POPULATION HEALTH ANALYTICS

How Humana Stratifies Medicaid Enrollees to Lower Risk and Improve Outcomes

January 4th, 2023
 |  
Risk Stratification & Population Segmentation  |  
Social Determinants of Health
How Humana Stratifies Medicaid Enrollees to Lower Risk and Improve Outcomes

Humana Medicaid recently experienced a period of rapid growth, which made it critical to understand the needs of its members quickly and effectively. Humana Medicaid called on its Health Informatics department for assistance and, using the ACG System, this team was able to organize and stratify Humana’s Medicaid population—identifying those with highest predicted utilization and risk—so they could create a proactive plan to assess individual health needs within their population.

Humana Health Informatics began by using the ACG System to group the Medicaid population based on similar resource use. This unique view enabled the Health Informatics and Medicaid teams to identify members who required specialized interventions, given their need for more health care resources, and to do so in a way that eliminated administrative pain points.

Humana Health Informatics also leveraged the ACG System’s new Patient Needs Groups (PNG) framework, allowing Humana to further segment their Medicaid population into risk cohorts based on specific health needs, individual characteristics and behaviors. The ACG System provides this innovative data analysis in support of Humana’s goal of offering human-centered care to their members.

The ACG System’s superior risk stratification capabilities enable Humana to make clear, actionable recommendations around state and regional initiatives and program designs. Additionally, Humana now gains a unique understanding of the impacts of substance abuse, behavioral health, health equity and Social Determinants of Health within the population.

Click here to learn more about Humana’s approach to risk stratification, and how it uses this to lower risk and improve outcomes.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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