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Humana Home Screening Test May Increase Its Quality Score in Pandemics




National health insurance company Humana announced Thursday that it would mail more than one million home colon cancer and diabetes management screening kits to Medicare Advantage and Medicaid members.

Humana said the screening kit will help expand access to preventive care that members may have postponed during the COVID-19 pandemic. Providing preventive care in the home also helps humana maintain a score for certain quality and performance measures and their ability to attract older people to their health plans that are important to their ultimate benefit. Useful Colorectal cancer screening and diabetes care are two of these measures.

Following CMS guidelines and state orders, healthcare systems, physician offices, and other healthcare providers have postponed non-urgent procedures and appointments over the past few months, but patient visits are beginning to recover. The patient also discontinued daily treatment because of fear of being infected with the new coronavirus.

Health insurance companies and providers have expressed concerns that deferred care may aggravate a patient’s condition.

“Because of the pandemic, many of our members, mostly elderly, are worried about leaving home for regular health care,” said Dr. William Schrank, Humana’s Chief Medical Officer. Said in a statement. “More than ever, active and preventive care is life-saving and life-changing for our members.

Fumana said home-based screening could help members identify early complications associated with diabetes and colon cancer, potentially reducing costs and improving health outcomes. Between June and September, kits will be available to eligible Medicare Advantage members at no additional cost. Some Medicaid members also receive a kit to evaluate how to manage diabetes.

According to a spokesman, the screening kit provided by Humana includes a stool specimen test for screening for colorectal cancer, a blood test for checking mean blood glucose levels in diabetic patients, and a urine sample for diabetic renal function. Inspection included. He said Humana shipped about 364,000 of these screening kits to members in 2019.

Humana encourages physician consultation by following up on members who receive unfavorable test kit results. Humana also said he is passing the test results to his doctors. The insurer will monitor the billing data to determine if the member has received follow-up care and will place a nurse to contact those who are not.

In a study note Thursday, an analyst at Evercore ISI said Humana is providing a home test to maintain or improve the Medicare Advantage star rating score. A star rating measures the quality of care and customer experience that Advantage plan enrollees receive. According to Humana, 92% of Medicare Advantage members plan to earn a 4-star rating or higher in 2020.

Richard Lieberman, chief data scientist at Mile High Healthcare Analytics, also said the star rating program may be motivating to provide in-home testing to Humana. A star rating is important for insurers because high scores promote health insurance and provide financial bonuses. Insurers with four or more stars will receive a 5% more monthly payment per member from Medicare, but insurers with lower scores will receive nothing more.

Losing this 5% bonus is catastrophic, according to Lieberman. He pointed out that insurance companies are likely to be panicked about maintaining their star rating. “Every place where older people are concentrated is devastating (by COVID-19) and there is no end in sight. So if I had a health plan, people wouldn’t go to doctors I’m just looking for it.”

But Lieberman asked if Humana would actually force members to undergo a colon screening and diabetes test, and see a doctor if needed. He also noted that some colon cancer screening tests are not very accurate.

The COVID-19 crisis has allowed health insurers to collect data and meet the Medicare Advantage Star Ratings reporting requirements. Insurance companies need to collect data by reviewing medical records and getting information from clinics, and some data collection activities are done directly.

Keeping in mind that collecting data creates safety issues when resource-intensive and puts insurers and doctors under the hood, CMS issued an interim final rule in March 2021. And relaxed some star rating report requirements for 2022.

Humana CEO Bruce Broussard acknowledged that the COVID-19 pandemic could cause star rating problems in 2023, especially based on the 2020 service period. It plans to ensure that Humana “fills those gaps in care that drive star results.”

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