Making Florida Healthier by Transforming Healthcare Delivery

Dr. Theo Sai, Humana Central Florida Medicare Medical Director

The traditional “fee-for-service” healthcare model, paying based only on the quantity of services provided, is ill-suited to serve America’s aging population. An integrated healthcare model, paying based on the quality of services and resulting health improvements, is a solution that gives people the comprehensive, personalized care they need.

The integrated, value-based model requires healthcare providers and organizations to work together closely. Humana’s real-time population health tools identify gaps in care for people living with chronic conditions. Care managers arrange needed care interventions before chronic conditions worsen. A payment system rewarding health improvement moves doctors away from the volume-driven pressures of fee-for-service.

This approach is working well at several practices in the Tampa Bay area. Now at Pinellas Hematology and Oncology, a five-physician practice, Pratibha Desai, MD, has served Humana Medicare patients under a value-based payment model for about 20 years.

“Under the fee-for-service system, if the physicians are not watching out for what they are ordering or how they are taking care of the patients, the expenses can be extremely high,” Dr. Desai says. “They really don’t have the incentive to be cost-effective.”

Under an integrated care model, specialists work as a team with primary care physicians to tailor care around patients’ specific needs, resulting in better health outcomes and reduced medical costs, Dr. Desai says. For some cancer patients near the end of life, for instance, the care team and patient can determine that palliative care is more appropriate and desirable than hospitalization.

At Bay Area Internal Medicine and Geriatrics, a 12-physician practice, Kirit Patel, MD, has been part of a Humana Medicare accountable care model for nearly three decades. The team approach means internists such as Dr. Patel are kept much more up to speed with patients’ conditions.

“I’m in the patient care loop all the time, whereas a traditional Medicare patient might on his or her own go to see a specialist, and I would not have even known that they had done that,” Dr. Patel says. “When my patient calls me at night, I’m able to advise a lot of things on the phone because I’m confident about their status.”

Success with this model of care has allowed Dr. Patel’s practice to improve patient health and use the cost savings to provide enhanced patient services, such as in-home visits.

The story of Humana and these Tampa Bay-area practices is not a new or unique one. Humana has always incorporated the care professional’s perspective into our delivery approach because our company began as a care provider and remains one today. By helping the system move toward integrated care, we see a future of improved health outcomes, lowered costs, and doctors doing what they do best: focusing on patient health, rather than sickness.