Seniors Have Fewer ‘Unhealthy Days’ When Screened for Social Determinants

Humana’s “Bold Goal” of improving the health of seniors through better management of populations in seven U.S. cities is showing promising results, according to a recent report from the health insurer.

Medicare Advantage members living in the company’s original seven Bold Goal communities have seen a 2.7 percent reduction in unhealthy days since 2015, the report notes. In San Antonio, members saw a 9.8 percent reduction in unhealthy days, which is halfway toward their goal.

The Bold Goal initiative uses measures established by the Centers for Disease Control and Prevention to track an individual’s physical and mental unhealthy days over a 30-day period. Social determinants of health for the patients are closely monitored, with more than 500,000 patients screened for food insecurity and loneliness and connected with community resources. Last year, for instance, Humana introduced social determinants screenings to their care managers and pharmacists and provided tools to support primary care physicians and clinicians in Bold Gold communities so they can better screen and solve for food insecurity, social isolation and loneliness.

The population health initiative comes as Humana and many other payers — both commercial and government — continue to move away from fee-for-service plans in favor of value-based care models that measure the success of health outcomes. Forbes notes that Blue Cross and Blue Shield plans, Aetna, Cigna and UnitedHealth Group are working on similar value-based models and community-based programs as they continue to shift more reimbursement to alternative payment models. Cigna in February said more than half of its Medicare and commercial payments to providers are now made through alternative payment arrangements.

Seniors increasingly are buying into Medicare Advantage plans, which contract with the federal government to provide additional benefits and services to seniors. Recognizing this, the Centers for Medicare & Medicaid is changing regulations to allow MA plans to provide broader coverage in the future. The move could boost enrollment from 22 million this year to nearly 40 million, or half the U.S. Medicare population, by 2025, according to some analysts.

The move to expand MA will only place hospitals and health systems further away from fee-for-service medicine, putting additional pressure on providers to improve quality and outcomes or risk being excluded from insurer networks.