By 2030, an estimated 171 million Americans will have at least one chronic condition, such as diabetes, congestive heart failure, or cancer. Many of those individuals will be covered by Medicare – 2030 is the same year that all the baby boomers will have aged into the program, bringing total enrollment to about 70 million, according to AARP.

Chronic illness will continue to stress our nation’s health care system and Medicare in particular, which already is spending the vast majority of every allocated dollar on treating chronic illness.

In addition, a Centers for Medicare & Medicaid Services (CMS) study last year found that two-thirds of beneficiaries in Medicare fee-for-service had two or more of 15 common chronic conditions.

The report also showed that the 12 percent of beneficiaries with six or more chronic conditions accounted for 43 percent of program spending. 

There is strong consensus that traditional Medicare produces fragmented care, which is especially difficult for chronically ill seniors.  This leads to duplication of services, unnecessary spending, and poorer health outcomes. And traditional Medicare does not cover the important non-medical services that many beneficiaries with chronic illnesses need – like help with bathing, eating, finances, and transportation.

At Humana, we have designed a national program – Humana Cares – especially for these vulnerable seniors. Part of Humana’s Medicare Advantage offerings, Humana Cares goes well beyond conventional disease management to offer integrated, holistic care by a team of medical and service professionals who intervene where appropriate and who activate community resources in the member’s home town. It offers telephonic and on-site management that also support families and caregivers, maximizing members’ ability to “age with grace” in their homes.

Humana Cares proactively identifies those who may be at risk before a serious health issue arises.  Members are assigned to a specially trained, multi-disciplinary team supported by registered nurses and other health professionals. 

Nurses and social workers also conduct community-based assessments to identify member needs and develop a personalized care plan.  Depending on those needs, services may include health education and coaching, medication education, physician care coordination, post-discharge support, meal and transportation support, caregiver training and home modification coordination. 

The results to date are encouraging:  Inpatient hospital admissions, emergency room visits, and hospital readmissions for Humana Cares members are all significantly less than for comparable Medicare beneficiaries who are not in the program.

Programs like Humana Cares will not solve America’s chronic illness pandemic by themselves.  That will require a multi-pronged, long-term national strategy.  Humana Cares is, however, helping to improve outcomes and control costs by keeping beneficiaries out of the hospital while enhancing their lives at home.