.”
The article said, “After only a few years, Bold Goal is
seeing clinical gains. The integration of SDoH information helped to increase
the number of self-reported “healthy days” by Medicare Advantage members in
Humana communities by 2.7 days. While 2.7 days might not seem like much,
Medicare Advantage beneficiaries in communities who did not participate in the
Bold Goal program saw a decrease of 0.6 healthy days for the year.”
In a series of LinkedIn Influencer blog posts, Humana President and CEO Bruce Broussard shares insights and ideas about the future of health care and discusses the importance of working together to improve the health-care system as well as our own health and well-being. His latest – Let’s seize health care’s great opportunity – is reprinted below. To see all of his blog posts, click here.
Each of us has experienced firsthand the complexity of our health care system, and we know how confusing and complicated it can be just to manage our own health records. We get it. We empathize with you. It needs to change.
I’ve heard from many of you that managing your health records should be as easy as managing your 401(k) account on your phone. Across the world, there is a growing movement to give consumers control over their data. Health data should be no different. Patients need to control their health data, and they need easy access to it.
There’s good news on the horizon. The health care industry is working to give patients, physicians, clinicians and health plans the ability to access and securely share clinical patient information in near real-time. This is the concept known as interoperability, which connects data across the health care system and allows patients to better manage their health and make informed care decisions.
While 86 percent of office-based physicians are using electronic medical records, many health systems cannot share these with each other, resulting in vast, isolated silos of critical patient information. However, if these systems could begin to talk to one another, we could improve care coordination and generate “more than $30 billion in annual health care savings.”
Interoperability gives health care consumers what they rightly deserve – ownership of their health information. Today, physicians, patients and health plans have a hard time sharing patient information. You experience this when you visit the doctor’s office and fill out personal-information forms – again – or urge them to send your information to another physician.
You might not realize this, but some companies that collect patient data are using proprietary systems and charging exorbitant fees to connect to other systems. These outdated business models profit from the sale of patient medical data at the expense of consumers having access to their own health data.
Despite these challenges, I’m optimistic about our industry’s ability to come together and embrace interoperability so we can bring much-needed simplicity to the system, which will improve care and lower costs.
We have a bold call to action to achieve interoperability. The Centers for Medicare and Medicaid Services (CMS) has issued an important call to action that will empower consumers to control, access and share their personal health data while also making it easier for physicians to share data with other physicians treating the same patients. Dubbed the Interoperability and Patient Access proposed rule, the goal is to “break down barriers to interoperability and health information exchange,” leveraging the progress of the Blue Button initiative.
CMS intends to require health plans like Humana to implement Fast Healthcare Interoperability (FHIR)-based application program interfaces (APIs) to enable patients to share their lab results, health claims, prescriptions and other clinical information with their physicians via the click of a button on a mobile device. These APIs make it easier for patients, clinicians and health plans to access and share critical health information.
Medicare Advantage enrollees can certainly benefit from interoperability. Today, nearly 75 percent of people over the age of 65 are living with multiple chronic conditions, and these conditions account for the majority of what we spend on health care. Interoperability could improve these people’s health.
Physicians treating patients with multiple chronic conditions would have a near real-time, holistic view of all the clinical actions performed by his or her peers. From reducing redundant testing to stopping conflicting prescriptions, these physicians could leverage this holistic patient data to make more-informed decisions.
The CMS proposal puts seniors in control of their own data, enabling them to decide who gets their information and empowering them to better manage their health. Health plans like Humana that administer Medicare Advantage also benefit from interoperability because it augments the holistic approach to care by using data analytics to garner and share insights from the patient’s data. That helps physicians and clinicians improve people’s health and well-being.
The health care industry has a great opportunity to band together to answer CMS’ call to help deliver a new patient experience. The promise of interoperability is inspiring because, if done right, it will be the foundation for transforming the system.
Physicians should have the best information available, and no one should have to spend hours tracking their health records. I empathize with anyone who has had a difficult experience.
When a natural disaster strikes, a community’s first
priority is responding to those in immediate need of assistance. Our hearts go
out to those impacted by Hurricane Barry and flooding caused by its storm
Recognizing many organizations in the greater New Orleans
community have shifted resources towards helping with Barry’s aftermath, The
Humana Foundation is extending its deadline for Strategic Community
Investment applications in New Orleans by one week. Organizations in New
Orleans will now have until Aug. 2 to apply for up to $1 million in investments
for initiatives addressing social determinants of health, the conditions under
which people are born, grow, live, work and age that impact overall health and
In 2019, The
Humana Foundation’s Strategic Community Investment Program is expanding to include
the greater New Orleans community. The Strategic Community Investment program
began in 2018, investing more than $7 million in organizations in seven of
Humana’s “Bold Goal” communities: Knoxville, Tn.; Louisville, Ky., San
Antonio, Texas; Baton Rouge, La.; Tampa Bay, Fla.; Jacksonville, Fla.; and
Broward County, Fla. The Humana Foundation contributes to Humana’s “Bold Goal”
– making communities by 20 percent healthier by 2020 and beyond – by
investing in local organizations addressing social determinants of health and
creating more healthy days together with community partners.
invited to apply for investments for initiatives that create greater health
equity for all and address one or more of the following social determinants of health:
Postsecondary attainment and sustaining employment.
Financial asset security.
In an effort to
encourage collaboration across sectors, special consideration will be given to
joint applications from two or more organizations working in partnership
towards results greater than what a single organization could achieve.
the greater New Orleans community can apply for a 2019 Strategic Community
Investment, including those in Jefferson, Orleans, Lafourche, Assumption,
Plaquemines, St Charles, St James, St John the Baptist, Terrebonne, St.
Tammany, Washington, and Tangipahoa parishes.
publication Inc. recently spoke with Humana’s Tim State, Senior Vice President of Associate
Health and Well-being, about employee engagement and Humana’s
success in improving overall worker satisfaction and adding Healthy Days.
The article noted
that Humana has increased physical workplace
satisfaction by 24 percent from 2015 to 2018 and that associates achieved their
Bold Goal of gaining 20% more Healthy Days.
Tim said the improvement “comes
from getting obsessed with centering decisions, priorities and activities
around the workers and their experiences at the office.”
The article noted Humana’s efforts to:
Redesign office space so
people can collaborate, focus and relax better
Offer more services
oriented to physical wellbeing, such as a fitness center open both to workers
and the larger community
Use technology to
resolve more day-to-day requests and work orders
He noted that successful companies move “from
traditional wellness that may address primarily physical health and some
aspects of mindset to an integrated and more holistic framework of human
wellbeing. This fully incorporates mental/emotional health and a sense of
belonging, security and even purpose or meaning in one’s life. These are
balanced with physical health and are interdependent within each of us. Plus,
they all can be significantly influenced in the context of our working