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 providers incentives and tools to help people be healthy.”
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.
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 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 providers are given incentives to improve outcomes, quality and costs, better results follow:
|Hospital admissions per 1,000||↓ 4%|
|Emergency department visits per 1,000||↓ 7%|
|Claims costs (per capita)||↓ 19%|
Source: Humana data, 2013
|Average rating for traditional fee-for-service providers of care for Humana members||Average rating for providers in Humana Medicare accountable care relationships|
|HEDIS star score (a national measure of care)||3.65 / 5||4.25 / 5|
Source: Humana data, 2013
Here are some ways technology is helping Humana members:
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 lowers hospitalizations by 34%, and its 30-day transitions program reduces hospital readmissions by 56%, a 2013 Humana at Home study found.
December 22, 2014
New medical clinics follow the example of integrated healthcare providers that work to treat the whole patient.
November 21, 2014
A former Obama administration official says quality-focused integrated networks can work well if designed properly.
March 31, 2014
Humana’s integrated care model allows its physicians to spend an average of 30 minutes with each patient.