Humana Piloting Care Management Initiative for MA Members

Feb. 18, 2021
The pilot will leverage analytics to deliver personalized care that includes SDOH integration, officials say

Health insurer Humana recently launched a pilot for its new Humana Care Support, a coordinated care management technology platform.

The solution will be to help support a select group of Medicare Advantage members, officials said in Feb. 17 press release announcement. 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,” they stated.

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 include a nurse, pharmacist, social worker and a behavioral health specialist, Humana leaders explained.

In its announcement, the Louisville, Ky.-based health insurer pointed out that 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 (SDOH).

As such, the Humana Care Support pilot builds upon how Humana leverages the concept of integrated care to address SDOH. 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. 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, Humana believes.

Humana leaders assert that 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 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 information on each member’s needs, they stated.

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.”

What’s more, the Humana Care Support pilot is also designed to enhance and support the integrated care members are already receiving from their providers, officials noted. “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,” they added.

Humana noted 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 insight on their preferences.

William Fleming, PharmD, segment president, clinical and pharmacy solutions, Humana, said he 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.”