Personalized Healthcare Solutions

 
What is Personalized Healthcare Solutions?
Personalized Healthcare Solutions is a fully developed and specifically designed network of credentialed healthcare providers within your service area.  This veteran-centric healthcare network provides personalized services directed to the individual needs of veterans when they are referred outside of the VA system for primary or specialty care.
 
What are the personalized services?

• Personal contact with an experienced Customer Care Representative.  Initial contact with the veteran is made by a Humana Veterans Customer Care Representative (CCR).  The CCR provides an explanation of the referral process and helps the veteran to determine the best time for the medical appointment prior to the CCR scheduling the appointment.  This approach accomplishes the following: (a) ensures the veteran is comfortable with what the medical appointment will entail; (b) ensures the veteran understands where the provider is located; and (c) ensures maximum reliability in terms of the appointment date established by Humana Veterans for the veteran and the Humana Veterans healthcare provider.  Our current VA contract has a veteran No-Show rate of only 7% compared to the community standard of 20%.
   
• Appointment Facilitation.  The CCR conducts a three-way conference call with the veteran and the Healthcare provider’s office.  As part of the Humana Veterans network agreement, our healthcare provider’s must schedule veteran appointments within 30 days.  A reminder call is made to the veteran 48 hours before the schedule appointment which provides an additional opportunity for the veteran to speak with a CCR.  In every event, the veteran agrees to the scheduled appointment date.
   
• Communication with the veteran.  The veteran receives a letter confirming the healthcare provider’s name, address, telephone number, date and time of appointment, instructions on how to obtain directions to the provider’s office, and Humana Veterans’ customer service number should questions or problems arise.  The local VAMC referring facility is also informed of the appointment details.
   
• Respect.  The veteran goes to the scheduled appointment with a Humana Veterans Healthcare provider who is credentialed and who is contracted by Humana Veterans specifically for providing healthcare services to our nations’ veterans.  Our healthcare network providers limit the veterans wait time to no longer than 20 minutes when they are in the office for their scheduled appointment.
   
• Quality healthcare.  Humana Veterans’ network providers are credentialed through a credentialing process that follows URAC standards and meets or exceeds all VA credentialing standards.
   
• Timely return of the written consult report.  After the appointment, Humana Veterans begins tracking the healthcare provider’s written consult report and ensures it is returned to VA for inclusion in the veteran’s electronic health record.  Humana Veterans’ average time for a consult report to be returned to VA is 11 days. The consult report is returned to VA in a secure electronic format for easy downloading into VA’s Computerized Patient Record System (CPRS).
   
• No hassle over payments.  Providers submit their claims directly to Humana Veterans.  We pay the provider directly within 30 days of receipt of the claim.  VA is then billed by Humana Veterans based on our negotiated rates.
   
• Third party reimbursement information. We can gather and verify any third party insurance coverage and provide that information to VA.  We can also prepare and bill the third party (using VA regulations and reasonable charges) with reimbursement going directly to VA.
   
• A seamless process for the veteran.  We are committed to a seamless “hand-off” of the veteran back into the VA system and their primary care provider’s.  This personalized approach is beneficial to the veteran.  The return of clinical information in a timely manner ensures quality and continuity of care.
   
• Data repository of statistical information.  Much like the VA’s Data Cube, Humana Veterans’ Data Mart captures and maintains all data related to the healthcare service provided to the veteran.  This allows the local VA user to create management reports based on service type, timeliness, clinical data return, cost, and much more.  Humana Veterans has developed a web based training tutorial for the VA user and maintains this secure data base.

How does Personalized Healthcare Solutions work in rural areas?
 
Humana Veterans has provided personalized services to thousands of veterans in rural and highly rural areas, as defined by VA.  Through a demonstration contract with VA, Humana Veterans has provided personalized services to 26,775 veterans.  Forty-three percent (43%) of veterans served under the Personalized Healthcare Solutions model between February 2009 and January 2010 were in rural or highly rural areas, as defined by VA.
 
How can I learn more about Personalized Healthcare Solutions and the services offered by Humana Veterans?
 
Contact:
Tim McClain, President & CEO
Humana Veterans Healthcare Services
Phone: 502-301-6984
Email: tmcclain2@humana.com