Humana has launched a pilot called Humana Care Support, formerly known as the Enterprise Clinical Operating Model, for a select group of Medicare Advantage members.
Care Support is customized, integrated and coordinated care management services. The care team will have real-time access to a member’s medical history and integrated clinician workflows through analytics and data integration from Microsoft’s cloud technologies Azure and Power BI.
The pilot is designed to enhance the integrated care members already receive from their providers. Many of Humana’s provider partners are in value-based care agreements serving Medicare Advantage members, which have their own care management capabilities already in place.
Within the pilot, clinician care teams identify, engage and support a select group of Medicare Advantage members living with multiple chronic conditions and complex congestive heart failure and diabetes in Kentucky, Pennsylvania and West Virginia. These multidisciplinary care teams include a nurse, pharmacist, social worker and a behavioral health specialist.
Humana said it expects Humana Care Support to be available to Medicare Advantage members in other states in 2021.
WHAT’S THE IMPACT
Humana Care Support helps the company’s efforts to deliver integrated care for Medicare Advantage members to improve their physical, social and behavioral health.
Today, 80% of older adults are living with at least one chronic condition, and 77% are living with at least two chronic conditions. Many of these older adults are more likely to fall behind in managing their health and suffer from social determinants of health, which are conditions in the environments in which people live, learn, work, play, worship and age that affect a wide range of health, functioning and quality of life outcomes and risks.
These chronic conditions are expensive to the healthcare system and for insurers.
The Humana Care Support work is guided by a series of simulations with members/caregivers, providing insight on their preferences, which helps with patient adherence to providers’ treatment plans.
It builds on Humana’s previous care management models and on how Humana leverages the concept of integrated care to address social determinants of health.
For the last several years, the company has been helping its members impacted by SDOH via its Bold Goal.
THE LARGER TREND
A 2019 PricewaterhouseCoopers report found that the rise in illnesses caused by peoples’ behaviors and the social determinants of health threatens to suffocate budgets in both wealthy and poor countries, while suppressing the power of modern medicine to improve lives.
By investing earlier in social determinants strategies that help people with housing, exercise, mental health support and the ability to afford medications, governments and health systems stand to save money in the long term and improve health outcomes.
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