Humana’s Innovative Approach to Improve Clinical Outcomes

Coordinating referrals across a disparate provider network is broken.

Long lead times, finding the right provider, efficiently coordinating care, and tracking the timeliness and completion of appointments are everyday obstacles.

These challenges create a time-consuming process, a poor patient experience and untimely access to care. As a result, many patients experience long delays or simply do not follow through on these referrals – correlating to lower clinical outcomes and increased medical costs.

In both fee-for-service and value-based models, such outcomes can have severe consequences.

To address these challenges, Humana created a digitally connected network across its employed primary care physician (PCP) offices and the corresponding affiliated specialist network through MyHealthDirect’s platform. “In our case, where we have valued relationships with specialists, MyHealthDirect helps us recognize and ensure that patients get to the right type of consultant,” says Dr. Yogi Hernandez.

Humana’s innovative approach to connect a digital network across disparate systems has facilitated more timely and convenient referrals, validated the power of real-time analytics to change referral behaviors, and successfully demonstrated that a platform across employed and affiliated providers can improve quality scores and completion rates.