Humana provider tools aid value-based care

Apr 03, 2015

As the Medicare program and the healthcare industry at large begins the transition from fee-for-service to value-based reimbursement models, health plans are responding by ramping up collaboration with providers to improve health outcomes, especially for medically-complex Medicare members.

As the Medicare program and the healthcare industry at large begins the transition from fee-for-service to value-based reimbursement models, health plans are responding by ramping up collaboration with providers to improve health outcomes, especially for medically-complex Medicare members.

BroussardAt the same time, healthcare systems are often challenged to integrate both interoperability and analytics components into their population health management strategies.

Enter: Humana’s formation of Transcend and Transcend Insights to serve as partners for healthcare systems, physicians and care teams, regardless of where they are in their population health journeys.

Transcend is a population health management company that meets doctors where they are on the path to practicing value-based medicine, according to Humana. It collaborates with physicians, medical groups and integrated delivery systems to make the transition to value-based care by engaging, partnering and offering practical services and solutions. It builds on Humana’s experience with specialty network care management, pharmacy management, clinical studies, and implementation and training.

Related:Top stakeholders for task force to accelerate shift to value-based care

“The launch of Transcend and Transcend Insights is reflective of Humana’s goal to improve the health of the communities we serve by making it easy for people to achieve their best health,” said Bruce Broussard, Humana’s president and chief executive officer. “Transcend and Transcend Insights reflect the continued evolution of Humana’s Integrated Care Delivery model. As physicians continue on their population health journeys, Transcend and Transcend Insights are strategically positioned to serve as their trusted partners while meeting their evolving population health needs.”

Adams“Moving more physicians towards value-based payment models is a proven strategy that increases clinical quality and patient satisfaction, and reduces medical costs,” said Patrick Adams, president of Transcend. “Through our first-hand knowledge in implementing successful integrated care solutions and proactive patient engagement strategies that support positive outcomes, Transcend is strategically positioned to help physicians spend more time with their patients and less time on the behind-the-scenes elements of population health.”

Transcend Insights is an integration of the insurer’s subsidiaries Certify Data, Anvita Health and nliven systems. According to the company, it simplifies the complexities of population health in three main ways:

  • Through advanced community-wide interoperability;

  • Real-time healthcare analytics, and

  • Intuitive care tools.

Transcend Insight’s HealthLogix platform provides healthcare systems, physicians and care teams with real-time clinical insights that help improve the health of the populations they serve. This leads to a higher level of patient care and lower costs.

“In order for healthcare organizations to tap into the transformative power of value-based payment models, we have to collaborate with physicians and care teams by engaging, partnering and offering practical services and solutions,” says Marc Willard, president of Transcend Insights and founder and former chief executive officer of Certify.

Willard“We collect, normalize and analyze the data and give doctors and care teams the real-time clinical insights they need to care for their patients,” Willard adds.

Willard says Transcend Insight’s focus is helping close care gaps. “We present the information at the point of care in a way that is intuitive to doctors. Last year we identified 36 million opportunities for care improvement and helped physicians close gaps in care.”

 

NEXT: Value shift driving population health tools

 

Value shift driving population health tools

Given the national focus on healthcare transformation through population health, Marty Hauser, partner, Chandler Group, and former chief executive officer of SummaCare, Akron, Ohio, believes that these types of programs will continue to evolve “and be developed by all carriers including the regional provider sponsored plans because of the need to support behavioral changes with ‘actionable data’ and support of the care delivery system.

Hauser“In addition, I would suspect that the payers are working hard to find ways through programs like this to add value to their traditional role as insurers,” says Hauser.

“One of the challenges as we see the industry evolve to these types of models and expanded services will be the ability of the providers, especially physician practices, to understand and manage the often- differing programs and approaches of the payers,” notes Hauser.

“As we learned in the past with pre-certification and pre-authorization lists and protocols, it is very difficult for physicians and their offices to implement and adapt a different process and data requirement for each payer.

Related:HHS announces historic changes to Medicare

“If you were to speak with physicians I would suspect that they would be supportive of these types of tools and support systems but express concern about the lack of ‘industry standards’ with every plan potentially developing their own programs. It ultimately goes back to the concept of creating actionable data and processes that are consistent, standard, and easy to follow and implement if providers are going to use them.”

Humana’s goal is to have 75% of its individual Medicare Advantage members covered under value-based relationships by 2017.

Tracey Walker is content channel manager for Managed Healthcare Executive.

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