 |
Member Evaluation
Humana has developed an array of methods to identify potential Health Resources participants quickly and accurately. Finding those in need of clinical guidance is the first step to realizing the benefits of Humana's programs. |
Member-Driven Evaluation Methods
Members can use these resources to gain insight into their health or receive help with a specific situation. At the same time, Humana identifies additional opportunities for health guidance. These processes allow the member to define the "when" of Humana's brand promise, "Guidance when you need it most."
Humana Health Assessment
A voluntary and confidential lifestyle questionnaire that:
- Identifies health risks
- Provides steps for improvement
- Refers potential candidates to Humana's nursing programs
Benefits
Promotes better health by:
- Bringing health to the forefront of members’ minds
- Giving members a personalized health report with immediate action steps
- Allowing Humana to identify guidance opportunities
The bottom line
Participants are directly referred to Personal Nurse ®, Disease Management, or Humana Beginnings® and are presented with links to wellness information and services.
 |
A toll-free number that gives members 24-hour-a-day access to a registered nurse. |
Transition of Care
Changing insurance plans is often stressful for members – especially those who need specialized medical treatment like chemotherapy. This program:
- Helps members transition to Humana with the least amount of disruption to care
- Refers members to appropriate clinical support
Through understanding of the circumstances of those in active treatment, Humana is able to proactively reach out with its clinical guidance programs.
Humana recommends that employers make this program a standard component of their benefits package.
Benefits
The program:
- Provides better support for members migrating from other health plans
- Does not hinder the doctor-patient relationship
The bottom line
- Immediate enrollment into clinical programs
- More timely transfer to in-network providers
Data-Driven Evaluation Methods
Humana has developed several methods to identify members who may be at risk for certain conditions. By reaching out to these members early – in some cases, before a health event occurs – we can make a greater impact on health outcomes and costs.
Predictive Modeling
Predictive modeling technology:
- Analyzes medical and pharmacy claims data, along with behavioral, socioeconomic, and environmental input
- Targets those with certain conditions at an early stage, so we can identify members before a major health event occurs
Benefits
Humana’s software has three key advantages:
- Greater accuracy – greater sensitivity and specificity
- More flexibility and speed – solid results with limited data
- More utility – various aggregations and visualizations
The bottom line
Humana has developed an industry-leading internal predictive model.
Data Mining
With over five terabytes of storage in our Electronic Data Warehouse (EDW), Humana has developed valuable knowledge in the management of healthcare data. Combined with consistent investments in technology and advanced analytic power, Humana can pinpoint members in need.
Benefits
- Optimizes more than 20 years of experience and expertise in the analysis and management of health data
- Humana can quickly implement and ramp-up new program and service offerings
Clinical Review
As doctors interact with Humana through the authorization and referral processes, Humana has the opportunity to identify Health Resources that could meet the individual’s needs. Methods include:
Standardized review list:
- Highly recommended for all ASO business
- Continually managed for consistent service
Enhanced concurrent review process:
- Examines all inpatient admissions that Humana receives notice about – application of Solucient length-of-stay guidelines
- Case management integration to assist providers with care coordination and discharge planning
Benefits
- Allows Humana to understand the member’s unique situation and identify Health Resources that could meet the individual’s needs
- Supports consumerism by promoting appropriate, cost-effective care
The bottom line
Clinical review allows Humana to understand the member’s unique situation and identify Health Resources that could meet the individual’s needs.
These programs and tools are not insurance products and are not guaranteed under any contract. Humana is not required to provide these services.
|
Humana.com Home
Explore Agent Self-Service Center
