LOUISVILLLE, Ky.--(BUSINESS WIRE)--Humana Inc. (NYSE: HUM) recently launched a pilot for its new Humana Care Support, formerly known as the Enterprise Clinical Operating Model (ECOM), to help support a select group of Medicare Advantage members.
Humana Care Support is Humana’s next generation of customized, integrated and coordinated care management services that builds on Humana’s previous care management models. It supports the company’s efforts to deliver integrated care for Medicare Advantage members, helping them improve their physical, social and behavioral health while aging in place.
Within the Humana Care Support pilot, Humana clinician care teams identify, engage and support a select group of Medicare Advantage members living with multiple chronic conditions and complex congestive heart failure and diabetes in Kentucky, Pennsylvania and West Virginia. These multi-disciplinary care teams, which bring together a diverse set of experiences and clinical knowledge, include a nurse, pharmacist, social worker and a behavioral-health specialist.
Helping members impacted by social determinants of health
Today, 80 percent of older adults are living with at least one chronic condition, and 77 percent are living with at least two chronic conditions. Research has shown that many of these older adults are more likely to fall behind in managing their health and suffer from social determinants of health, which are the conditions in the environments in which people live, learn, work, play, worship and age that affect a wide range of health, functioning and quality of life outcomes and risks.
The Humana Care Support pilot builds upon how Humana leverages the concept of integrated care to address social determinants of health. For the last several years, Humana has been helping its members impacted by social determinants of health via its Bold Goal, which is focused on addressing the needs of the whole person by co-creating solutions to address social determinants and the health-related social needs for our members and communities.
In addition, the Humana Care Support pilot is also designed to enhance and support the integrated care members are already receiving from their providers. Many of Humana’s provider partners are in value-based care agreements serving our Medicare Advantage members have their own robust care management capabilities already in place and it’s our goal to ensure members receive the primary and preventive care they need.
Delivering a better consumer experience
For Humana, this new approach is the next step toward becoming a more customer-centric organization driven by integrated care. The Humana Care Support consumer experience is co-designed and constructed in partnership with members, caregivers, front-line clinicians and non-clinicians. The work is further guided by a series of simulations with members/caregivers, which provided valuable insight on their preferences. In addition, the approach helps care teams working with members and their providers ensure patient adherence to providers’ treatment plans.
Within the Humana Care Support pilot, multi-disciplinary care teams support Medicare Advantage members in achieving their best health by not just looking at the information on their health history that is detailed in their claims, but also at the social and environmental needs that can affect their health. By leveraging the concept of data-enabled personalization, the integrated care service powered by Humana Care Support allows Humana to understand and address the unique and complex needs of each member, from diabetes complication to food insecurity.
Coordinated care supported by analytics
William Fleming, PharmD, Segment President, Clinical and Pharmacy Solutions, Humana, is highly confident the Humana Care Support pilot will help Humana Medicare Advantage members and others live independently in their homes, where they feel confident, safe and secure. “Long before the pandemic, the home has become the place where many older adults living with multiple chronic disease want to receive care and to age in place,” Fleming said. “Our Humana Care Support pilot will be instrumental in using best practices in coordinated home health, care management visits and virtual visits to help our members improve their health.”
The Humana Care Support pilot brings to life a modernized technology and analytics infrastructure. The care teams will be supported by Salesforce Health Cloud with a single, comprehensive view of a member’s medical history and integrated clinician workflows. Microsoft’s cloud technologies Azure and Power BI power the analytics, data integration and visualization so teams have real-time, actionable information on each member’s needs.
Heather Cox, Chief Digital Health and Analytics Officer, Humana, said Humana Care Support could help Humana deliver a new standard in personalized and holistic care driven by data and analytics. “Humana Care Support will help physicians, clinicians and care teams use predictive and reactive analytics to identify who needs help,” Cox said. “When you have an understanding of what’s most important to the member, you can leverage personalization to deliver comprehensive care that not only addresses medical needs, but also behavioral, social and financial ones. For example, when you see that a member is not adherent to their medication, we can leverage analytics to understand if the right outreach is from a social worker to explore social determinants of health and affordability or from a pharmacist to discuss how to mitigate common side-effects.”
Humana will expand Humana Care Support to Medicare Advantage members in other states in 2021.
Humana Inc. is committed to helping our millions of medical and specialty members achieve their best health. Our successful history in care delivery and health plan administration is helping us create a new kind of integrated care with the power to improve health and well-being and lower costs. Our efforts are leading to a better quality of life for people with Medicare, families, individuals, military service personnel, and communities at large.
To accomplish that, we support physicians and other health care professionals as they work to deliver the right care in the right place for their patients, our members. Our range of clinical capabilities, resources and tools – such as in-home care, behavioral health, pharmacy services, data analytics and wellness solutions – combine to produce a simplified experience that makes health care easier to navigate and more effective.
More information regarding Humana is available to investors via the Investor Relations page of the company’s web site at www.humana.com, including copies of:
- Annual reports to stockholders
- Securities and Exchange Commission filings
- Most recent investor conference presentations
- Quarterly earnings news releases and conference calls
- Calendar of events
- Corporate Governance information