Humana Inc. recently launched a pilot for its new Humana Care Support, formerly known as the Enterprise Clinical Operating Model (ECOM), to help support a select group of Medicare Advantage members. 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 its Medicare Advantage members, helping them improve their physical, social, and behavioral health while aging in place. The pilot populations are members with multiple chronic conditions and complex congestive heart failure and diabetes in Kentucky, Pennsylvania, and West Virginia.
Within the Humana Care Support pilot, Humana clinical care teams identify, engage and support the target Humana Medicare Advantage members. These multi-disciplinary care teams include a nurse, pharmacist, social worker and a behavioral health specialist. The care teams will be supported by Salesforce Health Cloud with a single, comprehensive 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 the Humana Care Support teams have real-time, actionable information based on their claims history on each member’s needs, including their social and environmental needs that affect health. 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.
The pilot builds upon how Humana leverages the concept of integrated care to address social determinants of health. For the last several years, Humana has been helping its members impacted by social determinants of health via its, 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.
In addition, the Humana Care Support pilot is also designed to enhance and support the integrated care members are already receiving from their providers. Many of Humana’s health care partners are in value-based care agreements serving its Medicare Advantage members, and have their own robust care management capabilities already in place.
As of January 2021, Humana had more than 4.2 million individual Medicare Advantage members. Its standalone Medicare Part D prescription drug plan had nearly 3.7 million members. Through its state-based Medicaid contracts, Humana had 772,400 members. Additionally, Humana had 777,400 members in group fully insured commercial health plans, and another 504,900 members enrolled in commercial plans for which Humana served as the administrative services organization. Humana provided services to nearly 6 million military members and families through its TRICARE East Region contract.
This was reported by Humana on February 17, 2021.