Humana launches value-based program aimed at the social determinants of health 

Humana is bringing its value-based care know-how together with its aptitude for tackling social determinants among its Medicare Advantage (MA) members.

The insurance giant announced it's launching a new value-based care model to support providers in identifying and addressing several social concerns. The program will cover “enhanced” care coordination for patient screenings, documentation of assessment findings and linking patients to resources. 

The model initially focuses on care to address food insecurity, housing, social isolation and loneliness. 

“Humana is dedicated both to value-based care and to addressing social determinants of health. This new program is a way for us to deepen those commitments, by interweaving both into our work with clinicians, toward a more holistic approach to care," Caraline Coats, vice president of population health strategy at Humana, told FierceHealthcare.

"The new model is, therefore, a logical ‘next step’ for us, as it broadens the scope of patient care to more holistically improve health outcomes—social determinants of health are linked to an increased risk of chronic medical conditions, so it’s critical that we address these key barriers to good health," Coats said. 

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The first health system signed on to the model is Ochsner Health, the largest nonprofit health system in Louisiana. Philip Oravetz, M.D., chief population health officer at the health system, said the partnership will offer a critical tool in personalizing care for varied communities.

The new model builds on Humana’s existing portfolio of value-based care programs, in which the insurer avoided about $3.5 billion in healthcare costs in 2018. 

About 2.4 million MA members and 115,000 commercial members are enrolled in value-based models, Humana said. 

“This new model is part of an ongoing expansion of Humana’s value-based program portfolio, as we continue to align with clinicians to more holistically address patients’ healthcare needs,” Oraida Roman, vice president of value-based strategies at Humana, said in a statement. 

“Humana is proud to collaborate with providers in proactively addressing impediments to well-being, instead of only treating people when they’re sick,” Roman said. “We’re committed to addressing the critical challenges presented by nonmedical health risk factors.” 

The Centers for Medicare & Medicaid Services has notably expanded what MA plans can cover to target beneficiaries’ social issues, and experts say the changes mark a “turning point” for Medicare.