Louisville native Crystal Rodgers beamed as she stood in the lobby of her Russell neighborhood apartment complex to welcome visitors, including a Humana nurse who visits her weekly. She shook hands, exchanged pleasantries and walked — slowly but steadily — to the elevator.
Three years ago, Rodgers could barely walk and had trouble breathing because of health problems, including sarcoidosis, obesity, emphysema and congestive heart failure. A suspected heart attack had landed her in the hospital for a week. She suffered from depression because her mother had just died.
Today, thanks in part to weekly visits by a nurse employed by Rodgers’ insurance company, Humana, Rodgers’ physical, emotional and fiscal health have improved and include a weight loss of more than 100 pounds.
“I’m doing great,” she said with a smile last week after she had sat down on the couch in her living room, wearing a black and red shirt and a red skirt that matched her lipstick and nails.
Rodgers, 64, has benefited from Humana at Home, a program that identifies patients with significant and often multiple health conditions that are likely to require additional intervention, especially if not treated properly. The program pairs health professionals with patients to help them learn about and take advantage of their health benefits and to give them personalized guidance to reduce their risk for serious medical procedures. While the program improves patients’ health, it also boosts Humana’s profits and its ability to offer other services because it cuts health expenditures for the most costly patients.
When Rodgers was released from the hospital about three years ago, she got a call from Brenda Ludwig, a field care manager for Humana.
Ludwig helped Rodgers understand her insurance benefits, conditions and drug regimen. She helped Rodgers find a psychiatrist. She explained medical procedures and terms. She talked about diet and exercise.
Rodgers, a Humana retiree, said Ludwig’s help also has improved her finances. She used to pay more than $100 per month for an antidepressant, and now she pays less than $3, thanks to a program for which Ludwig helped her sign up. The same program also eliminated the co-pays of many of Rodgers’ other medications.
Ludwig also employed the skills she developed during 13 years as a hospice nurse to boost Rodgers’ mood.
Ludwig typically cares for about 18 to 25 patients. Visits can last 30 minutes or two hours, depending on the patient’s needs. Some patients get a home visit every week, others get a visit every two weeks and phone calls in between.
Some patients need help communicating with their physician, Ludwig said, and others have transportation issues or cannot pay for their medication. A lot of the patients live on a limited budget and have to balance living and medical expenses.
“She helps me with everything,” Rodgers said. “She’s like a little angel that flies in the house every week.”
Identifying costly patients
Humana and Pfizer Health Solutions in 2004 teamed up for a pilot project, Green Ribbon Health, that targeted the 25 percent of Medicare patients who were generating 80 percent of costs. Kate Marcus, a director on Humana’s clinical team, said the program aimed to address chronic conditions holistically, focused on a patient’s individual needs. Early on, employees were dispatched to patients’ homes to gather information about why some patients were dealing with certain problems, such as repeated falls. In other cases, they made sure that patients had enough to eat. Over the years, the program evolved and expanded. It now provides meals during the first week after a hospitalization. And staffers developed a nationwide directory of community resources that may show options for free rides to doctor’s appointments, free food and help to defray the cost of medications.
The care managers who visit patients may coordinate meal delivery, inform family members about a patient’s changing condition or medications, and even may provide technology that tracks changes in blood pressure and weight.
Craig Drablos, Humana at Home vice president, told IL the program targets the 50 percent of patients who drive 90 percent of costs.
Humana uses algorithms — based on data including surveys, demographics and claims status — to identify the 5 percent of patients who account for 38 percent of costs, to pair them with care managers who visit them at home. One of the significant risk factors is a second chronic condition, which makes patients 7.5 times more likely to be in the top 5 percent most costly patients.
The overall goal, Drablos said, is to slow the progression of the chronic diseases. That means fewer hospital admissions, fewer days in the hospital, lower costs for Humana and better health outcomes — including greater odds of survival — for the patients.
“That’s hugely impactful for the members,” Drablos said.
The company receives a flat fee from the federal government for each Medicare patient, depending on their health risks, and if Humana can lower the patient’s health care expenditures, it gets to keep more of the fee.
“We invest a lot in this program,” Drablos said. “(but) the savings … (are) immense.”
He declined to provide specifics, but the program’s scope speaks volumes: The pilot program targeted 20,000 Medicare patients and included fewer than 100 employees. Today Humana at Home includes 3,000 telephonic care and 11,000 field care managers who help close to 1 million patients.
Ludwig said some of the savings for Humana simply come from access to information: A lot of people get nervous when they have health problems and often end up in the emergency room, which is expensive. With Humana at Home, the patients have a health professional they can consult for free, who can reassure them or refer them to the right doctor.
“That just gives people a sense of security,” Ludwig said.
The Humana at Home program is available to the company’s Medicare patients free of charge.
Last year, Crystal Rodgers’ knees were giving her trouble, and she was headed toward joint replacement surgeries. Ludwig showed her how to elevate her legs to reduce the pain.
To prepare for the knee surgeries, Rodgers needed to lose weight. She underwent gastric bypass surgery, and, with Ludwig’s help, changed her diet. She stopped drinking sugary sodas and instead quenches her thirst with water. She has replaced fried foods with fruits and vegetables. She carefully reads nutrition labels to avoid sugars. And she walks up and down the hallway of her floor 15 times a day, she said.
She has lost more than 100 pounds since the gastric bypass surgery.
“My legs don’t hurt anymore,” she said. “I don’t (need) my oxygen no more.”
She also no longer needs to have her knees replaced, because the weight loss has reduced pressure on the joints.
As her physical and mental health have improved, so has her quality of life: The grandmother of three and great-grandmother of two said she sometimes watches the little ones. Rodgers also serves as the secretary of the apartment building’s tenant council, planning get-togethers such as movie nights and “Oldies but Goodies” dancing nights, where she enjoys swaying to beats from The Platters and Bobby Womack.
“I have a whole new life,” Rodgers said with a smile. “I’ve turned into a mid-aged diva.”