Humana's ACO, medical home projects yield positive results


Humana has begun working with providers on several new, collaborative delivery system models that already have yielded successful results, the insurer told a Senate panel Wednesday.

Along with Humana, other witnesses provided the Senate Health, Education, Labor and Pensions Committee with steps they've taken to deliver better healthcare and lower costs, reported Kaiser Health News.

"We have a system-wide problem on our hands, and the solution must be system-wide, too," said Sen. Sheldon Whitehouse (D-R.I.), who chaired the hearing. "We need to look for best practices across all sectors of our healthcare system to inform our understanding of what is working on the front lines of reform."

Marcia James, Humana's director of network relations and provider engagement, said the insurer is working toward aligning payment and care through its different accountable care organizations (ACO) and patient-centered medical homes (PCMH). "Humana's experience has shown the importance of allowing for flexibility in payment redesign, based on the readiness of provider groups," she explained. "Adoption of a onesizefitsall approach will undermine the ongoing active collaborations to customize arrangements to meet the needs and capabilities of a wide range of provider groups."

One initiative Humana has undertaken is an ACO with non-profit integrated delivery system Norton Healthcare System, which James said, demonstrates how "two partner organizations with different, but complimentary, expertise come together to serve individuals in a coordinated manner." Humana evaluates participating providers based on certain quality measures, including diabetes measures, cancer screening, asthma care and cardiac care, and reimburses them based on improved outcomes and cost.

The ACO also establishes spending targets to reflect the expected costs of caring for the patients and participating providers that improve quality of care and slow spending growth receive a portion of any savings, FierceHealthPayer previously reported.

The Humana-Norton ACO already has improved quality, utilization and physician visits following hospitalization--9 percent decrease in unnecessary antibiotic treatment for adults with bronchitis, 6 percent improvement for diabetic testing and 8 percent improvement for cholesterol management in diabetics. And it has shown an almost 13 percent improvement in appropriate emergency room visits, as well as a 36 percent improvement in physician visits within seven days of discharge, James said.

Additionally, Humana has helped establish PCMHs in several states, serving more than 70,000 Medicare Advantage and 35,000 commercial members. In fact, Humana created one of the first PCMHs in the country in 2007 with Atlanta-based integrated delivery system WellStar. That arrangement resulted in a 6 percent improvement in diabetic and blood pressure management, as well as a 20 percent improvement in management of "bad" cholesterol levels.

The insurer's current partnership with Cincinnatibased Queen City Physicians, which also focuses on integrated care delivery, strong data integration and care coordination, has shown similar positive results. Humana has seen a 34 percent decrease in emergency room visits, 10 percent improvement in diabetic management, 15 percent improvement in blood pressure control and 22 percent decrease in patients with uncontrolled blood pressure.

To learn more:
- read Humana's statement
- check out the Senate hearing info
- see the Kaiser Health News article

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