Coordinated care approach addresses older-adult social and behavioral needs

Integral to Humana’s strategy is to create value in the healthcare our members receive. It is the guiding principle for working closely with primary care physicians to support them in establishing value-based care practices.  

Among the many ways Humana is investing in value-based care is by building practices where clinicians and members want to work together in their care journeys. Across the country, through Humana’s owned Conviva and CenterWell Senior Primary Care facilities, care teams organize around the unique needs of each patient. The care teams include not just clinicians, but also care coaches, and social and behavioral health workers. Together, they work to assure that social barriers to care do not impede physical health. 

For instance, if a patient cannot get to the clinic for an appointment, transportation might be offered. If there is an identified need for food or medication due to economic constraints, a member of the clinic staff will work to see that those patients have access to the right resources. And, if there is an immediate psychosocial concern, behavioral health specialists are on staff to ensure prompt care. 

“It’s a care team approach; we’re sitting down with people and understanding what’s happening in their lives in a way that makes them comfortable sharing,” said Reneé Buckingham, Segment President of Humana’s Care Delivery Organization. “The physician might spend 45 minutes with a patient in a preventive visit, so there’s a lot more time for them to build a trusting relationship. They will talk about their personal situations and get the help they need, but maybe were afraid to ask for. There is a whole lot of opportunity to become a partner with patients in this type of coordinated care approach.” 

Because Humana focuses on care that considers the social, behavioral and physical health needs of members, the clinics are an extension of that mission. Primary care, with a coordinated care approach, has been shown to reduce healthcare costs, and in the process, improve patient outcomes and satisfaction. 

With more than 160 primary care locations, which accept other health plans’ members, Humana is creating an ecosystem of whole person care in communities where it’s much needed. Clinics are often strategically placed in medically underserved areas so that older adults, who may have increased social needs and chronic condition management, are able to receive personalized care. 

Buckingham, whose organization oversees CenterWell Senior Primary Care and Conviva Care Solutions, said when the pandemic uprooted traditional health access, the clinics were able to support their patients in new and effective ways.  

“There was some worry in the industry that older adults would avoid medical visits due to concerns over COVID-19,” she said. “It turned out to be the opposite, in our experience. We quickly put into place alternatives for how our seniors could maintain their care, whether that was virtual or, in some cases, curbside. 

“At CenterWell, visits actually rose because we were able to reach out to the patients, reassure them and support them in getting care. About 87 percent of CenterWell patients made one or more visits to their local center in 2020, compared to 75 percent in 2019. In the case of annual wellness visits (AWV), 94 percent of at-risk patients had a comprehensive AWV in 2020, up from 89 percent in 2019. 

 “While there are a variety of explanations for the increase, we know that, in general, our patients felt comfortable – both physically and emotionally – visiting our centers.  We believe that keeping up with their primary care visits during the pandemic will be beneficial to their long-term health.”