Posts Tagged ‘managed care’

Infographic: Medicare Advantage Trends

January 10th, 2018 by Melanie Matthews

As medical groups and large systems transition to risk-based models, they expect nearly 60 percent of federal revenues will come from risk-based products (bundled payment, Medicare Advantage (MA), Medicaid Managed Care Organizations, and Medicare Accountable Care Organizations) by 2019, according to a new infographic by AMGA.

The infographic shows the anticipated the growth of MA as well as what this means for healthcare providers.

Healthcare Trends & Forecasts in 2018: Performance Expectations for the Healthcare IndustryGiven the powerful patterns disrupting healthcare, what will it take to succeed as a high-velocity healthcare organization in 2018?

Healthcare Trends & Forecasts in 2018: Performance Expectations for the Healthcare Industry, HIN’s 14th annual business forecast, is designed to support healthcare C-suite planning as leaders react to presidential priorities and seek new strategies for engaging providers, patients and health plan members in value-based care.

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6 Criteria for Remote Patient Monitoring Applications in Managed Care

July 10th, 2014 by Cheryl Miller

Among the six criteria that Humana uses to evaluate vendors for remote patient monitoring applications are reducing medical costs and generating a positive ROI at a program level, says Gail Miller, vice president of telephonic clinical operations in Humana’s care management organization, Humana Cares/SeniorBridge. Applicants have a tough bar to pass, because programs not only have to work, they have to work better on those already being care managed.

First, we put together criteria for what we wanted to do in a managed care application. We were looking at reducing medical cost and generating positive return on investments (ROIs) at a program level. Our studies are more difficult to set up because all these people are under care management. Whenever anyone is going to work with us, they have to understand that they have a tough bar to pass, because not only does the program have to work, it also has to work better on someone who is already being care managed. We are looking for that incremental lift that we could get from remote monitoring.

Everything has to be customer friendly and easily adaptable to our members’ lifestyles. We want our members to feel rewarded by their efforts to monitor their health. We want to involve the members, physicians, caregivers and families so that everybody in the care circle is included, and we want to test with little disruption to our large organization.

We have more than 2,000 nurses and social workers on the telephone. This is something that you have to consider to introduce new pieces of technology, in addition to considering how you are going to put it into your operational stream. We have been able to do that. We decided to move forward with this new care management model using all of the tools that we had and to extend our reach by using remote monitoring.

We were specifically looking for remote monitoring technology to help our members manage their conditions, to reduce hospitalizations, and to improve their consumer experience. We have nine remote monitoring care management pilots underway. We have a tenth pilot that is in development. People have to consent to both care management for Humana Cares as well participation for the pilot.

The member selection for our remote monitoring program was based on complex clinical analysis. There was no additional cost to our members to participate in these pilots, and the equipment that we use is considered a loan to the member for the duration of the pilot or as long as they are members of Humana if that pilot is rolled out.

Excerpted from: Remote Patient Monitoring for Enhanced Care Coordination: Technology to Manage an Aging Population.