Medicare Advantage

The Commonwealth Fund, a nonprofit private foundation supporting independent research on health policy reform and a high-performance health system, recently reported on the CHRONIC Care Act, which passed in 2018 and made it possible “for Medicare Advantage plans to begin covering services like adult day care, support for family caregivers, pest control, or other benefits that help members maintain or improve their health.”

The story cited Humana’s Bold Goal:

“In 2015, Humana launched the Bold Goal initiative, an effort to improve members’ health 20 percent by 2020 and beyond by identifying the social determinants of poor health and partnering with community organizations to address them. The insurer is working in 14 markets, where thus far some 1 million members have been screened. About 15 percent of Medicare Advantage plan members reported being food insecure and about 37 percent report being socially isolated — both factors that put people at increased risk of getting sick and accruing higher medical spending.

Andrew Renda, M.D., Humana’s associate vice president for population health, was quoted, saying, “When you have someone with a chronic condition and put social needs on top there’s an exponential increase in cost. That’s the perfect storm we’re trying to avoid.”

The story also cited Humana’s efforts in Tampa, where lonely seniors can utilize “grandkids-on-demand;” programs in Kansas City and Knoxville, in partnership with Walgreens, to screen thousands of people for food insecurity; and toolkits to help clinicians identify and address food insecurity.

The story also noted that, “this year, Humana will introduce grocery benefits for 50,000 members in its Medicare Advantage Special Needs Plans (for people eligible for both Medicare and Medicaid).”

Read the full story here.

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Humana President and CEO Bruce Broussard recently spoke at the 2019 Forbes Healthcare Summit, where he participated in a panel discussion titled “Supercharging the Medicare Advantage Experience.”

Bruce and other panel participants discussed how Medicare Advantage plans are evolving to address social determinants of health, such as food insecurity.

The value of Medicare Advantage

Bruce Japsen, Senior Healthcare Contributor, Forbes, who moderated the panel, began by asking Bruce about Medicare Advantage. Bruce spoke to three key elements that make it impactful:

  1. Taking full risk for a population. Bruce talked about how health plans are paid a fixed fee but are “responsible for overall population. That gives us a lot of freedom on what we can do.”
  • He said “the consumer decides (their health plan selection), as opposed to the HR department or some other individual that is not the user.” The industry must compete to serve the customer, which drives innovation.
  • The third element “which is really unique is you get paid more for taking care of sick people, which is not an insurance model…It’s an upside down insurance model.” Bruce added that this gives Humana the freedom in what we can do to improve people’s health.

People need a purpose to improve their health

During the panel, Bruce also spoke about how people are motivated to change their health when they find purpose. He talked about Jo, a Humana Medicare Advantage member living with multiple chronic conditions. She is also responsible for taking care of her adult son, who is mentally disabled.  

Bruce credits the Humana nurse – Vicki – with getting Jo engaged in her care after having a stroke and being hospitalized.  Jo stopped smoking and started doing breathing exercises, and Humana helped her find financial assistance so she could afford her medications.

“Vicki didn’t say, ‘You’re a diabetic and you need to do these things and that smoking was bad for her.’ What she found was this motivator…She was a caregiver for her son that was mentally ill. Vicki began the conversation around let’s be able to walk with John today. That began to start having the engagement around a purpose of why she should do this as opposed to the health care system saying that she should do it. It was much around what is personal for her and what motivates her.”

Bruce said Jo’s story is “the beauty of the (Medicare Advantage) model. It’s not about just getting paid for doing a treatment; we get paid for outcomes. And those outcomes allow us to have both these broad services, but motivation and innovation to help engage with the member.”

“That’s not a fee-for-service environment. Medicare Advantage encourages organizations like ours to wrap services around them. That’s why you see us acquiring and building these capabilities and services, being able to wrap those around and have a holistic view, as opposed to just treating a particular circumstance of an individual.”

Integration is essential for this holistic approach to care

Bruce also spoke about the need to take a holistic view of an individual, incorporating lifestyle with social determinants of health, primary care, home health and behavioral health, and doing so in the “the best way that helps the individual overall.”

Humana and the industry are part of a movement to “integrate the insurance to the health care services side.” He said, “We find that that integration allows a much smoother way to manage the population health orientation, but then you also are able to integrate it and make it much easier for the individual to use it, as opposed to there’s a treatment, we get something fixed, and the person goes away.”

Brenda Schmidt, Founder & Chief Executive Officer, Solera Health; and Felicia F. Norwood, Executive Vice President and President, Government Business Division, Anthem, Inc., were the other two panel participants.

For more information on Humana’s Medicare Advantage efforts, click here to check out the company’s annual Value-based Care report, which was issued last month.

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Humana announced today that it is launching the Humana Honor Medicare Advantage plans for 2020. ‘Honor’ underscores Humana’s commitment to veterans and is designed to complement health care provided through Veterans Affairs (VA). Humana Honor also boosts Humana’s Medicare Advantage slate of plans that are available to all Medicare-eligible individuals, which offer affordable health benefits and wellness programs with added convenience and a holistic focus on health and well-being for veterans and their families. Humana Honor Plans are available to anyone eligible for Medicare, but are designed in a way that may complement the benefits a veteran receives through VA Healthcare.

Highlights of Humana Honor Medicare Advantage plans for 2020:

  • All plans are $0 premium, and all but one offer a Part B giveback (premium reduction).
  • Enrolling in Humana Honor may augment VA coverage and help close any gaps in health care coverage.
  • Humana Honor may provide Medicare-eligible veterans with additional health care services and location options.
  • Humana Honor will give veterans access to robust dental coverage.
  • Humana Honor plans offer a broad network, including Urgent Care access.

Humana’s coordinated effort in creating Medicare Advantage plans that enhance options for veterans is an important milestone in helping veterans overcome barriers to achieving their best health.

“The launch of Humana Honor is a natural next step in our commitment to veterans and their families,” said Alan Wheatley, president, Retail Segment at Humana. “Considering care options from multiple sources can be confusing, and we understand that veteran health goes beyond physical symptoms – it’s a state of general well-being that encompasses a healthy body and mind – and our 2020 Humana Honor plans reinforce our ongoing commitment to support the total care our veterans need, not just in the doctor’s office.”

Humana Honor consists of 17 plans, available in 28 states including; Alabama, Arizona, Arkansas, California, Colorado, Delaware, Florida, Georgia, Idaho, Illinois, Indiana, Kansas, Louisiana, Maryland, Michigan, Mississippi, Missouri, Nevada, New Mexico, New York, Ohio, Oklahoma, Oregon, Pennsylvania, South Carolina, Tennessee, Utah and Washington.

Humana has served Medicare beneficiaries for more than three decades, with 8.4 million Medicare members in all 50 states, Washington, D.C. and Puerto Rico, as of June 30, 2019. Slightly over 4 million of those members are enrolled in a Medicare Advantage plan, which often provides them with extra coverage, such as prescription drug coverage and dental, hearing and vision benefits.

Humana has a longstanding relationship with the military community, and is committed to the well-being of all veterans and their families. Since 2012, Humana has built strong national relationships with the Veterans of Foreign Wars (VFW) and American Veterans (AMVETS). Through a partnership with the VFW’s Uniting to Combat Hunger campaign, Humana has helped to raise over 500,000 meals for veterans and communities. The VFW and AMVETS have selected Humana as their national MA/MedSupp/PDP provider1. VFW and AMVETs members are able to select any MA plan, including a Humana Honor plan offered in their respective areas.

Humana Military was awarded the TRICARE East Region contract that covers more than 5.9 million lives across a 30-state region. This is the largest TRICARE contract to date, and it took effect January 1, 2018.

For More Information

For more information about Humana’s 2020 Medicare offerings, visit www.Humana.com/Medicare or call toll-free 1-800-457-4708 (TTY: 711).
Licensed sales agents are available 8 a.m. to 8 p.m. local time, seven days a week.

1 These agreements do not establish any group health plan nor do the agreements obligate any individual VFW or AMVET members to purchase a Humana MA, PDP, or Medicare Supplement product.

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Humana is hiring hundreds of employees in De Pere, Wisconsin; Louisville, Kentucky; Glendale, Arizona; and Springdale, Ohio. The Kentucky team needs employees to support open enrollment for Medicare, which begins October 15. In Wisconsin, customer service representatives will provide telephone support to members. The Arizona and Ohio teams are looking to add pharmacy technicians.

In Louisville, Humana is looking for part-time and full-time enrollment representatives to process Humana Medicare Advantage member applications. Enrollment representatives will review reports and make adjustments, additions and deletions based on Center for Medicare and Medicaid Services (CMS) regulations respond to inquiries, and reconcile enrollment application information before they are entered in Humana’s member enrollment systems. These employees will be based in downtown Louisville and will serve for six months or less during the open enrollment season. These professionals need to be detail-oriented with strong computer skills and an ability to practice strict confidentiality for all sensitive information. A variety of part-time work schedules are available, including 7-11 a.m.; 9 a.m.-1 p.m.; 10 a.m.-2 p.m. and 1-5 p.m. Overtime is available, but not mandatory.

Interested candidates can apply in person at a Humana career event on Saturday, September 7 from 8 a.m. to 2 p.m. at 1325 S. Hurstbourne Parkway in Louisville.

The Humana team in De Pere, Wisconsin is looking for people to provide telephone support to Humana Medicare Advantage members, which may include answering plan and benefit questions. The successful candidate will have a high school diploma or GED, and previous customer service-related experience is preferred.

Humana is conducting interviews at an open house on Saturday, September 21 from 8 a.m. to 4:30 p.m. at Humana’s De Pere office at 1100 Employers Blvd.

Pharmacy technicians are needed for the Glendale, Arizona and Springdale, Ohio Humana Pharmacy teams. These roles may be taking calls from Humana members, resolving matters related to mail-order pharmacy, making outbound calls to doctors’ offices or Humana members, dispensing/filling prescriptions, or performing data entry of prescriptions. In Ohio, there is a career fair to learn more and apply on Friday, September 13 from 3 to 7 p.m. and Saturday, September 14 from 9 a.m. to 2 p.m. at 111 Merchant Street in Springdale. In Arizona, the career fair is Wednesday, September 18 from noon to 5 p.m. and Thursday, September 19 from 9 a.m. to 2 p.m. at 8990 W. Glendale Avenue in Glendale.

For all the career events, it is recommended that candidates dress professionally for an interview and bring several copies of a current resume. Humana offers competitive hourly pay, benefits, and a bonus/incentive program, all of which start on the first day of employment.

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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 — I aspire to deliver “life-changing” care— is reprinted below. To see all of his blog posts, click here.

Bruce Broussard

In many of my previous blogs, I have discussed the importance of lifestyle on health outcomes. Historically, our health care system has been oriented toward episodic treatments, and we have seen significant advancement in science allowing more effective treatments for complicated conditions, like cancer, Hepatitis C and severe cardiovascular disorders. These treatments are extending life; however, without assisting patients with their lifestyle needs, the advancement in science will be diluted. This is especially true in population segments that are more impacted by social determinants of health.

I am excited to see the increasing sophistication of health care policy that’s encouraging the integration of social determinants into health care.  Recently, CMS has taken two large steps in the integration, including: 1) the interoperability of health care information through their recent efforts in Blue Button and the Interoperability and Patient Access Proposed Rule and 2) the addition of new supplemental benefits within Medicare Advantage (MA). 

For example, MA organizations like ours can expand offering services such as transportation for non-medical needs, home-delivered meals, fresh produce, and social benefits that address isolation. Some of these new plans will offer better rewards and incentive programs, more accessible telehealth services and – ultimately – better wellness and care planning.

In this more favorable landscape for supplemental benefits, MA plans can better tailor offerings, address gaps in care, and improve health outcomes for the chronically ill. We’re excited to see such fresh creativity in benefit design as it will make it easier to help members like “John.”

Care needs to go beyond the clinical.

John is a Humana Medicare Advantage member in his late sixties. Medicare Advantage, the private form of Medicare that John has chosen for his health care, helps seniors address their health and non-health challenges so they can focus on living the lives they want. Medicare Advantage takes a comprehensive, holistic approach to help seniors like John slow the progression of chronic diseases like diabetes.

John had a high A1C, and he wasn’t going to his appointments, increasing his chance of vision loss, a heart attack or a stroke. Our Partners in Primary Care (PiPC) clinicians proactively contacted John and found that he could not afford the $15 copay for his office visit, he couldn’t buy healthy foods, and he couldn’t cover his portion of prescription costs.

The good news for John is that his Medicare Advantage program wasn’t just designed to address the clinical aspects of his care. Through personalized interactions, his plan also revealed his lifestyle needs, which contribute greatly to overall health and well-being. The PiPC clinician team helped him fill out a Supplemental Nutrition Assistance Program (SNAP) application, and he was preapproved for up to $165 in benefits. The PiPC team also helped John get the power company to lower his monthly bill because of his low income.

At Humana, we’re privileged to help our physician and clinician teams like PiPC and others deliver quality care to people like John in the most appropriate/most preferred setting, whether it’s in the doctor’s office or his home. This teamwork helps support a comprehensive, empathetic approach that removes these barriers to better health.

I was humbled to hear John say this type of support has been “life-changing” for him.

We’re working together to build a connected system to remove barriers to health.

In addition to being able to offer more services and benefits through the Medicare Advantage program, technology is playing a key role in creating an interconnected system, helping consumers use their own smart phones and tablets to manage their health care data.

Interoperability—where information systems are connected and coordinated—is freeing up data and providing a real-time, holistic view of each patient’s health. Put simply, the free flow of data makes it easier for everyone involved to deliver the right care at the right time and in the most appropriate setting.

That’s key for seniors, because they’re often living with multiple chronic conditions and need help removing barriers to their health.

Let’s keep helping John and others improve their health and save money.

Seniors like John who participate in Medicare Advantage are spending less time in the ER and have fewer hospital stays than those with traditional Medicare, and their medical costs have been shown to be 15.6 percent lower.

There’s an atmosphere of optimism in health care around what’s possible, and the changes taking place today are certainly moving the industry in the right direction, with the ultimate goal being to help people like John live happy and healthier lives. 

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