Managed Care

 

A paperless health plan

MANAGED CARE September 2001. © MediMedia USA

A paperless health plan

MANAGED CARE September 2001. ©MediMedia USA

Plan: Humana
Strategy: Humana rewires its systems, in the process, rebuilding relationships with patients and providers
Progress: Launches in Memphis on Jan. 1

Humana Chairman David Jones told a group in June that he was reinventing the company he cofounded — again. "Sometimes," he said, "you need to thoughtfully abandon yesterday's success."

The nursing home company-turned-hospital operator-turned-managed care company is now pursuing a business model that uses the Internet to change the way insurers interact with members and physicians. The first evidence of this will turn up in Memphis, where Humana intends to launch a "digital health plan" on Jan. 1.

Jonathan T. Lord, MD, Humana's chief clinical strategy and innovation officer, says the plan, which eventually will be rolled out in other markets, is designed to ease interactions with physicians, consumers, employers, and brokers — removing hassles while saving the company significant administrative expense.

It's not just a matter of "web-ifying" existing business, as Lord puts it. "This plan is built from the ground up, with a new way of thinking through some of the processes that support the work. That, coupled with an entirely new claims-processing engine that allows for employers and individuals to customize benefits and adjudicate claims instantly, and provide up-to-date eligibility information — those are huge changes in the way business is going to be done."

Eligibility, of course, powers the whole claims train, and employers can use the system to add and delete members instantly. They'll also be able to pay premiums electronically. For physicians, "As long as they or their staffs do an online eligibility check and we tell them the member is eligible, we're not going to deny a claim later because of membership status," says Lord. "We're trying to deal with some of the things that have frustrated physicians."

For members, the system offers online enrollment, as well as the ability to check benefits and claims statuses, print ID cards, and chat with a customer service representative. But for some patients, the real value of Humana's new system may be in its medically oriented applications.

In time, the company will create, for each patient, a personal health profile — an online compilation of one's entire claims history. From a convenience standpoint, it will save patients the drudgery of filling out information on a clipboard in the doctor's office. Instead, with the patient's permission, the physician can download a patient's health profile, thus answering all the questions on the clipboard. From a safety standpoint, any information a patient might have forgotten to write down — medications being taken, for instance — is there for the physician to see.

Members can add personal health information. An example, says Lord, is herbal-supplement use. "That information can be uploaded to the profile, and the system will look for interactions with any medications being taken. That's something we know often isn't reported to physicians.

"It's progressive and integrated systems thinking," he says, "instead of looking at this in a silo fashion."

Meetings

4th Partnering With ACOs Summit Los Angeles, CA October 27–28, 2014
PCMH & Shared Savings ACO Leadership Summit Nashville, TN November 3–4, 2014
2014 Annual HEDIS® and Star Ratings Symposium Nashville, TN November 3–4, 2014
Medicare Risk Adjustment, Revenue Management, & Star Ratings Fort Lauderdale, FL November 12–14, 2014
World Orphan Drug Congress Europe 2014 Brussels, Belgium November 12–14, 2014
Healthcare Chief Medical Officer Forum Alexandria, VA November 13–14, 2014
Home Care Leadership Summit Atlanta, GA November 17–18, 2014
HealthIMPACT Southeast Tampa, FL January 23, 2015