Have a Chronic Condition? Value-based Care Could Help You Manage It.

Wednesday February 16th, 2022

According to Humana’s Value-based Care Report 2020, more than 91% of Humana Medicare Advantage members have at least one chronic condition, and more than 85% of Humana Medicare Advantage members have two or more chronic conditions.1

If you have a chronic condition, you might feel like it’s the defining aspect of your life; everything circles around it, from your schedule to what you to eat to what you do. That can feel overwhelming. But thanks to the value-based care model, the way doctors screen for and manage chronic conditions is changing.

What are chronic conditions and the risk factors for them?

A chronic condition is defined as a physical or mental health condition that lasts for one year or longer, often requiring ongoing medical attention and/or limiting daily living.2 Here are the top 10 most common chronic conditions in older adults in order of prevalence:3

  1. Hypertension
  2. High cholesterol
  3. Arthritis
  4. Heart disease
  5. Diabetes
  6. Chronic kidney disease
  7. Heart failure
  8. Depression
  9. Alzheimer’s disease and dementia
  10. Chronic Obstructive Pulmonary Disease (COPD)

Risk factors for many chronic diseases can be attributed to behaviors such as:4

  • Using tobacco
  • Poor nutrition
  • Lack of physical exercise
  • Excessive alcohol consumption
  • Not enough sleep

In addition, a family health history of chronic disease,5 your socioeconomic status6 and your race7 may contribute to your personal risk factors for chronic disease. It’s important to note that chronic disease among racial groups is not biological but, rather, a result of varied and complex systemic barriers such as lack of access to healthcare, healthy foods and/or quality of life.7 Learn more about what Humana is doing to improve health equity here.

How is a chronic condition treated differently in a value-based care setting?

Value-based care aims to provide better care at lower long-term costs by focusing on the patient and their health outcomes.8 Value-based care providers are uniquely positioned to screen for and manage chronic conditions thanks to their emphasis on prevention and their team-based, coordinated approach. Here’s why.

More preventive screenings1

“Prevention represents the foundation of value-based care,” said Maycie Elchoufi, MD, Humana Medical Director, Medicare Retail Market.1 Humana’s Value-based Care Report 2020 shows that in-network, Humana value-based care providers perform more preventive screenings compared to non-value-based care providers:1

  • 8% more screenings conducted overall
  • 19% more colorectal and diabetic eye exams
  • 22% more post-discharge medication reconciliations

With preventive screenings and lifestyle adjustments, you and your value-based care provider may be able to avoid a chronic condition from developing. Or, if a screening catches a condition early enough, you and your value-based care provider may be able to stop it from progressing further.

A team-based, coordinated approach

Many value-based care providers in Humana’s network have coordinated care teams consisting of a primary care provider (PCP), nurse, health coach and behavioral specialist. Imagine what a team of healthcare professionals working together could mean for your health. Learn why these Humana members say they found the right value-based care providers for them. Here’s how they help you manage chronic conditions.

Primary Care Provider (PCP)

Your value-based care PCP is like the care team’s quarterback. They call the shots on the field, so speak. Here’s how a PCP coordinates your care:

  • They develop your care plan, which includes determining which screenings and treatments you need for your health situation.
  • They communicate your care plan with their internal care team (nurse, health coach and behavioral health specialist) and coordinate your care with outside specialists such as cardiologists, endocrinologists, nephrologists, pulmonologists and others to ensure everyone is on the same page when it comes to your health.
  • They can help you with your medications to see if you’re on the right ones for your treatment plan.

To sum it up, your PCP manages your overall care to be sure everything is working together as planned. They are the central person in your care who ensures everyone is working to maintain your health and well-being. Discover how to find the right value-based care provider for you here.

Nurse

Your value-based care nurse supports you through screenings, treatments and with your medications. If you need to monitor your blood pressure daily, for example, your nurse can give you a tutorial on how to use your blood-pressure machine and record your numbers. Or if you take insulin by injection, a nurse can show you how to properly administer your medication.

Health coach

A value-based care health coach supports you in making healthy lifestyle adjustments and choices, whether through the food you eat or the activities you do. They can help you understand which foods are better or worse for your condition. They can connect you to activity groups in your area so you can make new social connections while staying active.

Behavioral health specialist

Your value-based care behavioral health specialist can support you with your emotional and psychological well-being, since having a chronic condition can take its toll on your mental health due to increased pain or limits on your lifestyle.9 A behavioral health specialist can help you with frustration, fatigue, depression or social isolation through developing mindfulness, practicing breathing exercises and reframing your perspective and the story you’re telling yourself about your condition.

How can a Humana Medicare Advantage plan help you manage chronic conditions?

Humana’s Medicare Advantage plans offer benefits and services that can make managing chronic conditions easy and affordable (benefits vary by plan and service area). Here’s how:

  • Fitness benefits: Many Humana Medicare Advantage plans include SilverSneakers® as a benefit, giving you access to 15,000+ gyms nationwide as well as virtual and on-demand classes from the comfort of your home.10 This benefit can help you stay active without the added costs of a gym membership.
  • Wellness incentives: Many Humana Medicare Advantage plans include Humana’s Go365® program, which incentivizes you to make healthy choices like getting preventive screenings, engaging in community events and completing verified workouts. You earn points that you can then redeem for gift cards to major retailers like Walmart, Home Depot, Amazon and others.
  • Over the counter (OTC) allowance: Many Humana Medicare Advantage plans provide a monthly or quarterly OTC allowance for health and wellness products such as vitamins, supplements, home medical equipment like a blood-pressure monitor or diabetes products such as compression socks.
  • Healthy Foods Card: Many Humana Dual-Eligible Special Needs Plans (DSNPs) include the Healthy Foods Card, which gives you a monthly allowance to use on groceries like lean meats and fresh produce. It was designed to make access to nutritious foods easier for those who are eligible for both Medicare and Medicaid.
  • Insulin Savings Program: Available on certain Humana Medicare Advantage plans, Humana’s Insulin Savings Program helps qualifying members access affordable, predictable costs on select insulins. Eligible members will pay a maximum copay of $35 for up to a 30-day supply for each select insulin (some plans offer copays as low as $0 per 30-day supply).11

Your health is in your hands

You have the power to choose a health plan and healthcare model that puts you and your health first, especially if you have a chronic condition. As licensed Humana sales agent Tracy says, “You’re never too old to be vital.Discover the Humana plans and value-based care providers that are right for you.

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More personalized care starts with one person: your Humana Sales Agent.

Humana will connect you with a licensed sales agent in your community. And they will help connect you with value-based primary care that has been shown to deliver better patient outcomes.*

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*Humana VBC Report, 2020, digital.humana.com/VBCReport/

Humana is a Medicare Advantage [HMO, PPO and PFFS] organization [and a stand-alone prescription drug plan] with a Medicare contract. [Humana is also a Coordinated Care plan with a Medicare contract and a contract with the [state] Medicaid program.] Enrollment in any Humana plan depends on contract renewal.

Not all members are eligible for Value Based Insurance Design (VBID) benefits. Eligibility will be determined by Humana, after enrollment, based on relevant criteria such as clinical diagnoses or participation in a disease state management program

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1https://digital.humana.com/VBCReport/VBC_Report_2020_digital.pdf

2https://www.cdc.gov/chronicdisease/about/index.htm

3https://www.ncoa.org/article/the-top-10-most-common-chronic-conditions-in-older-adults

4https://www.cdc.gov/chronicdisease/about/prevent/index.htm

5https://www.cdc.gov/genomics/famhistory/famhist_chronic_disease.htm

6https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(19)30226-9/fulltext

7https://www.webmd.com/diabetes/features/minority-chronic-condition-burden

8https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based-Programs/Value-Based-Programs

9https://www.nimh.nih.gov/health/publications/chronic-illness-mental-health

10https://tools.silversneakers.com/

11https://www.humana.com/medicare/medicare-programs/insulin-savings-program