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The upgrades target the chronically ill who have more expensive plans.
By KRIS HUNDLEY, Times Staff Writer
Published March 4, 2008
Humana, Florida's largest Medicare insurer, will announce today that it is rolling out enhanced benefits for members of its higher-priced plans.
The new complex care management program targets chronically ill beneficiaries who have joined Humana's PPO or private fee-for-service plans. Both plans typically charge a monthly premium and require higher out-of-pocket spending than Humana's popular Medicare HMO.
The new program is an offshoot of a pilot project started by the Centers for Medicare and Medicaid Services in September 2005.
Under the pilot, Humana and Pfizer formed Green Ribbon Health to address the needs of 20,000 chronically ill Humana members on the west coast of Florida. Among them was 95-year-old Sam Messina of Tampa.
When the Green Ribbon team learned Messina, who has a bad hip, was getting around his house by hanging on to his furniture, they arranged a home visit by a registered nurse.
A few weeks later, Messina had a free bench installed in his tub to eliminate potential falls.
Vicky Taliaferro, with Green Ribbon in Tampa, said Humana's new program differs from what has been offered in the past because it tries to eliminate problems before they arise.
"It's prospective, not crisis management," she said. "If you reduce the fall risk, you reduce hospitalizations."
Though five groups were involved in the pilot plan, Humana spokesman Mitch Lubitz said his group is the first to expand the program.
It will initially be offered in Florida and three other Southeastern states. Lubitz said Humana does not get higher reimbursement from Medicare for the extra services. But an independent appraisal of the pilot project in June said that, in the short term, "fees paid to date far exceed any savings produced."
Members of Medicare Advantage plans have one opportunity to switch plans each year, but the deadline for all changes is March 31.
Kris Hundley can be reached at firstname.lastname@example.org or (727) 892-2996.
[Last modified March 3, 2008, 23:07:36]