Humana: ‘Unhealthy Days’ For Seniors Drop As Social Determinants Screened

Humana said Medicare Advantage enrollees in cities where they are screened for social determinants of health have seen a 2.7% reduction in their unhealthy days since 2015.

by Bruce Japsen | Apr 22, 2019 | This article originally appeared in Forbes


Humana: ‘Unhealthy Days’ For Seniors Drop As Social Determinants Screened

A project by Humana to improve the health of seniors through better management of patient populations in seven U.S. cities continues to show improvement, the company said in a new report out Monday.

The health insurer’s “Bold Goal” initiative uses measures established by the Centers for Disease Control and Prevention to track an individual’s physical and mental “unhealthy days” over a 30-day period. The social determinants of health for these patients are closely watched with patients screened for “food insecurity” and “loneliness.”

“The social barriers and health challenges that our Medicare Advantage members and others face are deeply personal,” Humana chief medical officer Dr. William Shrank said in a statement accompanying the report. “This requires us to become their trusted advocate that can partner with them to understand, navigate and address these barriers and challenges. With ‘healthy days’ as our barometer, we are able to track and trend population health, measure outcomes and triage members in unique ways to the resources they need.”

The original seven Bold Goal communities are Baton Rouge, Knoxville, Louisville, New Orleans, San Antonio, Tampa Bay and Broward County, Florida, and most have improved since the effort began four years ago.

“Medicare Advantage members living in the company’s original seven Bold Goal communities have seen a 2.7% reduction in their unhealthy days since 2015,” Humana said in its report. “In San Antonio, Texas, members saw a 9.8 percent reduction in Unhealthy Days, which means they are halfway toward their Bold Goal.”

Over time, Humana has expanded the number of Medicare Advantage enrollees screened as evidence has shown the overall effort has worked. “With the help of internal business partners, physician practices and community-based organizations, we screened over 500,000 people for food insecurity and loneliness and connected those who screened positive to community resources,” Humana’s report said. “We set a new goal of screening 1 million people by the end of 2019.”

Humana’s population health initiative comes as health plans move away from fee-for-service medicine that pays doctors and hospitals based on the volume of care delivered to value-based models that measure the success of health outcomes. Blue Cross and Blue Shield plans, Aetna, Cigna and UnitedHealth Group are also working on similar value-based models and programs in communities as well as shifting most payments from fee-for-service to alternative reimbursements.

Meanwhile, more seniors are signing up for Medicare Advantage plans, which contract with the federal government to provide extra benefits and services to seniors, such as disease management and nurse help hotlines, with some also offering vision, dental care and wellness programs. The Centers for Medicare & Medicaid Services is changing regulations to allow Medicare Advantage plans to provide broader coverage in the future, which is also expected to boost enrollment already at more than 22 million this year and headed to nearly 40 million, or half of the U.S. Medicare population by 2025, some have projected.

“This year’s report reflects our track record of success in managing chronic conditions over time,” Humana CEO Bruce Broussard said. “Given current demographic trends, we expect to see continued demand for a support structure that addresses social needs, along with clinical ones.”

Image credit: BLOOMBERG NEWS


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