Cutting-Edge Care

Humana is a pioneer in the health insurance industry and division president Jeff Fernandez is proud of that

“Much of America’s health-care system is fragmented. At Humana, we believe we can add value for our members and the system by assisting with the coordination of their care across the different parts of the system,” says Jeff Fernandez, a division president for the company’s Gulf South region (Louisiana and Mississippi). “We have case managers who follow patients throughout their treatment. For example, if someone is going into the hospital, we get a call. We monitor their progress during their stay and coordinate their post-discharge plan. After they get home, they’re normally not ready to prepare themselves meals, so we’ll provide Meals on Wheels for ten days.”
Humana also has intensive disease management programs that even entail putting networked equipment into people’s homes, according to Fernandez. For example, patients who suffer from congestive heart failure need to monitor their weight carefully because a significant overnight weight gain may indicate an impending heart episode. A special scale is placed in the patient’s home. Every morning when the patient gets on it, the weight is recorded and sent to nurses who keep an eye out for red flags. The company operates four clinical intake units at the Galleria in Metairie, where Humana has its local offices.
“If I’m a diabetic, and there are lots of diabetics in Louisiana, my doctor will prescribe many things for me to do. I’ll be told how I have to manage my diet, medication and exercise, and then the doctor will go on to the next patient,” Fernandez says. “Many times, that patient will feel overwhelmed. We’ll reach out to them and ask about how they’re doing and help them with any issues managing their health.”
Humana began in Louisville, Kentucky, in 1961 when two lawyers saw an opportunity to provide better nursing home care in that area. The company later expanded into running hospitals and ventured into the health insurance business in order to drive customers to its facilities. The insurance side kept growing, and Humana sold off its hospitals in the early 1990s. The company had only a limited presence in Louisiana until about five years ago when Ochsner sold Humana its health benefits plan.
Having contracts with Ochsner as well as Touro, EJGH and all the other major health-care facilities in the region, Humana’s commercial division (selling insurance plans both to employers and individuals) is now the third largest in the state. The Medicare Advantage division, which is the one Fernandez is in charge of, is the largest of its kind in Louisiana, with 65,000 members producing $1 billion in revenue annually. Indeed, this seems consistent with the firm’s overall national strategy. Research firm Hoovers notes in its brief on the company, “Humana is counting on Medicare to make it a big-time player in the health insurance game.”
“If someone has traditional Medicare, they may buy a separate Medigap policy to cover coinsurance and deductibles. Then they’ll have to buy a separate drug coverage program. Medicare Advantage programs are private options to traditional Medicare and cover everything from hospital stays to prescriptions under one umbrella,” explains Fernandez. “In New Orleans and surrounding parishes, Humana has a zero-premium HMO option. The government pays us a fixed amount each month to cover each member. Our success is measured by how effectively we help them adopt healthy lifestyles.”
While President Obama talked a lot about health-care reform during his campaign, little action has been taken during the early months of his tenure, and no one in the industry quite knows what to expect.
“They haven’t shown their hand yet. They’ve been busy dealing with the economic crisis, and then Tom Daschle withdrew his name from becoming the Health and Human Services Secretary,” Fernandez comments. “When the focus does come to health-care reform, they’ll look to the marketplace for ideas and hopefully look to Humana to see how to make Medicare Advantage work throughout the country.”
On a national level, Humana has also been working to make health care more consumer-oriented by publishing medical prices and quality measurements on its Web site. After all, health care is one area of the economy where customers have no idea what they will be paying and what quality of service they will receive until they walk out the door. The company is also moving into “real-time claims adjudication,” meaning doctors can receive payment the same day a patient visits instead of going through an onerous billing process.
Fernandez was born in Metairie but grew up in Baton Rouge and attended LSU. While an undergraduate, he got a part-time job as a sales assistant for a local health plan. From those early days of making copies and faxes, he moved up the ladder in the health insurance industry, earned an MBA and came to Humana in 2005. While employed there full time, he decided to go back to school for a law degree by taking evening courses at Loyola .
“I never had a grand idea about becoming a lawyer,” he comments. “I just wanted to learn about the law. Health care is one of the most regulated industries in America so knowledge of the law is certainly useful.”