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Care Management: The Payer Perspective

March 17, 2011
by Jennifer Prestigiacomo
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Humana’s care management program links with Intel on telemonitoring

Humana Cares, Humana’s (Louisville, Ky.) chronic care management program, grew out of Green Ribbon Health (GRH), one of the Medicare Health Support Program pilots. The Medicare Health Support Program in 2008 sought to help increase adherence to evidence-based care, reduce unnecessary hospital stays and emergency room visits, and help participants avoid costly and debilitating complications and co-morbidities. Green Ribbon Health in central Florida started as 50/50 partnership between Pfizer (New York, N.Y.) and Humana to provide the acute care management of Medicare recipients.

Humana Cares, which launched in 2009, currently uses a system of telephonic care managers and field managers to supervise their high-intervention patients and help connect them to community resources. So far this program has had a 35 percent reduction in inpatient hospital admissions, with a 5 percent drop in hospital length of stay; a 22 percent decline in emergency room cases; and a 20 percent drop in medical claims. Today Intel (Santa Clara, Calif.) and Humana Cares announced they will embark on an 18-month telehealth pilot to monitor 2,000 congestive heart failure patients across the country. Jean Bisio, president of Humana Cares shared a little background on the IT underpinnings of her organization with HCI Associate Editor Jennifer Prestigiacomo at the Population Health & Care Coordination Colloquium in Philadelphia held earlier this week. Here are some excerpts from that interview.

Healthcare Informatics: What type of management system does Humana Care use to coordinate its patients’ care?

Jean Bisio: So it starts from the beginning—how do you identify the right people for the program because this is an expensive model, and it’s not for everyone. But that top 5 percent of the people who really need this level of intervention, how do you identify the right people? And those people are always changing in a population.

Jean Bisio

So we have a system that we have medical claims in and historical [data]. We have pharmacy data. We have any type of specialty information. That’s the thing about an insurance company—we have a lot of data! So we’re able to look at the pharmacy, the medications, the practice, etc., all in one system. And using our predictive modeling that we develop, that helps us to identify the right people to manage.

We have a system where all of our care managers, whether you’re in the field or you’re in our care center in St. Petersburg (Fl.), [feed data] into one system. It is a Web-based platform, so that we work in the same record. It’s a combination of what we built at GRH and have since grown on behalf of Humana. Parts of Humana are on a commercial care management system, but our program is managed out of our own proprietary system. Data is the most important thing that allows us to continue to analyze how this program is working.

HCI: Does the information from the patients’ telemonitoring devices feed back into your care management system?

Bisio: We are in a pilot with Intel. We’re using the Care Innovations ( a Sacramento-based healthcare joint venture between the Fairfield, Conn.-based GE and Intel) platform, which is their personal health system. That in of itself has care management software that’s both at the patient’s home and in our command center, where we staff nurses and other professionals to monitor the alerts that come in—like for instance if someone’s blood pressure is high. It’s not at this time integrated into our care management system, and the reason is this is a pilot that Humana and Intel are partnered to help solve the issue of the cost of this type of monitoring and the access to it. The telehealth field has been really slow to get volume in it. We’re really excited about that, as Intel develops this new platform, which will allow us to reach many more people.