Medicaid Healthy Behaviors yearly program review

Mother and son resting on the ground after having played basketball

Overview

A healthy lifestyle is important to start early and maintain throughout your life. These programs are designed to encourage healthy behavior, help you reach your goals and enable you to earn rewards such as gift cards. The information below represents our yearly evaluation of this program.

  1. Health risk assessment (HRA) – Offers qualifying members an incentive to complete the assessment.
  2. Baby well visit (BWV) – Encourages the frequency of child well visits to the primary care physician during critical periods in the baby’s growth and development.
  3. Mom’s First prenatal and postpartum – Incentivizes enrollees for prenatal and postpartum education and care management to help decrease the risk of pregnancy complications, including preterm delivery associated with high-risk pregnancies.
  4. Pediatric well visit (PWV) – Incentivizes enrollees to complete their annual well-child visit.
  5. Humana Family Fit – Incentivizes obese and overweight members to join a 6-month weight management intervention.
  6. Smoking cessation – Encourages members to quit smoking through both counseling and medication therapy.
  7. Substance abuse – Encourages members to maintain and live a drug-free and/or alcohol-free lifestyle.

Performance

The program enrollment and completion counts are from July 2018 through June 2019.

Program Enrollment Completion Health risk assessment* 8,669 8,669 Baby well visit 5,272 3,021 Pediatric well visit 10,792 8,985 Mom’s First prenatal and postpartum 4,971 932 Humana Family Fit 16 2 Smoking cessation 72 4 Substance abuse 58 2

*Note the health risk assessment counts began in December with the rollout of our new contract.

Clinical success measures

Baby/child well visit

  • Increased primary care physician engagement/encounters, improved early detection of illness or developmental delays and improved adherence to treatment (as applicable) leading to lowered emergency room (ER) visits and inpatient (IP) utilization (risk adjusted)
  • Increased immunization rates

Mom’s First

  • Increased enrollment/engagement
    • Reduced preterm deliveries
  • Increased compliance with prenatal and postpartum appointments
    • Early identification and reduced preterm and postpartum risk and complications leading to ER, admissions, preterm delivery and adverse outcomes

Substance abuse/smoking cessation

  • Reduced medical and behavioral health costs by reducing admissions to ER and acute levels of care
  • Increased utilization of community resources and community providers to build a network of support to reduce risk of relapse
  • Increased use of healthy coping skills when facing psychosocial stressors resulting in improved member lifestyles and overall well-being

Family Fit

  • Increased enrollment and member engagement around activities to reduce weight, increase physical activity and improve nutrition
  • The goal is to promote a healthy lifestyle and reduce adverse outcomes and disease progression related to obesity.

Next steps

Here at Humana, we have increased the call campaigns for the healthy behavior programs to promote member engagement.

The program has devoted new resources as Humana’s Medicaid focuses on these important strategic outcomes. More attention and emphasis have been placed on all healthy behavior programs to promote engagement. New partnerships with clinical personnel will help drive member and program engagement.

We are excited to partner with The Agency of Health Care Administration (AHCA), vendors and other community engagement programs to better improve overall wellness to our members’ lives.

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