Social Determinants of Health provider program launched

In March 2020, Humana launched its first value-based care payment initiative designed to support clinicians in addressing nonmedical health risk factors affecting Humana members. The Social Determinants of Health Value-Based Program aims to improve health outcomes by encouraging a more holistic approach to patient care that goes beyond traditional clinical treatment.

Social determinants are the life circumstances and environments that impact a person’s health and well-being, including an increased risk of chronic medical conditions.

In particular, the new program is to address food insecurity, social isolation, loneliness, and housing instability. The model offers providers tools and resources to identify and address those social determinants, and will provide compensation for enhanced care coordination centered on three program components — patient screenings; documentation of assessment findings; and connecting the patient to appropriate resources.

“Humana is committed to advancing the transformation to value-based care, and incorporating a focus on social determinants of health is the logical next step in that evolution,” said Caraline Coats, Vice President of Population Health Strategy at Humana. “Through this program, Humana is pleased to invest in a new approach that includes focusing on nonclinical barriers to health. We’re better able to support clinicians as they broaden the scope of patient care to improve health outcomes.”

The Social Determinants of Health Value-Based Program is designed to complement existing value-based agreements between Humana and health care providers. Its inaugural participant is Ochsner Health, Louisiana’s largest non-profit, academic health care system.

“We’re 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,” said Philip Oravetz, MD, Chief Population Health Officer at Ochsner Health. “This new program considers the impact of important factors that affect the well-being of our patients. It’s an exciting development as we continue to adapt our approach to care to meet the comprehensive and diverse needs of the communities we serve.”

Humana is dedicated to supporting providers as they move away from the traditional fee-for-service system. According to Humana’s most recent annual Value-based Care Report, issued in November, clinicians in value-based arrangements encouraged more engagement from their Humana Medicare Advantage members as compared to providers in non-value based contracts. This has resulted in higher rates of preventive care and screenings; fewer emergency room visits and hospital admissions; and higher overall Healthcare Effectiveness Data and Information Set (HEDIS) scores.

“This new model is part of an ongoing expansion of Humana’s value-based program portfolio, as we continue to align with clinicians to more holistically address patients’ health care needs,” said Oraida Roman, Vice President of Value Based Strategies at Humana. “Humana is proud to collaborate with providers in proactively addressing impediments to well-being, instead of only treating people when they’re sick. We’re committed to addressing the critical challenges presented by nonmedical health risk factors.”

Humana has an extensive and growing value-based care presence. As of Dec. 31, 2019, Humana has more than 2.4 million individual Medicare Advantage members and approximately 115,000 commercial members who are cared for by approximately 62,000 primary care physicians in more than 1,000 value-based relationships across 43 states and Puerto Rico. As of January, 2020, Humana’s total Medicare Advantage membership is approximately 4.4 million members, which includes members affiliated with providers in value-based and standard Medicare Advantage settings. For more information, visit humana.com/provider/support/vbc.