Humana Announces MA Chronic Disease Management, SDOH Model

Humana has launched a pilot program for Humana Care Support to help seniors with chronic disease management through integrated care management and improved data analytics, the payer announced.

“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,” the press release explained.

“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.”

Humana Care Support was previously called Enterprise Clinical Operating Model (ECOM).

The Humana Care Support pilot targets seniors who are living with complex congestive heart failure and diabetes along with multiple chronic conditions. Using an integrated care management model, seniors will have access to a multi-disciplinary team that includes nursing staff, pharmacy support, social workers, and behavioral healthcare specialists.

The member experience portion of this pilot received design input from members, caregivers, physicians, and other stakeholders through collaboration with these individuals as well as through an imitation of relevant member and caregiver touchpoints.

The pilot will leverage value-based care agreements and care management strategies that have already been established to deliver integrated care for Medicare Advantage members.

This approach is intended to serve not only the clinical needs of seniors’ chronic disease management, but also the social determinants of health that may impact seniors’ care needs and progress.

To best serve members in their chronic disease management and to address their social determinants of health, Humana will provide personalized care through data analytics.

By using cloud technology, data integration, and visualization, providers will have access to real-time member data. Having the ability to perform real-time data analytics has become increasingly possible and advantageous for payers, particularly during the uncertainties of the coronavirus pandemic.

“Humana Care Support will help physicians, clinicians and care teams use predictive and reactive analytics to identify who needs help,” Heather Cox, chief digital health and analytics officer at Humana, 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.”

One of the main aims of the program is to continue senior care from home, instead of transferring members to a facility. Other major payers, such as Aetna, have also leveraged this approach for Medicare Advantage members with multiple chronic diseases and complex chronic disease management.

“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,” William Fleming, pharmD, segment president of clinical and pharmacy solutions at Humana, 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 pilot will be available to seniors in Kentucky, Pennsylvania, and West Virginia and will continue to expand into other states in 2021.

Although payers prefer to deliver senior care at home to promote lower healthcare spending, long-term care is inevitable for some members due to the complexities of their conditions.

Recently, Humana sought to improve the member experience for Medicare Advantage members who find themselves in such a scenario by establishing a value-based hospice care coordination model. The model aims to help members take advantage of hospice care as soon as they are eligible and to give them the opportunity to carefully consider their end-of-life care.

Humana also recently announced a partnership that aims to leverage artificial intelligence to improve member engagement for all members. An artificial intelligence-enabled virtual assistant will help callers with simple questions find answers quickly.