How Humana Improved Access and Outcomes

Humana was looking for a way to enhance access to specialists and improve clinical outcomes across their provider network with a digital solution. Typically, coordinating referrals across a disparate provider network has many challenges: long delays between referral order and actual appointment, identifying appropriate specialists, inefficient appointment coordination and scheduling, and inability to track data in real time.

These challenges lead to poor patient experience, diminished access to care, wasted time, negative clinical outcomes, and increased medical costs.

Case Study: Humana Builds a Digital Network
To address the challenges, Humana partnered with MyHealthDirect to create a digitally connected referral network across primary care physician (PCP) offices (wholly owned and joint venture practices) and a range of specialists based on existing referral patterns, quality and cost. PCP referral coordinators, both in call centers and in the practices, were equipped with the ability to schedule and track referrals on a digital platform. This case study provides the findings and results:

Results: Improved Access and Outcomes
Simply put, with the digital network Humana realized that not only is the process more efficient and trackable, but patients are getting the care they need and they are getting it faster.

  • Completion rates went up 19%
  • Lead times decreased by 8.5 days
  • Time spent scheduling was cut in half
  • Average cost per referral was reduced by 33%

Our data concluded that a greater percentage of specialist appointments were completed by the patient when the time period between the referral and the specialist appointment was short. Essentially, the less time patients have to wait for their appointments, the greater chance that they will show up and get the care they need. It couldn’t be clearer: long wait times mean more no-shows. Moreover, we found that when patients are getting the care they need in a timely manner, they are less likely to require an ED visit or hospitalization. In fact, the decrease in ED and hospital visits was found to be 1.3%, which translates to a 26% decrease in ED/IP utilization – a huge impact on reducing overall medical costs.

By providing patients with better access and reducing lead times through a better referral process, Humana’s innovative approach not only improved the patient experience and outcomes, but also greatly improved efficiency for the providers – creating a win-win for all involved.

To learn more about how creating a digital network improves referral coordination, patient access to care, and clinical outcomes, download our case study: Specialty Referrals Reimagined.