Humana, Cleveland Clinic CEOs: Payer-provider collaboration benefits MA members

By Annette M. Boyle

In the effort to improve outcomes and control costs for beneficiaries in its Medicare Advantage program, a major payer and major provider have found collaboration is key, according to a Forbes contributed post by Humana CEO Bruce Broussard and Cleveland Clinic CEO Toby Cosgrove, M.D.

The structure of Medicare Advantage requires plan sponsors such as Humana to keep their medical care costs below the Medicare fee-for-service rate schedule, the post notes. To meet these requirements and its own goals of improving members' health, Humana offers additional benefits to MA beneficiaries such as allowance for over-the-counter medications, in-home care management, medication-adherence programs, HumanaVitality incentives program and behavioral health programs.

Collaboration with hospitals, physicians, pharmacists and other providers has also been central to Humana's efforts to improve the value offered by MA to enrollees, notes the post. Working with providers enables members to access community services, which can improve outcomes for seniors and individuals with disabilities.

For providers, the collaborative approach means enhanced rewards for spending more time with patients, providing preventive health services and promptly addressing any gaps in care identified by the insurer.

The Humana at Home program, for instance, helps ensure that individuals are managing their chronic conditions through interventions such as phone calls and in-home visits by care managers to coordinate care, answer questions and identify issues for members.

That program was able to reduce hospital admissions by 44 percent in 2015, and allowed members to remain at home for a total of 1 million more days than they would have otherwise, according to Broussard and Cosgrove.

To learn more:
- here's the post