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Humana Offers Clinical Support
Programs for MA Members
Humana's
Medicare Advantage plan coverage includes a wide range of clinical
programs designed to support member's
health goals and reinforce physicians' care plans. Below
is a summary of clinical programs available to Medicare Advantage
members:
- Diabetes program – Medicare members
with diabetes are eligible to participate in this program, which
is designed to improve health outcomes and decrease complications
from diabetes. The program focuses on self-management, based
on American Diabetes Association (ADA) guidelines. Enrollees
receive a combination of patient education materials and follow-up
telephone support. Members may also access the HumanaFirst nurse
triage line for additional support 24 hours a day, seven days
a week, at (800) 622-9529. To refer a Humana Medicare-insured
patient to the diabetes program, call (866) 470-2481.
- Health risk assessment (HRA) – The
Centers for Medicare & Medicaid
Services (CMS) requires that each new Medicare member receive
a health risk assessment within 60 days of their effective date.
This year, Humana began using the PraPlusTM (Probability
of Repeat Admissions) tool developed by Johns Hopkins University
as its Medicare HRA. The PraPlusTM is
a 17-item screening questionnaire that is used primarily to identify
seniors at high risk for heavy use of health-related resources
in the future. Members can be classified into risk categories
based on their final score or PraTM value.
This new tool, which is administered
by Corphealth, a behavioral-based solutions company and Humana subsidiary, allows
for better identification of members who may benefit from a Humana
case or disease management program.
- Behavioral health case management – Humana
and Corphealth have implemented an integrated approach to care
management to improve outcomes for Humana members, while
reducing utilization of noncovered benefits.
Humana and Corphealth associates work together
to support members through a "total person" approach,
addressing mind and body. Integrated care plans are developed and
delivered by a primary case manager from either Humana or Corphealth.
The care plans address underlying root behaviors that can lead
to poor overall health.
Members may enter the program through a
referral from any of Humana's
clinical programs, a referral from their primary care physician
or self-referral. For guidance about Humana clinical resources,
physicians and members can contact HumanaFirst at (800)
622-9529.
In
addition, Humana offers a wide array of disease management programs
to all of its members. Medicare members may benefit from programs
targeting heart failure, chronic obstructive pulmonary disease,
renal failure and 13 other complex, chronic diseases. For more
information about Humana's disease management offerings,
visit www.humana.com. From the home page, click "Providers" and
then "Health & Wellness" to view a list of links
to specific disease management offerings.
These programs can help
Humana's Medicare Advantage members
realize better outcomes. Physicians are encouraged to discuss these
resources with their Humana-insured patients, and refer patients
as appropriate.
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MA Provisions to be Updated
Physicians should be aware that the Medicare Advantage provisions
in their Humana Medicare contracts will be updated by the
end of 2007. Physicians will receive the new Medicare Advantage
provisions in an amendment that will be mailed by December
31, 2007.
When the provisions are received, please review
them with appropriate staff, evaluate practice operations
and make changes as necessary. The provisions should then
be filed with the practice's Humana MA contract.
For
more information, contact your contracting representative. |
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