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, about 80 percent of seniors have one chronic condition, and almost 70 percent have two or more chronic conditions. Additionally, 95 percent of healthcare costs for older Americans can be attributed to chronic diseases. 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 ↓ 44%
Two year odds of survival ↑ 26%

More than one million more healthy days in the home (versus hospitalization) than they would have had without intervention

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:

According to a 2017 analysis of health-services data by Rand and CMS, as reported in “Medicare Advantage and Fee‐for‐Service Performance on Clinical Quality and Patient Experience Measures: Comparisons from Three Large States”:

  • Medicare Advantage clinical quality scores are better on average compared to fee-for-service Medicare for all measures, including screenings for colorectal cancer, cholesterol management and diabetes care.
  • Medicare Advantage quality scores for prescription drugs are better on average compared to fee-for-service Medicare for all measures, including medication adherence for diabetes, hypertension and cholesterol.

Additionally, a 2017 study from the Harvard T.H. Chan School of Public Health, titled “The Persistence of Medicare Advantage Spillovers in the Post-Affordable Care Act Era,” reports that higher Medicare Advantage market penetration rates lead to lower costs in traditional Medicare to the tune of $146 per person. The primary drivers of the reduction in spending were fewer home health visits, fewer hospital admissions and shorter inpatient stays, as well as fewer imaging events for traditional Medicare beneficiaries.

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 43 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.