Humana Expands Reach with National Program to Support Additional 60,000 Living with Chronic Disease

Humana Cares, Humana Inc.’s (NYSE: HUM) complex care management division, will offer the potential to improve the quality of life for approximately 60,000 people in the United States who live with chronic disease and offer programs to address the medical and personal needs that materialize as a result.

Humana today announced its Humana Cares division, headquartered in St. Petersburg, is now hiring 270 additional associates in preparation for the January 2011 launch of its new program, Humana Cares Chronic Condition Management. The new associates will serve 60,000 Humana commercial health plan and Medicare Advantage members across the country suffering from chronic conditions, including congestive heart failure, obstructive pulmonary disease, coronary artery disease and complex diabetes.

In addition to touching the quality of life for so many, the additional 270 Humana Cares associates, to include telephonic managers, onsite field care managers and community health educators, will have a major economic impact on St. Petersburg and the surrounding Tampa Bay area. Humana Cares, which opened its doors in February 2009 with approximately 250 associates, expects to employ 780 associates by year-end.

“Humana Cares is fast becoming one of the premier health care employers in the Tampa Bay area,” said St. Petersburg Area Chamber of Commerce Chairman Sid Morgan, “and today’s announcement that Humana Cares will hire another 270 professionals this fall provides a much-needed boost to St. Petersburg’s business community and to the overall health of our bay area economy. The St. Petersburg Chamber applauds Humana Cares’ strong and growing commitment to St. Petersburg.”

“We’re very pleased that Humana has chosen to significantly expand its national chronic care management division here in St. Petersburg and bring hundreds of new jobs to our community,” said St. Petersburg Mayor Bill Foster. “It’s a great credit to the depth and skills of our labor pool that Humana Cares is once more growing its workforce and its business in our city.”

Humana Cares incorporates a holistic approach to helping those who live with chronic medical conditions, focusing not on a single disease but on the whole person.

“Today, in the United States, 38 percent of Medicare beneficiaries live with three or more chronic health conditions,” said Humana Cares President Jean Bisio. “Our goal is always to keep members independent and safe in their homes. At Humana Cares, we don’t manage a disease; we work side by side to help our members manage their health and improve their quality of life.”

And for the more than 50,000 Humana members under its current active complex care management program, this holistic approach is working. Humana Cares members have experienced a 36 percent decline in hospital admissions and a 22 percent drop in emergency room visits.

Humana Cares teams work together to:

  • Help members remain independent and safe in their homes
  • Create one-step care for both medical and quality-of-life needs, such as making sure members have safety items installed in their homes and ensuring their transportation and prescription needs are met
  • Provide education on self-care management, including preventive measures like teaching a diabetic to monitor and record daily blood sugar levels
  • Place a variety of remote bio-metric monitoring devices in the member’s home to provide education and peace of mind, and identify and treat events, such as escalating blood pressure, before they lead to emergency or inpatient admissions
  • Assist members in navigating through a complicated health care system
  • Put members in touch with community resources.

For more information about the new positions at Humana Cares or to apply online, please visit www.humana.com/resources/about/careers/.

About Humana

Humana Inc., headquartered in Louisville, Ky., is one of the nation’s largest publicly traded health and supplemental benefits companies, with approximately 10.3 million medical members and approximately 7.3 million specialty-benefit members. Humana is a full-service benefits solutions company, offering a wide array of health and supplemental benefit plans for employer groups, government programs and individuals.

Over its 49-year history, Humana has consistently seized opportunities to meet changing customer needs. Today, the company is a leader in consumer engagement, providing guidance that leads to lower costs and a better health-plan experience throughout its diversified customer portfolio.

CIGNA Study: CDHPs Deliver Real World Health Care Reform.

As overall medical costs continue to increase by double digits annually, medical costs for individuals in account-based consumer-driven health plans (CDHPs) went down 26% over four years, while levels of care for their preventive medicine, chronic disease management and evidence-based treatments were higher than their counterparts in traditional PPO and HMO health plans, according to a new multi-year study of health care claims experience of 655,000 CIGNA customers.

The Fourth Annual CIGNA Choice Fund Experience Study is the latest evidence that more than any health reform proposal currently on the table, these innovative free market plans have been consistently proven to deliver actual quality, accessible health coverage at substantially lower costs.

The empirical data is in and its undeniable: when health plans provide incentives for people to be engaged, their health care quality goes up and costs go down, said CIGNA President and Chief Operating Officer, David M. Cordani. CIGNA’s study shows that the incentives offered by consumer-driven plans — such as lower premiums, freedom of choice, and the ability to build up health savings — result in an immediate and sustained improvement in health care quality and lower costs.

Key findings of the Fourth Annual CIGNA Choice Fund Experience Study include:

  • Immediate and sustainable cost savings: CDHP medical costs are 14% less than traditional plans the first year, cumulative cost savings rise to 19% in the second year, 23% in the third year and 26% in the fourth year.
  • Higher levels of care: People with CIGNA Choice Fund received recommended care at compliance rates that were similar or better than those covered by traditional CIGNA health plans. Key indicators such as use of preventive care, evidence-based care and disease management program participation were measurably better among those in CIGNA CDHPs than those in PPOs and HMOs.
  • Less cost for those with chronic conditions: Medical cost trend was substantially less for CIGNA Choice Fund customers with hypertension (27% less), joint disease (21% less), and diabetes (15% less), than for individuals with either of those diseases in traditional CIGNA health plans. According to the study data, these cost savings were achieved without sacrificing care.

According to Cordani, if the share of Americans enrolled in a CDHP rose from a current 18% to 50%, and the results of the CIGNA study were applied, the U.S. could achieve $350 billion dollars in savings over 10 years.

Chris Policinski, President and CEO of Land OLakes, Inc., noted: Offering consumer driven health plans to Land OLakes employees is helping to keep health care costs in check, while maintaining or improving care quality. For Land OLakes, this approachsupports our commitment to employees, while at the same time ensuringthat we remain highly cost efficient.”

Customer: Engagement is Key

One of the nations premier agricultural cooperatives, Land OLakes, Inc., offers both CIGNA Choice Fund CDHP and traditional health plans. The company confirms that its employees are increasingly electing to enroll in the CDHP for cost savings with eight of 10 employees choosing CDHP over traditional managed care plans.

Since January 1, 2007, when our first CDHP was offered, our company and employees have saved more than $10 million in health plan costs, said Land OLakes Director of Benefits and HR Operations Pamela Grove. From 2006 to 2007, our health care trend decreased from 13% to negative 5% – a decrease of 18% year over year. Our employees are making smart choices: increasing their use of preventive care and the CIGNA 24-hour nurse line, as well as opting to use less-costly urgent care facilities or convenience care clinics rather than heading to the emergency room for non-emergency events.

We attribute this enormously successful enrollment to honest and open communication with employees coupled with consumer-focused information and tools, said Grove. Thats a strategy that we will continue to focus on and, so far, it has produced very impressive results.

Individuals Making the Most of their Health Benefits

Noting the solid clinical compliance among those enrolled in CIGNA Choice Fund plans, CIGNA Chief Medical Officer, Jeffery Kang, M.D. said: America is a land of smart shoppers, and what our study shows is given the right plans, tools and information, people will make rational, wise and successful health care decisions.

Individuals enrolled in CIGNA Choice Fund plans continued to receive recommended care at the same or higher levels as those enrolled in traditional plans in an evaluation of compliance with 400 evidence-based measures of health care quality. In fact, first year Choice Fund customers had higher statistical compliance with 11% of evidence-based measures than their counterparts in traditional plans, and 16% higher for Choice Fund customers enrolled for multiple years.

Moreover, individuals with chronic illnesses covered by CIGNA Choice Fund plans are more engaged and more likely to comply with and complete their plan disease management programs. Disease management program follow-through and completion rates are 22% higher among those in CIGNA Choice Fund plans than their counterparts in traditional CIGNA managed care plans.

Preventive care visits for first-year CIGNA Choice Fund customers were an average of 16% greater when compared to traditional plans, with CDHP preventive care visits continuing at higher rates than those in traditional plans in the second year.

The trend in pharmacy costs for new CIGNA Choice Fund customers who also have their pharmacy benefits with CIGNA was cut by more than half when compared to those enrolled in traditional plans.

CIGNA’s mission is to improve peoples health, well-being and sense of security; said Dr. Kang. During the past four years, CIGNA Choice Fund studies have consistently demonstrated that CDHPs are part of the solution for creating a more affordable, accessible, sustainable and high quality healthcare system.

CIGNA (NYSE:CI), a global health service company, is dedicated to helping people improve their health, well-being and sense of security. CIGNA Corporation’s operating subsidiaries provide an integrated suite of medical, dental, behavioral health, pharmacy and vision care benefits, as well as group life, accident and disability insurance, to approximately 46 million people throughout the United States and around the world. To learn more about CIGNA, visit www.cigna.com.

Geisinger Health Pricing Innovations Not Appreciated by Other Health Plans.

For most service industries, standing behind your work is hardly considered to be innovative, nor is it considered a marketplace differentiator. But, healthcare is not most service industries and it is a big deal when a hospital says that it will guarantee its work for 90 days.

That is exactly what Geisinger Health System is doing. According to The Washington Post, Geisinger, located in the coal country of Pennsylvania, offers a 90-day warranty on elective heart surgery, promising to get it right the first time, for a flat fee. If complications arise or the patient returns to the hospital, Geisinger bears the additional cost.

The Post reports that not only does the health system guarantee its work, but heart patients have fared measurably better, and the health system has cut its bypass surgery costs by 15 percent. Today, Geisinger has extended the program to half a dozen other procedures.

One might look at this as a great example of how innovation can lower healthcare costs and improve outcomes. You would think that health insurance carriers would embrace such a system and encourage other systems to adopt similar practices. This is, however, not the case. In fact, Geisinger runs the program through its own insurance unit and only benefits those who are covered by these health plans.

The Post’s article said that other insurers “are not convinced that the savings would be large enough to make it worthwhile for them to renegotiate contracts with the health system. Many still feel more comfortable with the traditional pay-per-procedure approach, even though they run the risk of having to pay thousands of dollars to fix surgeries that go wrong.”

What is even worse is that the Post’s article notes that “most hospitals are also skeptical of Geisinger’s innovation, saying they would lose money by being unable to bill for treatment of patients who must return.”

With health care costs quickly approaching the level where they are a threat to the national economy, it is disappointing to learn that “best practices” like those being demonstrated at Geisinger are not being embraced by the health care industry.

To find out more about Geisinger and how they have developed their guarantee, click here.

New Whitepaper Presents Clear Vision for Sustainable Healthcare Systems.

A new white paper produced by IBM Global Business Services outlines the drivers that the authors believe make today’s healthcare environment fundamentally different from the past as well as the possible scenarios for healthcare for the near future.

The paper called Healthcare 2015: Win-win or lose? makes the case that change must be made to the health care systems around the world and that the choices that have been left to the stakeholders of today’s healthcare systems are when and how.

The authors warn that if today’s stakeholders wait too long to act or do not act decisively enough, their systems could “hit the wall” – in other words, be unable to continue on the current path- and then, require immediate and major forced restructuring.

Instead of this forced restructuring the paper suggests stakeholders will need to make tough decisions and work hard to reach new levels of accountability.

The authors suggest that action and accountability are the basic ingredients of change and to successfully transform healthcare systems, countries will need to undertake the following actions:

  • Focus on value – Consumers, providers, and payers will agree upon the definition and measures of healthcare value and then, direct healthcare purchasing, the delivery of healthcare services, and reimbursement accordingly.
  • Develop better consumers – Consumers will make sound lifestyle choices and become astute purchasers of healthcare services.
  • Create better options for promoting health and providing care – Consumers, payers, and providers will seek out more convenient, effective, and efficient means, channels, and settings for health promotion and care delivery.

Health Plan Innovation Take: Clearly, this group of researchers has a good grasp on where the health care system should be by 2015 in order to remain sustainable. The problem remains: How do we get there? To this question the authors write, “Successful transformation will require all stakeholders to actively participate, collaborate, and change.” This we know. If someone was just able to align the interests of providers, insurers, patients, drug companies and others we could solve this problem well before 2015. The problem is we have not developed the forum in which this collaboration can take place.

The IBM authors note that this lack of a forum is a problem.

“Even so, bringing the entire portrait to life is an extraordinarily difficult, but vitally important task, which must be informed and achieved through a process of debate and consensus, and action and accountability.”

Perhaps the best “forum” for debate and consensus with this number of stakeholders with unaligned interests is consumerism. Let the market be the forum for aligning stakeholder incentives to achieve the goals of focusing on value, developing better consumers, and creating better options for promoting health and providing care. Otherwise, we will be facing the predicted “forced restructuring” sooner than we think. To see how that might look, just open the business section of your daily newspaper and read about the forced restructuring now underway in the financial services industry.

Be More Like America

In looking for innovative health care solutions, I was drawn to an op-ed piece that Republican presidential candidate Rudolph W. Giuliani published in the Boston Globe back on August 3, 2007. In a piece titled A free-market cure for US healthcare system he writes, “Instead of being more like Europe, we need to be more like America.”

Giuliani goes on to write, “America is best when we solve our problems from our strengths, not our weaknesses. Healthcare reform must be based on increased choice, affordability, portability, and individual empowerment.”

Then he strikes at the heart of the matter — tax fairness. “We need to begin by bringing fairness to the tax treatment of healthcare. The current tax system penalizes millions — including the rising ranks of the self-employed and 40 percent of employees at small firms — who pay for insurance on their own and receive no tax benefit.”

The candidate begs the question, why is it that Americans without employer-based insurance, or those who would rather have individual coverage, cannot enjoy the same tax benefits as the 175 million Americans with employer-based coverage?

Giuliani proposes a new tax-free income exclusion up to $15,000 for Americans without employer-based coverage. Any amount a family pays less than $15,000 — for individuals, less than $7,500 — could be put tax-free into a Health Savings Account. This, he says, would create a powerful incentive for more Americans to own their private health insurance — making it portable instead of dependent on an employer.

The conclusion of Giuliani’s article states, “The future of America’s healthcare system lies in free-market solutions, not socialist models. We can increase individual choice and decrease costs by increasing competition, encouraging innovation while always compassionately caring for people in need. That’s the American way to reform healthcare.”

To read the article, click here.

P.S. Thanks to the guys at the HSA Truth blog for the tip about this article.

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