Humana

Client: Humana

Category: Health Services

Member Populations:

• Managed Long-Term Supportive Services

Key Program Highlights:

• Objective – Designed to collaborate with Humana’s care coordinators, actively engaging eligible MLTSS members.
• Outcomes – Our program is committed to delivering positive outcomes, including improved health results, enhanced quality measures, a better quality of life, and reduced healthcare costs.
• Expertise – Engaging Solutions brings a wealth of experience and expertise in the working with CHW’s and addressing the complex web of Social Determinates of Health.
• Partnership – We are proud to partner with Humana to extend our reach and deliver the comprehensives care and support to our members.

Engagement Process for Community Health Workers:

• Humana provides referrals to CHW’s through service platforms.
• Members use Humana systems to access demographic and claim information to locate member addresses and phone numbers
• CHW’s make outreach attempts to engage with the members.
• Upon engagement, CHW’s assess member needs and conduct necessary assessments.
• CHW’s provide resources and referrals for the members.
• All outreach activities and resources are tracked and documented in Humana-designated systems.

*The primary member engagement strategy is face-to-face, with telephonic outreach used as needed.

 

Project Goals and Outcomes:

• Aging at Home: Ensure more Hoosiers can choose to age at home and simplify access to Home and Community-Based Services (HCBS).
• Diversion from Nursing Facilities: Appropriately divert individuals from long-term nursing facility stays with a person-centered
• Care Coordination: Provide high-quality care coordination across Medicaid and Medicare for dual-eligible members, spanning physical health, behavioral health, and social
• Enhanced Quality and Consistency: Improve quality outcomes and consistency of care across the delivery
• Person-Centered Care: Deliver person-centered and strengths-based care to
• Member Choice and Access: Ensure member choice, protections, and access to essential services.
• Supporting Caregivers: Promote caregiver support and skill development to enhance the caregiving experience.
• Health Equity: Understand, measure, and address health inequities in care and access for all members.
• Primary and Preventive Care: Promote primary and preventive care to improve overall health outcomes.
• Optimized Healthcare Services: Ensure the appropriate use of health care services, optimizing member care.
• Health Literacy: Develop informed health care consumers by increasing health literacy and providing price and quality transparency to both members and their informal caregivers.
• Quality and Continuity: Encourage quality, continuity, and appropriateness of medical care for all members