Louisville, Ky.-based Humana has been snapping up accountable care agreements around the country for the past year or so.
Currently, about 1.2 million of Humana's Medicare Advantage members are receiving care from 38,000 primary care physicians who participate in more than 900 accountable care relationships with Humana around the country.
More importantly, the accountable care relationships have seen some signs of success: Within its accountable care continuum, Humana reported improved costs, decreased ER visits, decreased inpatient admissions and better screening compliance for various measures like cholesterol and colorectal cancer, compared to Humana members treated in traditional, fee-for-service and original Medicare settings.
"We've had great success with measurements for quality with respect to our pay-for-value programs," said Thomas Van Gilder, MD, JD, MPH, chief of medical services at Humana-Certify Data Systems. "Central to successful quality measurement and improvement is interoperability — the ability to capture data of different types from different systems and share it in ways that are meaningful to all systems and all users."
So how exactly does a payer help achieve successful health outcomes?
Humana uses a couple of different platforms to support the delivery of care, according to Dr. Van Gilder. He leads medical services for one of those platforms: a rapid, large-volume analytics engine called the Anvita Insight analysis engine, developed by Anvita Health, which is currently offered through Certify Data Systems' HealthLogix platform. Humana acquired Anvita Health in 2011 to strengthen clinical management. In 2014, Anvita Health analytics became a stand-alone product of Humana and a key feature of Certify's HealthLogix platform.
The Anvita Insight analysis engine and the HealthLogix platform compile data from claims, EHRs, lab results and other sources to identify gaps in care, drug safety concerns or other opportunities for health improvement. This information is delivered in real time to healthcare organizations, physicians and care teams through community-wide interoperability, so opportunities to improve care can be acted upon in the exam room.
Incorporating data into the delivery of care can be one of the biggest challenges for ACOs. In a survey of 62 ACOs conducted by Premier Inc., 83 percent reported challenges integrating technology analytics into workflow.
"We want to get involved in the physician-patient interaction and deliver more actionable information at the point of care. The technology that we've developed and continue to develop is for point-of-care delivery," Dr. Van Gilder said.
So, for example, the Anvita Insight analysis engine and HealthLogix platform can help improve vaccination delivery in adults, who often miss vaccinations because the schedule for adults is not as fixed or as clear as the schedule for children. The information provided can help physicians identify patients in need of vaccinations at the point of care.
Humana is also starting to track patients' personal health choices through a program called HumanaVitality, which allows beneficiaries to track fitness and nutrition choices and set health goals. "We're bringing all these things together in an attempt to engage a person, regardless of their state of health, and bring all their information on to a platform for nurses, health coaches and physicians to promote health," Dr. Van Gilder said.
So far, the program has produced positive results, according to Dr. Van Gilder. Giving patients incentives to make healthier choices every day may also help improve outcomes in the long run.
"Our goal in all of this is to improve the health of the community and of individuals, and support health care at the point of delivery, so physician-patient interactions in the exam room or hospital are the highest quality possible with the best outcomes possible," Dr. Van Gilder said.
More articles on accountable care:
22 recent accountable care agreements
The new "ACO-enabling organization" in Texas
9 principles to improve ACOs from the "75% by 2020" task force