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Humana: ‘Unhealthy Days’ For Medicare Population Fall As Social Determinants Screened

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A project by Humana to improve the health of seniors in private Medicare plans through better management of patient populations continues to show improvement five years into the effort, the health insurer said in a new report. 

Humana’s “Bold Goal” initiative, which began in 2015, 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 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 five years ago. “The number of healthy days among all of our Medicare Advantage members across all markets improved for the first time since we began benchmarking - with a decline in the average reported unhealthy days from 13.44 to 13.42,” Humana said in its 2020 Bold Goal progress report.

A key to addressing social determinants of health are screenings upfront for issues beyond medical conditions, Humana’s report indicates. The success of the Bold Goal initiative convinced Humana executives to expand to 16 cities, the insurer said last month.

“Throughout 2019, Humana put increased emphasis on conducting health-related social needs screenings, discussing with members their needs such as having access to healthy food, transportation and social support,” Humana’s report said. “We entered into 2019 with a goal of completing 1 million screenings. With the help of numerous resources across the enterprise, we far exceeded that goal, achieving more than 2.6 million screenings.”

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, CVS Health’s Aetna health insurance unit, 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 has also changed regulations to allow Medicare Advantage plans to provide broader coverage, which has increased enrollment nationally to more than 22 million this year.  

“During the last five years working in the Bold Goal communities, we have seen firsthand the impact of clinical and social needs on our members,” Humana chief executive officer Bruce Broussard said.

The report analyzed data from 2019 so it doesn’t include efforts made for patients this year amid the spread of the coronavirus strain Covid-19. The pandemic has hit seniors particularly hard and executives say efforts to address social determinants of health in communities that have been disproportionately hit by the virus will need additional support.

“COVID-19 has further widened ongoing health disparities, disproportionately affecting Black and Latino communities,” Broussard added. “Humana is deeply committed to working with our community and government partners to ensure we support members in improving their mental and physical health. Working together, we can break down barriers to drive lasting change.”

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