Helping people with chronic conditions

In healthcare, a large percentage of medical costs are generated by a small percentage of people. For example, among Humana Medicare Advantage members, approximately 75% of the costs are generated by 20% of the people.

That suggests a need to look at the 20% and create a better model for their care. What can be done to help people keep their diabetes, congestive heart failure, and other common chronic conditions under control? What can be done to cut down on emergencies?

That’s where Humana at Home comes in. Through health assessments and predictive modeling, Humana finds people who could benefit from special care programs. Then multi-disciplinary teams evaluate the needs of individual patients, create care plans, and connect them to the resources and services they need. Some people stay enrolled in their Humana at Home program for the long term; others are in for a short time during a care transition.

In the Humana at Home program, the teams include care managers who stay in touch by phone; nurses and social workers who visit in person; and community health educators who figure out how to connect members with the particular community and social services they need. Services could include transporting patients to and from doctor appointments; teaching members to use home monitoring devices; seeing that they have the prescriptions and food they need; and modifying the home environment to minimize the risk of falls.

Results: The Humana at Home program is improving health and lowering costs. Our data found:

  • After six months, hospital admissions for participants drop 30–40% compared to admissions prior to management.
  • Program participants with diabetes mellitus, congestive heart failure or chronic obstructive pulmonary disease have on average a 30–40% decrease in admissions and a 20–30% drop in costs per member per month.
  • On average, the reduction in claims for participants is $330 per member per month.

The Humana at Home program is also improving quality of life. In a 2010 self-reported survey, Humana members who had had difficulties with activities of daily living (washing dishes and bathing, for example) in the previous six-month period said the program helped them in many ways, including:

  • 16% who had previously reported their health as poor to fair reported it good to excellent.
  • 14% who had reported their pain level as interfering with their daily lives reported it under control.
  • 15% who had reported falling in the previous six months reported no fall in the next six months.