Delivering integrated care

Humana understands that integrated care is one of the best ways to address the U.S. healthcare system’s cost and quality challenges. As Humana President and CEO Bruce Broussard describes it, “Integrated care is the opposite of sick care. We are advancing from a fee-for-service model, where no one really takes responsibility for a patient’s health, to a model that gives physicians and other healthcare providers incentives and tools to help people be healthy.”

Starting with emphasis on primary care

Putting a primary care physician in charge of a patient’s health is like putting a contractor in charge of a construction job: it provides someone who oversees and manages the project, while also ensuring the right actions are taken by the right experts at the right time. Experts knew decades ago that primary care would be “the logical foundation of an effective healthcare system,” according to a 1994 Institute of Medicine study. Under integrated care, primary care doctors and their teams take responsibility for patients and coordinate their care with specialists, and they work to keep a comprehensive medical record for each patient.

“A primary care-centric system makes it easier for doctors to do what they want to do anyway: know their patients, stay in touch, and help them be as healthy as they can be,” says Dr. Roy Beveridge, Humana’s Chief Medical Officer.

Encouraging doctors and other care providers to become accountable

The healthcare reform law encourages the development of “accountable care” models, and Humana has had accountable care relationships for more than 25 years. Many of the doctors and other healthcare providers we work with are accountable for the health of the population they serve and the cost of treating those patients. When quality and efficiency measures are met, they are rewarded.

Our experience shows that when care providers are given incentives to improve outcomes, quality and costs, better results follow when compared to those in traditional, fee-for-service Medicare:

Inpatient hospital admissions per 1,000 ↓ 7%
Emergency department visits per 1,000 ↓ 6%
HEDIS star score (a national care rating) ↑ 19%

Source: Humana data, 2015

New technologies support integrated care

Here are some ways technology is helping Humana members:

  • Our technology allows us to identify people in need of special care programs.
  • It sees “gaps in care”—for example, doctor visits missed, prescriptions not refilled, health screenings needed.
  • It detects unusual activity or irregular readings from home-health monitoring devices.
  • It enables us to communicate clinical information across more than 60 types of electronic health record systems.
  • It sends care alerts to care providers so problems can be addressed quickly and doctors can help their patients avoid emergency room visits and hospitalizations. Humana delivers 500,000 “gap alerts” every month. As a result, more than 30% of those care gaps close, a 2013 Humana internal study found.
  • It uses predictive analytics with data from claims and other sources to predict gaps in care before they occur, allowing appropriate clinical interventions.
  • And we're working on ways to enable doctors to access your entire health history in one place.

Programs for people with chronic conditions

Care management at Humana includes multi-disciplinary teams that connect people with chronic conditions to the resources and services they need. Care managers stay in touch by phone, nurses and social workers visit face-to-face, and community health educators connect Humana members with community and social services.

Some people stay in care management programs. Others are in for a short time—for example, when they transition from hospital to home. These programs are making a difference in quality of life. Humana’s chronic care program lowered hospitalizations by 40% for those at highest risk for frequent admissions, resulted in a 26% improvement in two-year odds of survival, and allowed members to spend more than one million more days at home over the past four years than they would have experienced without the program, Humana studies from 2014-2016 found.

Helping people achieve their best health

Keeping people healthy doesn’t just involve doctors, medications, care programs and technology. Part of Humana’s mission is to make it easier for our customers to do what they need to do, too.

  • Many of our primary care centers have physicians and specialists under one roof, provide patients transportation to and from, and fill prescriptions on the spot.
  • Electronic in-home monitoring devices help people stay in their own homes.
  • Mobile technology makes getting information and health supports easy.
  • Rewards programs and one-on-one coaching support people in their journey to develop healthy habits.
  • Humana Guidance Centers offer exercise classes, health-related activities and health information.
  • We take the mystery out of the business of healthcare by sending members simplified statements.