Bruce Japsen, Senior Contributor
Apr 22, 2019, 09:00am
A project by Humana to improve the health of
seniors through better management of patient populations in seven U.S. cities
continues to show improvement, the company said in a new report out
Monday.
The health insurer’s “Bold Goal” initiative
uses measures established by the Centers for Disease Control and Prevention to
track an individual’s physical and mental “unhealthy days” over a 30-day
period. The social determinants of health for these patients are closely
watched with patients screened for “food insecurity” and “loneliness.”
“The social barriers and health
challenges that our Medicare Advantage members and others face are deeply
personal,” Humana chief medical officer Dr.
William Shrank said in a statement accompanying the report.
“This requires us to become their trusted advocate that can partner with them
to understand, navigate and address these barriers and challenges. With
‘healthy days’ as our barometer, we are able to track and trend population
health, measure outcomes and triage members in unique ways to the resources
they need.”
The original seven Bold Goal communities are
Baton Rouge, Knoxville, Louisville, New Orleans, San Antonio, Tampa Bay and
Broward County, Florida, and most have improved since the effort began four
years ago.
“Medicare Advantage members living in the
company’s original seven Bold Goal communities have seen a 2.7% reduction in
their unhealthy days since 2015,” Humana said in its report. “In
San Antonio, Texas, members saw a 9.8 percent reduction in Unhealthy Days,
which means they are halfway toward their Bold Goal.”
Over time, Humana has expanded the number of
Medicare Advantage enrollees screened as evidence has shown the overall effort
has worked. “With the help of internal business partners, physician practices
and community-based organizations, we screened over 500,000 people for food
insecurity and loneliness and connected those who screened positive to
community resources,” Humana’s report said.
“We set a new goal of screening 1 million people by the end of 2019.”
Humana’s population health initiative comes as
health plans move away from fee-for-service medicine that pays doctors and
hospitals based on the volume of care delivered to value-based models that
measure the success of health outcomes. Blue Cross and Blue Shield plans,
Aetna, Cigna and UnitedHealth Group are also working on similar value-based
models and programs in communities as well as shifting most payments from fee-for-service
to alternative reimbursements.
Meanwhile, more seniors are signing up for
Medicare Advantage plans, which contract with the federal government to provide
extra benefits and services to seniors, such as disease management and nurse
help hotlines, with some also offering vision, dental care and wellness
programs. The Centers for Medicare & Medicaid Services is changing
regulations to allow Medicare Advantage plans to provide broader coverage in
the future, which is also expected to boost enrollment already at more than 22
million this year and headed to nearly 40 million, or half of the U.S. Medicare
population by 2025, some have projected.
“This year’s report reflects our track record
of success in managing chronic conditions over time,” Humana CEO Bruce
Broussard said. “Given current demographic trends, we expect to see continued
demand for a support structure that addresses social needs, along with clinical
ones.”
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