Refocusing on primary care

Humana knows that the health system needs to refocus on providing people with recommended preventive care and other primary care services that will keep them healthy and keep them out of the hospital. All too often, patients don’t receive the primary care they need, or the care they do receive is inefficient and not coordinated.

Under the traditional fee-for-service system, health professionals too often focus on patient care only when those patients are in front of them, not after the patients have left the office. Providers don’t receive enough useful information about the populations they are treating. Barriers in the system interfere with efforts to improve health quality, access to needed care and patient experience.

Such shortfalls are very costly, both in outcomes for the patient and in financial impact on the system. There are better ways to encourage accountable, data-driven, patient-centered primary care, and Humana is advancing those innovations throughout the system by building a primary care continuum. We have numerous initiatives within this continuum that share best practices based on accountability, information, and Humana’s triple aim of quality, access and patient experience.

Accountability for total patient care

Primary care must be improved by ensuring that providers are responsible for the comprehensive care of the patient. Greater accountability means serving the patient’s total needs—not just in the office but also extending beyond the walls of the clinic, after the patient has gone home or moved onto specialists, hospitals or skilled nursing facilities. Many primary care shortfalls occur when physicians find it difficult to follow up on these patient handoffs and to coordinate patient care adequately.

Concept in action

CAC Florida Medical Centers (link opens in new window)  have a coordinated, comprehensive, repeatable model for providing primary care to members. The Humana-owned centers give members access not just to a physician office, but to a multispecialty, patient-centered medical home where they can receive all of their recommended preventive care. With CAC Centers providing most of the care a member may need under one roof, the care is naturally coordinated, doctors work as teams when caring for patients, and members are less likely to slip through the cracks after they leave.

Giving providers the information they need

One major barrier in the effort to refocus primary care comes from a lack of needed information. The system needs to arm providers with the necessary data to be fully informed about their patients’ health needs. When health professionals have the information they require about their patients from all parts of the healthcare system, no matter the setting, they can truly feel that they are part of a culture that breeds a sense of caring about what goes on in all of those settings.

Concept in action

Continucare (link opens in new window)  demonstrates how information systems can help transform primary care. Because the Humana-owned network provides pediatric, adult and geriatric care, it has adopted an inclusive approach to care for patients of varying ages and health needs, and it is intently focused on improving population health. In line with those goals, Continucare is implementing an electronic health records system to operate across all of the clinics, giving every facility access to needed patient records as well as the same scheduling platform and referral management system. Such standardization allows primary care professionals to get back to doing what they do best: focusing on keeping their patients well and keeping them out of the hospital.

A system built on quality, access and experience

The end goal of primary care transformation is to construct a system with a triple purpose—high-quality care, access to needed services, and an excellent patient experience. These three pillars of care are all necessary. Take one away, and the primary care system will fail to reach the place where it needs to be.

Concept in action

JenCare (link opens in new window)  demonstrates how access to care is about getting patients the right care at the right place at the right time. The multispecialty facilities —operated through a Humana joint venture— can provide needed specialty care onsite, sometimes the same day as the primary care office visit. If patients need services at the clinics but don’t have a good way to get there, JenCare provides van transportation with pickup service. Patients needing prescriptions can receive many of them from the on-location pharmacy.

Primary care proving grounds

Humana understands that there is no single best model for transforming the health system and refocusing it on primary care. By encouraging shared best practices while preserving unique concepts of individual models that prove effective, Humana will help bring about a primary care continuum that works better for patients and for providers.

Concept in action

MCCI (link opens in new window)  and MetCare (link opens in new window)  demonstrate that good patient coordination doesn’t necessarily require one singular approach to delivering primary care. Although many of the patients in these provider groups receive comprehensive care through Humana-owned multispecialty clinics, they also can receive care from independent physician offices that contract with the networks. In this way, MCCI and MetCare can offer resources that help patients receive the care they need and help physician offices function well and manage risk—all while retaining accountability for a patient's total care.

Learn more about how Humana is refocusing on primary care:

CAC Florida Medical Centers (link opens in new window) : Humana-owned multispecialty medical centers serve patients in nearly 20 locations.

Continucare (link opens in new window) : A Humana subsidiary provides primary care through 19 medical centers and independent practices.

JenCare (link opens in new window) : Through a joint venture, multispecialty medical centers in six major U.S. markets serve Medicare and private-pay patients in medically underserved areas.

MCCI (link opens in new window) : A medical group founded by physicians operates in Humana-owned medical centers and independent offices.

MetCare (link opens in new window) : A Humana-owned primary care network of physicians, nurses and specialists serves Medicare seniors from 18 locations.