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Aetna, Humana, Harvard Pilgrim Target Patient Health Outcomes

Three health insurers have focused their efforts on improving patient health outcomes among their member base.

Value-Based Care

Source: Thinkstock

By Vera Gruessner

- Commercial health insurance companies have pursued a number of different approaches to improve patient health outcomes and reduce wasteful medical spending. The payers Aetna, Humana, and Harvard Pilgrim conducted some key collaborations to achieve these goals.


In early December 2016, Aetna announced in a company press release its partnership with the National Center for Complex Health and Social Needs to collaborate on the “Neighborhood Health Compass” program. With 5 percent of the nation’s population responsible for 50 percent of healthcare spending, Aetna decided to pursue this partnership to improve patient health outcomes among those who utilize the most medical services.

The partnership between Aetna and the National Center for Complex Health and Social Needs involves advancing the integration and sharing of cross-sector data among medical providers. The data sharing is meant to improve the treatment and patient health outcomes among individuals with complex behavioral and social needs.

The National Center for Complex Health and Social Needs is a new undertaking of the Camden Coalition of Healthcare Providers, which received the MacArthur “Genius” Fellowship in 2013.

“Our vision is to make Camden the first city in the country to ‘bend the cost curve’ while improving quality,” stated Jeffery Brenner, MD, the Executive Director of the Camden Coalition. “Using this grant, we can not only expand our ability to share our learnings among health care providers, but also support the development of similar models that will truly improve the health of communities and neighborhoods across the country.”

The grant funding is being used to build a national office that will target communities and offer support to boost the patient health outcomes of those facing complex social and medical issues.

“We know that cities and counties have the power to create a long-term positive health impact throughout their communities by addressing social determinants of health,” said Garth Graham, MD, MPH, president of the Aetna Foundation. “Dr. Brenner’s approach has improved the health of the residents of Camden, and we will work collaboratively with the National Center for Complex Health and Social Needs to expand this model for improving care for patients with significant health care needs.”


This month, Humana announced in a press release that its retail pharmacy Partners in Primary Care will make it more convenient for patients to obtain refills for their prescribed medications. Medicare beneficiaries will be able to get their medications refilled in the same building as their primary care physicians. The coverage accepted by this retail pharmacy will include Humana’s Medicare Advantage health plans as well as Medicare Advantage plans of other insurance companies.

On-site Partners in Primary Care pharmacies will be open from 8:30 AM to 5:00 PM in the following locations: 2001 E. Greenville St. and at the Orchard Park center at 105 Orchard Park Dr. The two new pharmacy locations are now in a group of nine other Humana retail pharmacies.

With pharmacists located in the same building as the physicians, any drug problems or adverse reactions to prescriptions could be noted and resolved much more quickly. Pharmacists will be able to offer medication consultation services among Medicare beneficiaries as well.

With a new structure meant to improve coordination between pharmacists and primary care physicians, Humana hopes to enhance patient health outcomes and reduce adverse drug reaction rates.

Harvard Pilgrim

In a company press release, the Harvard Pilgrim Health Care Foundation announced on May 18, 2016, that it awarded grants totaling $202,950 to 22 nonprofit organizations in Massachusetts, Maine, and New Hampshire. The funds will count toward the ‘Healthy Food for Every Age’ program, which was created to teach and support older adults in eating healthier.

Older adults will be able to participate in cooking and nutrition programs as well as community gardening due to the nearly $203,000 in grants. The funding will also be renewable for an extra year. Harvard Pilgrim has awarded more than $1.6 million in Healthy Food Fund grants between 2015 and 2016.

In 2015, Harvard Pilgrim awarded approximately $1.1 million in Healthy Food Fund Grants among community gardening projects and food distribution programs in Massachusetts.

Large healthcare payers around the nation have been targeting their efforts on improving patient health outcomes through value-based care platforms, which is expected to reduce wasteful spending associated with the fee-for-service reimbursement structure.


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