Humana CaresSM, a subsidiary of Humana, serves as Humana’s care management provider for complex care, dual and chronic care special needs plans and chronic and specialty condition management. Humana Cares engages family members, caregivers and others in the plan of care, including the member’s health care providers. The goal of all Humana Cares programs is to stay ahead of the disease trajectory, identify issues that can be changed and improved and eliminate or mitigate complications, including preventable hospitalizations. Our model of care is multidisciplinary and focuses on a holistic approach to self-care management, empowering members to interact effectively with their providers as informed health care consumers.
Humana Cares programs meet the specialized needs of members who have multiple comorbidities and challenges to managing their health, including financial, social, behavioral, environmental and cognitive barriers and end of life concerns.
Humana Cares staff provides care coordination and health coaching support to members by telephone and through in-home assessments. Care managers facilitate communication between members and providers, especially when clarification of the treatment plan or medication regimen is needed.
All Humana Cares programs include care-coordination services such as:
- Arranging access to transportation
- Assessing the members’ risk for falls and providing fall-prevention education
- Referring members to meal delivery programs
- Referring members to financial assistance resources
- Helping caregivers access support and respite care
- Assisting members in obtaining home health and durable medical equipment
Other key areas of intervention include medication reviews, post-discharge support, assessments of daily living activities and cognitive, behavioral and social support and referrals to advance directive preparation services.
The Complex Care Management Program assists the most frail and vulnerable members. This program emphasizes a “member for life” strategy. Members are not discharged from the program unless they are no longer enrolled in one of Humana’s Medicare Advantage products. Care managers continually assess members’ acuity and support them throughout life’s course, particularly as new issues arise.
The Specialty Conditions Management Program coordinates medical, social and behavioral health care for members with one or more of these 13 complex conditions:
- Amyotrophic lateral sclerosis (Lou Gehrig's disease)
- Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP)
- Cystic fibrosis
- Lupus (systemic lupus erythematosus)
- Multiple sclerosis
- Myasthenia gravis
- Parkinson’s disease
- Rheumatoid arthritis
Services focus on health education, coaching and lifestyle management support.
The Chronic Condition Management Program serves members with primary diagnoses of chronic obstructive pulmonary disease (COPD), congestive heart failure (CHF), coronary artery disease (CAD) and diabetes. It is designed to shift the member’s focus from a single disease state to an overall healthy living approach. Care managers educate members about identifying and managing symptoms, as well as the need for routine health screening and preventative care. Guidance is based on the latest evidence-based medicine and care protocols. Care managers encourage members to adhere to their physician’s treatment plan and help members resolve physical, psychosocial and/or economic barriers to improving health.
The Special Needs Plan Program provides care management services for members enrolled in a Medicare Advantage Dual Eligible or Chronic Condition Diabetes Special Needs Plan. The care managers coordinate medical, social and behavioral health care. They support the member’s understanding of and adherence to the overall care plan and assist the member in setting and meeting individualized health goals, utilizing the expertise of a multidisciplinary care team.
Eligibility and Cost
All Humana Cares programs are available to eligible members at no additional cost.
The Complex Care Management Program is available to critically ill members who require 24-hour care and support. Humana Medicare Advantage and Medicaid members may be eligible for this program. The program is not available in Puerto Rico.
The Specialty Conditions Management Program is available to Medicare health maintenance organization (HMO) and commercial HMO, preferred provider organization (PPO) and point-of-service (POS) members in all Humana markets, except Puerto Rico. Members in some Medicare HMO risk groups are not eligible.
The Chronic Condition Management Program assists Medicare and commercial members 18 years of age and older who have a primary diagnosis of CHF, COPD, CAD or diabetes and have medium- to high-acuity care-management needs. The program is not available in Puerto Rico, and members in some Medicare HMO risk groups are not eligible.
The Special Needs Program is available to members in approved service areas who enroll in a Humana Medicare Advantage Special Needs Plan and:
- Are eligible for Medicare benefits and have a medical diagnosis of diabetes, as confirmed by a medical doctor or;
- Are eligible for a Dual-Eligible Special Needs Plan, according to criteria defined by the Centers for Medicare & Medicaid Services
For more information about Humana Cares programs, please call Humana Health Planning and Support at 1-800-491-4164. We are available to take your call Monday through Friday from 8:30 a.m. to 5 p.m. Eastern time. This line is available for anyone who wishes to refer a Humana member to a Humana Cares program, including physicians, social workers, hospital staff, caregivers or the member himself.
These programs and tools are not insurance products and are not guaranteed under any contract. Humana is not required to provide these services, but makes them available to eligible members.