The value of value-based care

MCCI physicians share how their patients benefit from their value-based care model.

My name is Dr. Andrew Denicco and I'm an internal medicine doctor with MCCI. I didn't really know that I wanted to be a doctor entirely until I was in college and I was studying biology. And I realized I really enjoyed that and I wanted to do something with my life that involved helping people.

My name is Dr. Arnold Needleman. I'm a board-certified internist in primary care practice with MCCI. Right out of residency, I went into a managed care situation where I practiced medicine as well as was administrator of a very large primary care practice, managed care practice.

"Hello, are you Ms. Everdeen?"
"Hello, how are you?"

My name is Dr. Alyn Casal-Fernandez. I'm the vice president of MCCI Hospitalist group in the expansion markets.

"Breathing nice and clear?"
"Yes."
"Not struggling for breath?"
"No."

I started working with MCCI. I really liked how they were patient-centric. They, you know, worried about each and every patient. They treated their patients like they were, you know, their grandmother, their grandfather. And I really liked that. It was how I felt medicine should be.

I think the hardest thing to overcome at the beginning was, because there was a lot of fraud with the managed care, and it was perception of doctors that, oh you know you're joining something that you're not giving good healthcare, everything's on the cheap and this and that. And I think what's turned that around over time is the way we practice.

I don't have to see a patient every 10 or 15 minutes. I can spend as much time as I need. If I need to spend 45 minutes or an hour with a particular patient, I can.

I get to achieve what I thought I was going to be able to achieve. Exam your patient, figure out what they need and then get the resources to them.

We don't let the patients fall through the cracks. I think under fee for service if the patient doesn't end up coming into your office, you might never know about it.

"You stopped, you mean?"
"Yes."

We're more proactive, we have data that's helping us to say well the patient hasn't been here in X amount of time. So we're on top of getting people in, getting them in for their preventive checkups and I think people are more grateful for that.

"Good."
"I feel fine. I don't know why he found anything wrong with my lungs."

The fact that you are able to see patients that much more frequently allows you to really build the relationship with the patients and without that relationship, you really don't have a chance of making an impact. Because so much of medicine and healthcare in general is about trust.

You know, I've had a number of patients where we've picked up diabetes early, where we've picked up early arteriosclerosis, where we've intervened, getting people with family histories and doing tests for proactively picking up things in an earlier state. They've been very grateful for what we've done.

If you work in some other system, you know, like a fee for service style, you don't ever get that kind of feedback, you just…OK I saw you, you had a cold. I gave you prescription for antibiotics, you know, come back when you're sick again.

It's much more satisfying to be able to see a patient more frequently, especially as patients get older and older more diseases accumulate more and more chronic conditions. You don't have to do things and then follow up in 6 months and see where things are going. You can see in more real time the changes that you're making.

In integrated care you have primary care, wellness, prevention, specialty care, acute care, sub-acute and chronic care.

They can come to our office and pretty much get what they need in our office as opposed to going from one place to another.

Here's this team of people who are all working towards this common goal and we're going to improve healthcare one patient at a time. And at the end of the day, guess what? They're going to be healthier and it's going to be less expensive.

Support and care for your patients

At Humana, we are patients, mothers, fathers, aunts, uncles, sons and daughters and, yes, even physicians and nurses. Because we can relate, we continuously strive to make sure the programs we offer support patient care. The list below of programs, services and capabilities help support physicians who are transitioning to or are currently participating in a value-based care model. The programs, services and capabilities you see here are just part of our commitment.

Please note that this list is not exhaustive of all Humana programs and services, and availability of the patient programs and services below varies by benefit plan. Not all patient programs and services are available under all benefit plans.

  • Acute, episodic events
  • Long-term health
  • Across all health levels
  • Capabilities for your practice

Acute, episodic events

Health Planning and Support

  • Determines which program or service is available to help the patient
  • Provides nonurgent nurse advice, guidance to in-network providers and preventive screening reminders; available 8:30 a.m. to 5 p.m. local time

Humana At Home Transitions Program

  • Provides in-home care management support for patients transitioning from an acute hospital admission to the home setting
  • Employs care managers who collaborate with physicians/clinicians to enable patients to continue living at home safely while addressing their physical, behavioral, cognitive, social and financial needs
  • Reinforces care plans prescribed by patients' physicians
  • Transitions to the Humana At Home chronic care program within 30 days

HumanaFirst® (administered by Citra Health)

  • Offers access 24 hours a day, seven days a week to nurse advise for immediate medical concerns
  • Helps patients pursue appropriate care options when a physician is unavailable

Case Management

  • Performs short-term care management (less than 90 days) for acute members
  • Provides post-discharge care coordination to decrease risk of avoidable, unplanned readmissions
  • Makes referrals to other clinical programs, such as complex case management and disease management

Telemedicine

  • Enables video telemedicine visits
  • Serves as a resource for patients and provides alternative care options when their physicians are unavailable

Well Dine®

  • Delivers meals cost-free to patients at home after hospitalization, with the goal of improving nutrition to reduce readmission
  • Provides added meal support for patients with certain chronic conditions (including diabetes, congestive heart failure, and coronary artery disease)

Long-term health

End-stage renal disease and chronic kidney disease management (administered by VillageHealth®)

  • Offers individual care guidance, patient education and coordination of care for patients with end-stage renal disease and late-stage chronic kidney disease
  • Facilitates compliance with the physician's treatment goals and communicates with the physician as a liaison and advocate for the patient and his or her family
  • Coordinates with network dialysis centers

Humana At Home Chronic Care Program

  • Offers in-home and telephonic nurse support for patients with multiple chronic conditions and functional limitations
  • Employs care managers who collaborate with physicians/clinicians so that patients can continue living at home safely while addressing patient physical, behavioral, cognitive, social and financial needs
  • Uses a database of community resources to which care managers can refer patients
  • Works to lower the risk of frequent hospitalizations

Humana Behavioral Health

  • Reaches out proactively and engages with patients experiencing coexisting medical and behavioral issues
  • Combines medical and behavioral support to improve behavioral health issues that could hinder progress to better physical health
  • May improve patients' adherence to physicians' treatment plans by addressing underlying behavioral concerns
  • Includes case management and utilization management of inpatient and outpatient behavioral healthcare services

Across all health levels

Humana Health Alerts

  • Reaches out proactively via multiple channels when opportunities to improve health outcomes are identified in these categories: preventive care, condition-specific best practices, drug-to-drug and drug-to-disease interactions
  • Uses Member Summary to reach physicians at the point of care (summaries accessible via Availity.com)

Humana Pharmacy® Mail Delivery

  • Is the preferred cost-sharing mail-delivery pharmacy for Humana Medicare Advantage plans (excluding Puerto Rico)
  • Offers patients the lowest comparable cost shares available through their plan
  • Includes a 90-day supply of maintenance medications shipped to the patient's chosen location

Humana Pharmacy Solutions®

  • Is Humana's pharmacy benefits manager, offering patients programs designed to improve their safety and adherence and reduce medication-related complications
  • Includes medication therapy management, which addresses therapeutic duplication, disease/drug contraindications, drug allergies and misuse or abuse

Humana Specialty Pharmacy®

  • Is Humana's specialty prescription mail-delivery pharmacy offering high-touch clinical programs and services to patients on specialty medicines
  • Includes a clinical team of registered nurses, pharmacists and pharmacy technicians to help manage side effects and secure financial assistance to help patients stay compliant with medication plans

Predictive modeling

  • Identifies disease and health risk indicators early on, leading to earlier intervention and helping avoid or mitigate future health issues
  • Enables cost savings and optimal health outcomes associated with earlier identification and engagement

Transportation assistance

  • Coordinates transportation to help patients get to routine healthcare visits (e.g., medical appointments; ongoing care appointments, such as dialysis)
  • Helps remove a barrier to prescribed care

Capabilities for your practice

Transcend Insights

  • Simplifies the complexities of population health through advanced community-wide interoperability, real-time healthcare analytics and intuitive care tools
  • Uses the company’s HealthLogix platform to provide healthcare systems, physicians and care teams with valuable clinical insights that enable more informed decisions at the point of care while enhancing the patient experience and reducing costs

Team-based approach to integrated care

Jacquelin Castillo, M.D., and John Ryan, M.D., discuss their team-based approach to integrated care.

Physicians' stories: An interview with Jacquelin Castillo, M.D., and John Ryan, M.D.

The healthcare industry is changing and that's evident to everyone, whether you're the patient, a clinician or anyone on a healthcare staff.

Years ago, we did it all ourselves. When I first came out of residency, we were in the clinic. We went to the hospital. We came back out. We saw the patients ourselves. But now, in the new system, the technology is enabling us to work as a team so, the specialist and the hospitalist can be an extension of what we do in our clinic. And when they come back to us, there's continuity of how we're taking care of the patient.

Integrated care involves team-based approach within Humana. So, the care coordinators, the physicians, the hospitals, the specialists and as primary care physicians, we’re trying to be this center hub of that entire system to have a patient-centered medical home.

And this is where a big organization like Humana can help us organize the data, so that when we're in real time with the patient, we have what we need to help the patient. We have options now. We can directly communicate with our specialists, and there is much easier exchange of information.

And so that helps with the coordination of care. And then knowing, after we refer, we know what their plan is, and that we can coordinate the medicine changes or anything that's happening to help the patients and better their care afterwards.

The pharmacy is very important for our patients. They can go fill their prescriptions at local pharmacies, but if they set it up with the mail-order pharmacy, the convenience of having everything mailed to their house. It helps with the compliance issues, and then it helps us with the tracking issues, too. And making sure nothing’s interacting with each other because everything's getting filled in the same pharmacy.

And we've started to have diabetic educators coming out to our office and meeting with the patients.

When you have a dedicated professional that has nutrition and also can work with the patient, that's going to empower the patient to understand how to eat, to encourage them to walk and get exercise and, as they start doing this, they start feeling better. And it's easier to motivate them to continue.

In a small town, a lot of times our patients are not comfortable driving, especially to see a specialist in the big city traffic.

Because we have the resources, we're able to go and be at the forefront, at the point of the spear of the change in medicine. Dealing with the insurances without the resources is difficult. But, because we're in this system, we have the tools that let us practice cutting-edge medicine, take care of our patient and use the new approach that a large organization can provide to us.

So, we're moving into better managing the overall health of our patients, and in trying to prevent and take care of patients and keep them well, as well as just the acute problem. But it's the people that make the difference, and we couldn’t do it without working with the team.