- A recently launched initiative from Humana aims to help clinicians address nonmedical health risk factors affecting members. The social determinants of health value-based program targets issues like inconsistent access to nutritious food, signs of social isolation or loneliness and housing instability among patients.
- The program for members in Medicare Advantage plans is designed to encourage clinicians to provide more holistic care that goes beyond traditional medical treatment. It promotes patient screenings and other assessments to address social factors that could negatively affect health outcomes. Humana says it will reimburse for such coordination, although it's unclear exactly how that will work.
- The first provider to participate is Ochsner Health, Louisiana's largest non-profit, academic health care system. Humana officials told Healthcare Dive the company "will be looking to expand the program to include participation by other providers elsewhere in the country."
Socioeconomic status, education and housing can affect health outcomes and identifying them early can help with prevention, especially for chronic conditions. Humana says it's dedicated to supporting providers as they move away from the traditional fee-for-service system. This program is in line with its push for value-based care, namely better access to primary care.
Philip Oravetz, a physician and chief population health officer at Ochsner Health, said in a statement the system is "pleased to deepen our value-based work with Humana in identifying and addressing critical drivers of poor health that occur outside of the doctor's office."
Humana isn't the first payer to try this approach.
CMS has also aimed to expand value-based programs that reward health care providers for the quality of care they provide, especially in the MA program.
In 2018, Intermountain Healthcare invested $12 million in an effort with city, county and state government agencies and community-based organizations in Utah to tackle issues related to social determinants of health.
UnitedHealthcare and the American Hospital Association announced plans last year to create additional billing codes to identify specific risk factors, allowing providers to identify when patients are unable to pay to fill prescriptions or don't have access to transportation for appointments, among other things.
But research has found those codes are rarely used. In a CMS study on Medicare fee-for-service claims, they were used for only 1.4% of the total beneficiary population. The most frequently used code was for homelessness.
U.S. health systems are also investing heavily in programs around social determinants of health — at least $2.5 billion from 2017 to 2019, according to a February report from Health Affairs.
SDOH programs are increasingly popular with those issuing MA plans. After payers were allowed to incorporate more such treatments into their plans for 2020, some added benefits for services like pest control, transportation assistance and adult day care.
Humana says it has more than 2.4 million individual MA members and about 115,000 commercial members cared for by providers engaged in its value-based programs.
This brief has been updated with language clarifying program eligibility and overall participation in Humana's value-based programs.