Overview of programs
Members who choose to enroll in a Humana case management or chronic care program are assigned a care manager who supports them by phone (eligible members also receive home visits). The manager's goal is to anticipate members' needs and problems, encourage preventive care and prevent costly interventions through home-safety assessments and evaluations of medical, functional and psychosocial status.
Services may include:
- Facilitating conference calls between the member, the physician and the care manager as needed to clarify treatment plans, medication regimens or other urgent issues
- Monitoring medication adherence
- Assessing the member's daily living activities and cognitive, behavioral and social support
- Assessing the member's risk for falls and providing fall-prevention education
- Connecting members and their families with professionals who can help them address medical, legal, housing, insurance and financial issues facing older adults
- Helping caregivers access support and respite care
- Arranging access to transportation
- Assisting members in obtaining home health and durable medical equipment
- Referring members to meal-delivery programs and advance directive preparation services
Some chronic conditions addressed by our programs include chronic obstructive pulmonary disease, congestive heart failure, coronary artery disease, hypertension, HIV/AIDS, asthma and diabetes.
Eligibility and Cost
Humana's predictive modeling tools and assessment process identify eligible members based on their disabilities, comorbidities and chronic care management needs. Case management and chronic care programs are available to eligible members as part of their benefit plan and at no additional cost. Members can opt out of the programs at any time by notifying their care manager of their wishes.
Services are available for select Medicare, Medicaid, commercial, healthcare exchange and Administrative Services Only members in all markets, except Puerto Rico.
These programs and tools are not insurance products and are not guaranteed under any contract. Humana is not required to provide these services but makes them available to eligible members.