Care Management: The Payer Perspective
Jean BisioSo we have a system that we have medical claims in and historical [data]. We have pharmacy data. We have any type of specialty information. That’s the thing about an insurance company—we have a lot of data! So we’re able to look at the pharmacy, the medications, the practice, etc., all in one system. And using our predictive modeling that we develop, that helps us to identify the right people to manage.We have a system where all of our care managers, whether you’re in the field or you’re in our care center in St. Petersburg (Fl.), [feed data] into one system. It is a Web-based platform, so that we work in the same record. It’s a combination of what we built at GRH and have since grown on behalf of Humana. Parts of Humana are on a commercial care management system, but our program is managed out of our own proprietary system. Data is the most important thing that allows us to continue to analyze how this program is working.HCI: Does the information from the patients’ telemonitoring devices feed back into your care management system?Bisio: We are in a pilot with Intel. We’re using the Care Innovations ( a Sacramento-based healthcare joint venture between the Fairfield, Conn.-based GE and Intel) platform, which is their personal health system. That in of itself has care management software that’s both at the patient’s home and in our command center, where we staff nurses and other professionals to monitor the alerts that come in—like for instance if someone’s blood pressure is high. It’s not at this time integrated into our care management system, and the reason is this is a pilot that Humana and Intel are partnered to help solve the issue of the cost of this type of monitoring and the access to it. The telehealth field has been really slow to get volume in it. We’re really excited about that, as Intel develops this new platform, which will allow us to reach many more people.