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New Study from Humana and Wisconsin Health Information Exchange Finds Health Plan Costs Decrease When Health Information Exchanges are Used

Technology resulted in cost savings, improved health care provider efficiencies during emergency department visits

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Friday, August 26, 2011 11:00 am EDT

Dateline:

MILWAUKEE

Public Company Information:

NYSE:
HUM
US4448591028
"Emergency department utilization continues to increase across the country, with inefficiencies such as duplicative testing and lack of medical history contributing to increased costs and creating a burden on the entire health care system"

MILWAUKEE--(BUSINESS WIRE)--A new study conducted by Humana (NYSE: HUM) and the Wisconsin Health Information Exchange (WHIE) found that health information exchanges (HIE), when used in emergency departments, resulted in improved provider efficiencies and health plan cost savings. The peer-reviewed analysis, which is the first to closely examine the benefits accrued by health plans that support health information exchanges, is published in the July/August issue of American Health & Drug Benefits.

The study, which ran from December 2008 through March 2010, evaluated the effectiveness of community-based HIEs – the secure transfer of health care-related data among facilities, health information organizations and government agencies, for patients seeking care in emergency departments. The analysis examined 1,482 fully insured Humana members in Southeast Wisconsin who sought care at emergency departments at 10 Milwaukee hospitals. Clinicians in the emergency department could query the HIE to view patients’ historical medical encounter information to help them make diagnosis and treatment decisions.

“Emergency department utilization continues to increase across the country, with inefficiencies such as duplicative testing and lack of medical history contributing to increased costs and creating a burden on the entire health care system,” said Dr. Albert Tzeel, study author and National Medical Director, HumanaOne. “By allowing clinicians to have access to patients’ medical history at the point of care in the emergency department, we found significant cost reductions and a decrease in redundant diagnostic testing. This proves that HIEs not only provide a value for the health plan, but also improve care coordination and help control costs for patients.”

The research found definitive decreases in four of the top five emergency department-based procedures, including CT scans, EKGs, laboratory testing and diagnostic radiology, when the patient database was queried by clinicians. These decreases resulted in an average savings of $29 per emergency department visit due, in large part, to the reduction of test redundancy, which helped mitigate waste and control costs. Prior research has shown that even cost reductions of $10 per emergency department visit could yield substantial savings for health plans.

“While historically it has been difficult to measure the economic value of health information exchange, this research further demonstrates that HIEs provide substantial value for health plans, in addition to value realized by providers and patients,” said Kim Pemble, executive director of the Wisconsin Health Information Exchange. “Hopefully, HIE initiatives will see a rise in the adoption and support of this technology by health plans as a result of the increasing validation of its numerous benefits, including cost savings, patient safety and improved care coordination.”

Health information exchange is an integral component of the nation’s health information technology infrastructure and is crucial to meeting meaningful use requirements, which mandates that electronic health record (EHR) systems exchange health information electronically among health organizations.

“We believe this study from Humana represents a truly important step toward improving the quality of care and reducing health care costs,” said Nicholas Englezos, publisher, American Health & Drug Benefits. “This is a further step toward achieving greater value in health care, which reflects the editorial mission of this journal.”

Study Details

The study, entitled “The Business Case for Payer Support of a Community-Based Health Information Exchange: A Humana Pilot Evaluating Its Effectiveness in Cost Control for Plan Members Seeking Emergency Department Care,” was an observational and retrospective analysis of 1,482 fully insured Commercial Humana members who had a minimum of 12 months of continuous plan coverage. Patients were classified into two groups: the test group, which had the WHIE database queried during at least two emergency department visits, and a control group, which did not have a HIE utilized during either of at least two emergency department visits. Members who were self-funded, not fully insured or received coverage from government programs, such as Medicare, were not eligible to participate.

WHIE encourages ED clinicians to make querying the Exchange a standard part of the emergency department workflow for all patients seeking emergency department care, beginning at triage prior to the provider being aware of payer coverage for a given patient. For the purposes of this pilot, Humana provided incentives to the WHIE to promote clinician queries for eligible Humana members. Researchers then analyzed claims for cost and utilization in the emergency department to assess the savings per visit.

About Humana

Humana Inc., headquartered in Louisville, Kentucky, is a leading health care company that offers a wide range of insurance products and health and wellness services that incorporate an integrated approach to lifelong well-being. By leveraging the strengths of its core businesses, Humana believes it can better explore opportunities for existing and emerging adjacencies in health care that can further enhance wellness opportunities for the millions of people across the nation with whom the company has relationships.

More information regarding Humana is available to investors via the Investor Relations page of the company’s web site at www.humana.com, including copies of:

  • Annual reports to stockholders;
  • Securities and Exchange Commission filings;
  • Most recent investor conference presentations;
  • Quarterly earnings news releases;
  • Replays of most recent earnings release conference calls;
  • Calendar of events (including upcoming earnings conference call dates and times, as well as planned interaction with research analysts and institutional investors);
  • Corporate Governance information.

About Wisconsin Health Information Exchange

WHIE is the Wisconsin Health Information Exchange, a not-for-profit organization formed to improve the quality, safety efficiency and accessibility of health care and public health by enabling collaboration and information sharing across multiple health care facilities. The WHIE Emergency Department Linking project is being pursued in collaboration with the Milwaukee Health Care Partnership, WI Department of Health Services, and participating health care providers across Southeast Wisconsin.

WHIE launched the Emergency Department Linking Project in 2007, with clinical use beginning in March 2008. There are now thirteen emergency departments and one Federally Qualified Health Center using WHIE across three counties in southeast WI. In 2011 WHIE plans to expand the number of ED and ambulatory participants that are using the system and the number of health systems participating in syndromic surveillance through WHIE.

About American Health & Drug Benefits

American Health & Drug Benefits (AHDB) is an independent, peer-reviewed journal founded in 2008 on the concept that health and drug benefits have undergone a transformation: the econometric value of a therapy is currently of equal importance to clinical outcomes as it is to serving as the basis for coverage decisions and benefit designs. Because benefit designs are greatly affected by clinical, business, and policy conditions, the journal offers a forum for stakeholder integration and collaboration toward the promotion of value-based healthcare. AHDB further provides benefit design makers the integrated information they need to devise benefit designs and make coverage decisions that stand up to today’s special healthcare delivery and business needs.

Contact:

Humana Corporate Communications
Lindsey Minella, 312-441-5549
lminella@humana.com