Humana Member Story

Humana Care Management (Non-Waivered)

History:  Mr. N. is a 64-year-old male that has been with Humana (off then back on) since April 2018. When he was originally engaged, he was depressed, in a lot of pain due to severe osteoarthritis. He was caring for his disabled mother and feeling helpless about his situation. He was not receiving any type of medical intervention and was reluctant to participate in telephonic care management. 

Barriers:  The member was overwhelmed he was in a lot of pain and did not believe any type of medical intervention would help. He knew he needed a shoulder and hip replacement but feared the surgery would take him out of commission for too long, fearing he would not be able to care of his mother. The member also doubted that the intervention would make any difference and assumed he would always have to live with the pain.

Interventions:  Member was open about participating in our interdisciplinary care team by being linked to our social work department to discuss community resources and behavioral health access. The member started counseling and through care planning little by little started working on his health conditions. He first completed the shoulder surgery, which made such a huge impact on his pain and ability to perform activities of daily living. This gave him the trust and confidence to follow through with a hip replacement. This surgery resulted in a longer recovery and the member ended up in an assisted living facility. The facility did not accept his plan, so he was enrolled in a different one. Member wanted to come back to Humana because of his experience with care management. He got his own place and worked with our social work department to secure LTSS services for home maker services while recovering.

Outcome:  The member continued to work with his health providers and made it his goal to phase out the need for home health services. The member made this his goal because he wanted to return to community well, so he could work with his original care coach that he always remained in contact with. The member is thriving. He is fully engaged in care management and his health care goals. He was recently diagnosed with cancer but feels confident that he has the resources, supports with care management and is hopeful about his ability to overcome this new health challenge. The member shares his experience with the program with his family and friends. He reports that two of his sisters have enrolled with the plan. Care management allows for a level of continuity of care that transcends time and situations facing our members. Some members are still participating in the program since its inception in 2014 and for many of us they’re more like family.