Maximizing Medicare Advantage

Medicare is facing unprecedented cost and care challenges, and national policy experts have recommended myriad ways to make the program more sustainable. Those recommendations have included networks of contracted providers, integrated delivery systems, case management, new approaches to payment and delivery of services, and fee schedules that promote primary care.

But Humana’s Medicare Advantage (MA) plans are already doing those things.

MA plans help people be healthier

According to the National Council on Aging, 73% of seniors have more than one chronic condition, and almost a third have mental or cognitive impairments. But Original Medicare is not a health program, it simply pays claims and monitors for fraud. In contrast, Humana’s Medicare Advantage plans make it easier for people to achieve their best health.

  • Humana Medicare Advantage plans start with our integrated care model and a focus on primary care—with doctors and their teams taking responsibility for the health of their patients.
  • Our MA plans emphasize preventive care, coordinated care, special care programs and improved transitions from hospital to home.
  • Humana MA plan benefits include special services and supports that Medicare doesn’t offer—for example: behavioral and social care, 24 hour on-call nurses and follow-up phone calls, plus in-home visits and meal-delivery after a hospital stay.
  • Care delivery is supported by a constant flow of data that detects gaps in care in real time so those gaps can be quickly filled.

These things make a difference to our members in health and quality of life. Humana data shows:

  • Improvement in activities of daily living. For example, after six months’ enrollment in Humana at Home—the arm of Humana that helps people with complex chronic conditions overcome barriers to health—patients report less pain, fewer falls, better medication adherence, and not feeling as sad and depressed as before.
  • A reduction in hospitalizations, readmissions and emergency room visits. Here’s how Medicare Advantage members enrolled in Humana at Home fared compared to a similar cohort not enrolled.

Hospitalizations for those at highest risk for frequent admissions ↓ 40%
Two year odds of survival ↑ 26%

Source: Humana at Home, 2014-2015

MA: a better alternative to traditional Medicare

Medicare Advantage provides a better alternative to the traditional, fee-for-service part of Medicare in several key ways. Recent national, peer-reviewed studies of people with Medicare Advantage demonstrate the higher quality and value that MA plans bring to the healthcare system:

  • An examination of research data from throughout the nearly 30-year history of Medicare Advantage concludes that in recent years, MA plans have delivered higher-quality care, reduced racial and ethnic care disparities, lowered social costs through better patient outcomes, and delivered lower hospitalization costs than fee-for-service Medicare, according to a study in the June 2014 edition of The Milbank Quarterly.
  • A review of hospital readmissions from 2006 to 2008 appearing in the February 2012 American Journal of Managed Care found that Medicare Advantage plans had 30-day readmission rates that were about 13% to 20% lower than those for fee-for-service patients, after adjusting based on readmission risk and disability.
  • A study in the January 2012 Health Affairs of patients enrolled in Medicare Advantage Chronic Condition Special Needs plans concluded that average risk-adjusted hospital days per patient were 19% lower for enrollees in the special needs plans than for fee-for-service enrollees, and that risk-adjusted physician office visits were 7% higher for the special needs plan enrollees.

MA plans helping make healthcare easier

Because Humana’s integrated care model depends on strong primary care doctor-patient relationships, we have been expanding our primary care footprint. We support primary care “medical homes” in 16 states and more than 900 accountable care provider organization relationships across 40 states and Puerto Rico.

We continue to invest in wholly owned primary care clinics as well as joint ventures with physician partners, including multi-specialty centers focusing on senior populations in medically underserved areas. These centers take a holistic approach to health, with primary care doctors and specialists under one roof. Many have extended hours, offer transportation to and from the facilities, and fill prescriptions on site. The goal is to make it easy for people with Medicare to be as healthy as they can be, removing known barriers such as a lack of local access to care.

To read Humana’s policy about Medicare Advantage, check out this page.