living with multiple chronic conditions. The clinical support and care provided by Humana At Home is designed to improve health outcomes and result in a higher number of days members could spend at their homes instead of in an acute care facility. The company has accelerated its process for identifying and reaching out to members in need of clinical intervention. As of December 31, 2015, the company enrolled approximately 590,300 members with complex chronic conditions in the Humana Chronic Care Program, reflecting improved predictive modeling capabilities and focus on proactive clinical outreach and member engagement, particularly for the company’s Medicare Advantage membership. Clinical Programs The company is committed to the integrated physical and mental health of its members. Accordingly, the company takes a holistic approach to healthcare, offering care management, behavioral health services, and wellness programs. The company’s care management programs take full advantage of the population health, wellness and clinical applications offered by Transcend Insights and CareHub, the company’s clinical management tool used by providers and care managers across the company to help its members achieve their best health, to offer various levels of support, matching the intensity of the support to the needs of members with ongoing health requirements through telephonic and onsite programs. These programs include Personal Nurse, chronic condition management, and case management, as well as programs supporting maternity, cancer, neonatal intensive care unit, and transplant services. In addition, the company focuses on the behavioral aspects of a members' health, such as managing stress and work/life balance. Humana Behavioral Health takes a holistic, mind-and-body approach to behavioral healthcare to address the whole person, encouraging faster recovery and improving clinical outcomes. Other Businesses Other Businesses primarily includes the company’s closed block of long-term care insurance policies. The company has a non-strategic closed block of approximately 31,800 long-term care insurance policies associated with its acquisition of KMG America Corporation. Long-term care insurance policies are intended to protect the insured from the cost of long-term care services, including those provided by nursing homes, assisted living facilities, and adult day care, as well as home health care services. Membership Provider Arrangements The company provides its members with access to health care services through its networks of health care providers whom the company employs or with whom the company has contracted, including hospitals and other independent facilities, such as outpatient surgery centers, primary care providers, specialist physicians, dentists, and providers of ancillary health care services and facilities. These ancillary services and facilities include laboratories, ambulance services, medical equipment services, home health agencies, mental health providers, rehabilitation facilities, nursing homes, optical services, and pharmacies. The company’s membership base and the ability to influence where its members seek care generally enable the company to obtain contractual discounts with providers. The company uses various techniques to provide access to the use of health care services for its members. These techniques include the coordination of care for the company’s members, product and benefit designs, hospital inpatient management systems, the use of analytics, and enrolling members into various care management programs. The focal point for health care services in many of the company’s HMO networks is the primary care provider who, under contract with the company, provides services to its members, and might control utilization of appropriate services by directing or approving hospitalization and referrals to specialists and other providers. The company has available care management programs related to complex chronic conditions, such as congestive heart failure and coronary artery disease. The company also has programs for prenatal and premature infant care, asthma related illness, e
humana inc (HUM:New York)
500 West Main Street
Louisville, KY 40202
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