Lessons from a 25-year integrated care veteran

Humana headquarters building

Many healthcare organizations are just starting to adopt more integrated models of care--Humana has embraced the concept for 25 years.

"When we're talking about integrated care, we're talking about truly being accountable for that patient from the very beginning all the way through wellness and illness," Humana Chief Medical Officer Roy Beveridge, M.D., (pictured) told FierceHealthPayer in an exclusive interview. 

Humana's integrated care model centers around the primary care physician. While patient encounters in the normal fee-for-service system last about 12 minutes, Humana's integrated care physicians spend an average of 30 minutes with patients.

Over many years, the Louisville, Ky.-based insurer developed an integrated care model that also involves a transportation system. This was key for Medicare Advantage patients in Florida, as the insurer recognized many retirees have trouble getting around, Beveridge explained. So Humana has vans pick up patients from their houses and take them to Humana clinics or clinics run by physicians tightly accountable with the insurer.

When patients need to see a specialist, the insurer sets up the appointments and helps with transportation. "If she had trouble getting to our office, she's going to have trouble getting to the specialist's office," Beveridge said.

Humana also has nurses help admitted patients with their discharge and make sure they get appointments with their primary care physicians within two days. And with a post-discharge telephone system, the insurer can check whether patients received their prescriptions, whether they're taking them correctly and whether they need physical therapy at home. "We're monitoring that through a telephone system that's connected to the primary care doctor," Beveridge said.

The insurer has found standardized scores looking at process, results, medical outcomes and telephone surveys are significantly higher in the integrated, accountable model. Patients only seen by fee-for-service physicians have HEDIS (Healthcare Effectiveness Data and Information Set) scores that are half of what patients in the managed system achieve.

Humana's integrated approach, while primary care physician-centered, also goes beyond the delivery system. Its clinics offer Medicare Advantage members education about diabetes, cooking classes and exercise. For example, the insurer formed an arrangement with Wal-Mart where every time a patient goes to Wal-Mart and buys healthy food, he or she gets a 10 percent discount on fruits, vegetables, low-fat milk or lean meat.

"We're really trying to get these folks healthier in addition to taking care of them when they're sick," Beveridge said.