business-critical

Humana's population health management

Humana supports physicians in their work to prevent illness and improve the health of their patient population as a whole.

We have extensive experience partnering with physicians in accountable care relationships that change a fee-for-service model where process is rewarded to a model where outcomes and value are rewarded. We have more than 900 such relationships across the country. These partnerships span the spectrum of accountable care, including full-accountability, patient-centered-medical-home (PCMH), pay-for-value and shared-savings arrangements.

Hear from doctors (link opens in new window) about improved patient outcomes and practice performance.

Our accountable care partnerships:

  • Support primary care physicians (PCPs) treating more than 1.6 Million Humana Medicare members.
  • Support approximately 230,000 commercial members.
  • Includes more than 44,000 primary care physicians across 43 states and Puerto Rico.
  • Include joint venture partnerships, employed provider organizations, more than 200 integrated delivery systems and more than 30 patient-centered medical homes.

Our focus is to give PCPs the population health solutions they need to make the transition from volume to value and to help them be successful in the management of people's health. Our value-based care programs not only offer support for PCP practices as they move into value-based relationships, but they also help improve the patient experience.

Value-based reimbursement

Value-based reimbursement is the foundation on which we developed our accountable care continuum (202 Kb).

We offer financial rewards for improvements in outcomes, quality and cost management through Humana's Provider Quality Rewards Program. We created a continuum of programs that support PCPs as they develop their population health management capabilities and focus. As PCPs develop these capabilities, they can advance along this continuum of care and receive even greater rewards.

Population health solutions

In addition, Humana has invested in population health solutions, including technology and other assets, to offer a comprehensive set of capabilities to PCPs transitioning to accountable care.

Our population health solutions focus on four areas: care management, clinical integration, financial management and patient engagement. Clinical care integration and care management are two especially important areas of focus, and we are offering tools that support PCPs as they manage patients with chronic care conditions. These tools include predictive analytics, identification of real-time gaps in care, clinical alerts and health information exchanges.

The benefits

Humana's integrated approach to population health has meaningful impact on quality and costs.

Care management extends beyond the PCP's office. Humana’s multidisciplinary teams inspire better lifestyle choices for everyone, including healthy, chronically ill and underserved individuals. These teams are made up of health coaches, nurses, care managers and social workers who call and/or visit members and community health educators who connect members with the community and social services they need.

We're finding this type of outreach is making a difference in members' quality of life and health care costs. For example, the Humana Chronic Care Program (HCCP) identifies members for chronic care and post-acute transitions programs. This helps people stay at home longer and reduces hospital admissions and readmissions.

Because our experience shows that when we come together, we all get better results.

For more information, contact your Humana representative or send an email to providerengagement@humana.com.