LOUISVILLE, KY – Humana of Arizona has received only limited data since the June implementation of its INSPIRIS-based care management program for the frail elderly, but the program is showing promise in limiting re-admissions.
Not enough data has been to make results statistically valid, but the health plan is encouraged by early results, said Mark Kiffer, MD, vice president and CMO of the senior products segment of Humana’s western region.
Humana of Arizona has two programs in Arizona. The INSPIRIS model involves teams of care providers who coordinate with physicians to provide bedside care on a weekly basis in skilled nursing facilities and custodial care in the Phoenix metropolitan area.
“Everyone in the industry understands we have to attend to the frail elderly and the Medicare population,” Kiffer said. “This model allows us to close the gap in the continuity of care for this group.”
Mike Tudeen, CEO of INSPIRIS, said the U.S. Census Bureau predicts that from 2005 to 2015, the ranks of those 65 and older will increase by 28 percent, and the population of those 85 and older will grow by 16 percent to 17 percent. Within this latter group, 20 percent will live in long-term facilities, and a third of those will be in poor health.
“The population we focus on is the frailest of the frail,” Tudeen said. “They are the most expensive subset of an already expensive group.”
By helping Medicare, special needs and other health plans manage quality and cost, Tudeen said they are taking a care category that often results in a financial loss for providers and turning it into something that can be managed and made profitable.
Managing quality and cost for this population also is a concern for Senior Independence. The Columbus, Ohio-based provider of home- and community-based services is providing remote disease management services for its members. Sally Huston, RN, the firm’s clinical director, said telehealth programs reduce hospital, nursing home and emergency department admissions by providing care at the time it is needed.
"Baby Boomers are interested in prevention and want to be part of the solution," she said. Scott Sheppard, president and CEO of WebVMC, the vendor with which Senior Independence has partnered, said that telehealth for disease management helps educate Baby Boomers to be more compliant with their care management, which ultimately helps reduce healthcare costs.