admin January 9, 2020
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 – By
linking payment to performance, Medicare Advantage’s Five-Star Program is
driving better health – is reprinted below. To see
all of his blog posts, click here.
As all of us at Humana work to enhance the ways we can help our
members improve their health, we take many approaches to this. One aspect of
Medicare Advantage that doesn’t get the credit it deserves is the five-star
rating program – and how it not only helps people choose their coverage, but
also helps drive better health outcomes.
The development of the Star rating program more than a decade
ago by the Centers for Medicare and Medicaid Services (CMS) encourages
companies like Humana to constantly strive to improve members’ health and
experience. That’s because unlike traditional Medicare, Medicare Advantage
plans are measured by CMS on a set of core activities, like ensuring members
get key preventive screenings, that help drive better health outcomes.
Here’s an example:
In 2018, Humana member Leon K. opened his mail and found a
colorectal cancer screening test kit proactively sent to him by our company.
When Leon’s test came back, it showed that he had blood in his
stool – an indicator of colon cancer. That test encouraged Leon to make an
appointment with his doctor and get a colonoscopy – even though it was five
years before his next scheduled test.
The colonoscopy confirmed he had colon cancer.
Thankfully, since his cancer was caught early, Leon had surgery
to remove the cancerous area and avoided other costly and invasive treatments,
such as chemotherapy or radiation therapy that cause considerable side effects.
Today, Leon remains in remission.
“I don’t know whose idea it was to send that kit, but that kit
caught what I had in time,” Leon said. “You guys saved my life!”
Leon is not alone. Our focus on proactive, preventive care can
be lifesaving and life-changing for our members. This approach is also core to
the broader Medicare Advantage public-private partnership that creates
incentives for companies like Humana to improve people’s health by linking our
payment to our performance. This means that when we do a better job improving a
member’s health, we receive higher payments, creating an environment that spurs
innovation and new quality improvement initiatives.
This makes the Star rating system one of the few transparent
measurements in our health care system. Not only does the Star rating program
provide valuable information to consumers by rating Medicare Advantage plans on
a scale of one to five stars, it also drives competition between plans and has
led to improvements in quality of services, increased offerings, lower costs,
and overall better health care.
It’s not unlike other rating tools used by consumers — from
movie ratings on Rotten Tomatoes to restaurants on Yelp and household
appliances on Amazon. In the same way that ratings can help people avoid bad
purchases and find the right products, they can also help people navigate a
complicated health care system, where much more than a good movie or meal is on
the line. Rather, it’s your health, and whether a health plan can help you
manage it seamlessly and effectively while keeping your costs down.
And, the Star rating program is more than a comparison tool to
help Medicare beneficiaries select their plan. By linking our payment to
activities that drive better health outcomes, it aligns incentives for plans,
encouraging us to innovate and deliver proactive, preventive care that
identifies and helps treat chronic conditions and diseases at early stages,
which can lower costs and improve outcomes.
Studies show that the Star rating program is working. Since the
creation of the program, plans have improved on various quality measures,
including health outcomes, preventive screenings, and patient experience. These
measures range from controlling blood sugar if you are diabetic to ensuring
patients get regular preventive screenings, schedule appointments quickly and
access the right prescription medication. And patients are acting accordingly —
selecting higher quality plans and switching from lower to higher quality
plans.
Today, 92 percent of our Medicare Advantage members are enrolled
in plans that have a four-star or above rating, outpacing the industry average
and helping us deliver better health outcomes and lower costs for thousands of
our members.
One of the major ways we do this is by finding innovative ways
to encourage our members like Leon to get preventive screenings, which can help
them improve their health and avoid disease progression and avert preventable
adverse health outcomes.
Take diabetes and colorectal cancer as an example. By 2030, it’s
estimated that more than 55 million Americans will have diabetes. When not
managed well, diabetes can have a dramatic effect on health, quality of life,
and cost of care. For a Medicare beneficiary, low severity diabetes costs about
$600 a month, whereas high severity costs upwards of $4,500 a
month. Similarly, while survival rates for colorectal cancer have
increased since the 1980s, it is still a leading cause of death for many
Americans. Catching colorectal cancer early is critical to effective treatment.
That’s why we meet members where they are – at home. We proactively
mail easy-to-use colorectal cancer screening and diabetes testing health kits
to qualifying members’ homes to identify cases of colon cancer earlier – when
they are more successfully treated – or to assess a patient’s diabetes
management to tailor therapy and reduce complications of the disease. We also
hold health fairs in communities across the country where we provide those same
health test kits, perform mammograms, and offer diabetes-related eye exams and
bone density tests, as well as deliver educational materials to help prevent
chronic conditions from occurring or getting worse.
To be sure that screenings are effective, we make sure that the
member’s test results get to their care providers and, if the results are
unfavorable, that an appointment with their doctor has been scheduled. If we
don’t see an appointment after an abnormal test result, we follow up with the
member and his or her provider to help ensure no one falls through the
cracks.
This outreach makes a difference. After Reba C. – another Humana
member who received an abnormal colorectal test result – hadn’t followed up
with her doctor for a colonoscopy, a nurse from the Humana Stars Outreach Team
reached out to Reba and encouraged her to get it checked out. Our nurse
answered Reba’s questions and talked her through colon cancer survival rates
when it’s found and treated early. After our call, Reba got the treatment she
needed.
As a result of this outreach, nearly 93,000 Humana members who
should have taken a colorectal cancer screening but didn’t do so in 2017
received one in 2018 – resulting in more than 650 colon cancer diagnoses.
Similarly, more than 28,000 members who should have taken a mammogram in 2017
received this test in 2018, resulting in nearly 700 breast cancer diagnoses. And
more than 11,000 members with diabetes received a kidney screening in 2018,
resulting in more than 1,100 diagnoses of kidney disease.
Stories like Leon’s and Reba’s show the very personal effects
that are possible when innovation is applied to a large population. We
understand the responsibility that has been entrusted with us by participating
in the Medicare Advantage program. We are committed to proactively serving our
members by finding new and better ways to foster preventive care and achieving
better health. The Stars program is a critical tool in helping us achieve that
goal.
https://humananews.com/2020/01/by-linking-payment-to-performance-medicare-advantages-five-star-program-is-driving-better-health/
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