By: Deepthi Bathina, Chief Clinical Product Officer at Humana
Alice is a 66-year-old Medicare Advantage member who has Type 2 Diabetes, Multiple Sclerosis, and Major Depression. Being homebound with very limited mobility, she is fully dependent on a caregiver to help her with daily activities of living. In addition to her health challenges, Alice has few financial resources, consistently worries about her health costs, and feels hopeless.
As we know, Alice’s situation is not unique – according to the Centers for Disease Control and Prevention, 4 out of 10 adults in the U.S. have two or more chronic conditions.¹
For patients like Alice, health care is difficult to navigate; their health needs are complex, getting to the doctor is extraordinarily taxing (physically and logistically), and they don’t know what services are covered by insurance vs. out-of-pocket. As a result, patients like Alice often avoid or defer engaging the health care system, physical and behavioral health conditions often go untreated until they become acute, and quality of life worsens and costs skyrocket in the long run.
The rise of virtual health
“Telehealth” and “virtual health” have gained buzzword status in some regards, and often only focus on web-based or telephonic virtual visits. However, I see virtual health as a broader strategic category that also includes specialty care, digital engagement, remote monitoring, and AI-based health tech solutions that provide nontraditional access points to content, solutions, and coaching.
Patients like Alice can use virtual health to get the care they need without transportation and mobility obstacles. Additionally, virtual health and remote monitoring help Alice’s care team and caregivers by providing real time health data and enhance clinical workflows and processes by providing streamlined patient touchpoints. In turn, costs for patients fall while their health outcomes improve.
One positive development for virtual health in 2020 has been the Centers for Medicare and Medicaid Services’ (CMS) lifting of some of its strict limitations on delivering virtual health services. These changes have made it easier for members and providers to offer and use virtual services.
Humana’s approach to virtual health
This year, we have accelerated our commitment to remove barriers to care and meet members where they are; with the onset of COVID-19, we instituted $0 copays for COVID-related appointments for our Medicare Advantage population, and have since expanded this benefit to all telehealth visits through the end of the year.
Our overall goal is to build a customer-centric model of care that works with members across a comprehensive array of health services spanning all levels of intensity – from traditional services such as primary and urgent care to more nontraditional like Cognitive Behavioral Therapy, group therapy, and physical therapy.
To build this model, we have started from the customer-back and built pilot programs that incorporate new ways of working and engagement in areas across the care continuum. We’ve asked ourselves: What do members need that they can only currently get through brick and mortar? How can we remove barriers to our members getting that care? How can we make sure the same level of care is provided virtually?
One such pilot program we have built is in the area of behavioral health. This program brings together a myriad of technologies and best practices to provide a comprehensive, anticipatory, and proactive approach to behavioral health – all virtually. Specifically, the program leverages passive monitoring and AI to anticipate when a member may have a health event and wraps around different services such as medication management, talk therapy, text on demand to stabilize the member and provides a feedback loop.
On a larger scale, what we have learned has been fascinating:
Total visits – COVID-19 has helped to accelerate virtual visits and shift the site of care from in-office to the home. In April alone, we saw telehealth visits with traditional telehealth partners more than doubled and the growth is even more compelling when you factor in brick-and-mortar providers that have pivoted to telehealth.
Adoption and Repeat Usage– We’ve seen a higher number of repeat utilizers amongst our Medicare Advantage (MA) and Commercial populations with our national vendors.
Satisfaction – Both MA and Commercial members have reported a positive experience rate, with a 93% satisfaction rate on the MA side, and a 4.9 / 5 star rating on the commercial side.
Customer Experience – Members also reported short wait times (under 10 minutes) for virtual medical visits.
We’re excited about the progress we have seen, but we have miles to go. We’re continually assessing and learning from our customers on what they value most and where we can make the greatest impact.
Alice – A Success Story
Let’s revisit Alice’s situation:
On January 10, 2020, a Humana nurse contacted Alice for a health consultation. While speaking with Alice, the nurse learns she lives with an emotionally abusive partner, which exacerbates her depression. Worried for her safety, the nurse schedules Alice virtual appointments with Jan, a Humana Behavioral Health specialist, and a therapist, Deb.
Over the course of several months, Jan and Deb worked together as her care team, all virtually, to:
- Build trust with her as she moved to Indiana and out of her unhealthy living environment
- Re-establish her relationship with her former neurologist in Indiana who treated her MS
- Connect her to a physical therapist to improve mobility
- Help complete financial aid to assist with paying medical bills
- Find a new power chair affording her better mobility
- Stabilize her depressive symptoms
Because of how Humana leveraged virtual health channels, Alice is thriving – “the thought of changing insurances makes me emotional … I never want to lose support like you.”
Historically, it would have been challenging to support members in Alice’s situation – a long distant patient with complex medical and behavioral needs – but with virtual health, we were able to connect Alice with specialized clinicians, a behavioral health specialist and a therapist – all virtually – allowing us to make a difference in Alice’s life.
Looking towards the future
With any winds of change, one must adjust the sails. As the health care ecosystem—and our world—adapts to the “new normal” after COVID-19, we expect more members will gravitate towards virtual health.
From listening to our customers to learning from our pilot programs, we are continually rethinking routine and exploring how best we can advance our technology to pioneer simplicity, experience, and outcomes for our members. Because the less time people are in the hospital, the more time people can spend at home living their best lives.
Centers for Disease Control and Prevention. (2019, 10 23). Centers for Disease Control and Prevention. Retrieved from https://www.cdc.gov/ https://www.cdc.gov/chronicdisease/resources/infographic/chronic-diseases.htm