posted by Alicia Caramenico
on September 21, 2017
Humana’s President and CEO Bruce Broussard discussed health care transformation and innovation at AHIP’s Medicare Conference in Washington, D.C. His session focused on the role health plans play in helping Medicare Advantage (MA) members achieve their best health. Broussard shared some of his insights ahead of the event.
Bruce Broussard: Health care represents 18 percent of GDP, making it one of the largest economic issues for society. This is primarily being driven by an aging population, an increase in chronic conditions, and system inefficiencies. Of course, there are many challenges to overcome, but having an opportunity to play a leadership role in finding solutions to these challenges is very rewarding. At Humana, we call it our “opportunity of a lifetime.” One of our core beliefs is that the way to improve health care is by creating a better health care experience (simple and easy) and by improving people’s health.
I feel fortunate to lead such a purpose-driven organization. Our team is deeply committed to a single mission—helping people improve their health. In fact, two years ago we established an enterprise goal, called our Bold Goal, which centers on helping the communities we serve become 20 percent healthier by 2020 by making it easy for people to achieve their best health. In other words, it’s a dream with a deadline. To track our progress and hold ourselves accountable, we use the Center for Disease Control’s evidence-based Healthy Days measure. We’re making a difference. Over the past two years, we’ve improved healthy days in our communities by 3 percent overall, and in some markets by 9 percent.
Broussard: I’m very optimistic that the delivery of health care will improve significantly over the next decade, from payments evolving to value/quality (vs. volume), to advancements in technology, both medical and digital, which will enable more personalized treatments and a better overall health care experience. Both of these will contribute greatly to driving higher engagement in the holistic management of health.
As we think about Medicare Advantage and our role in helping our members with their health, MA is one of the few business models that focuses on and incentivizes managing the whole-health of an individual. It’s through this coordinated care approach and being aligned with providers in value-based relationships that we’re able to prevent and slow disease progression and lower the cost of care through more efficient utilization of services. All of this sets the stage for greater competition, which in turn fuels innovation.
There are major trends afoot like growing recognition in the effectiveness of the MA payment model, accelerated advancements in analytics and technology advancements, which are enabling broader access to care (digital, remote monitoring, telehealth, etc.). These trends will continue to put pressure on the current system and drive structural changes over time. It’s through all the “fits and starts” of these trends that an evolved health care system will emerge, offering more convenient access to care and a personalized experience that focuses on health vs. volume.
Again, I feel optimistic about Humana’s future, particularly given the tremendous experience and expertise we’ve gained over the years in being a leader in this space. Our strategy and priorities also positon us strongly as we continue to make deep investments in our integrated care delivery (ICD) model, which we’ve been building over the years. Our ICD model centers first and foremost around our members, recognizing too the importance of creating strong provider partnerships and working together as a team to deliver the best possible health care experience for our members.
Broussard: The complexity of the system is something we’re responsible for changing and improving. While no company alone can transform the industry—and partnerships among government, providers, communities and other organizations will be necessary—we are not waiting for change. Within our own organization, we started to evolve our business, focusing first on integrating more deeply with members and providers to improve health outcomes, costs and a friction-free overall experience.
The way the health care system works today creates a significant amount of friction for consumers and providers. Humana contributes to this, too. The complexity has much to do with the inherent structural challenges that exist, like payments for treatment vs. value, unconnected information sources/silos, and underdeveloped utilization of technology. Given our proximity to and knowledge of our members, we believe the role of health insurers is to play a leadership role in partnering with providers to assist them in their transition to value-based reimbursement. We do this by providing them with rich information, offering payment arrangements to meet them where they’re at in their transition from fee-for-service to value/risk, and working with them to care for members holistically by integrating health care and lifestyle needs.
For people living with chronic conditions, navigating the health care system can be particularly challenging. Helping our members, in partnership with their provider, navigate and make sense of the complexity is something we see as one of our primary responsibilities. Take a member with type 2 diabetes. By leveraging real-time data analytics to identify early indicators of a member’s health condition, we’re able to share this information with their provider to trigger interventions that prevent disease progression, enabling the member to keep their condition at low severity.
What this means is working with a member’s provider to create an integrated, shared care plan that might include activities like ensuring the member is getting regular eye exams, helping them care for foot ulcers, and ensuring they’re adhering to their medication regime—and doing all that using advanced technology that provides ease, speed and makes collaboration among care teams and families easy. It’s through partnering with providers, prompting early intervention combined with integrating clinical and financial information in the workflow that we’re able to proactively engage in a member’s health.
Broussard: While for some time we’ve been building a strong integrated care delivery model, we recognize that integrating at a much deeper level is what’s needed in the future. So you’ll find a big theme for us is ‘integration’ in three distinct areas. First is integrating with providers. This is about integrating more deeply with providers by aligning incentives around holistic health and by connecting workflows and processes, ensuring we are working as a team in managing the health of the member/patient.
Second is integrating health and lifestyle. Lifestyle is such an important determinant of health with things like loneliness, food insecurity, transportation limitations and financial struggles all having an impact on health. While we today are fortunate to have a strong platform of clinical capabilities, we’re building deeper capabilities in areas such as home health, pharmacy, and behavioral health so we’re able to provide care and services to members that supplement what’s available in their doctor’s office.
Third is integrating workflows and systems. This is about removing the friction and pain points that make today’s health care system so difficult for members and providers to engage in. This means leveraging technology to simplify and personalize the experience, while also improving overall productivity.
Last but not least, our organization has been on a journey for a number of years, pivoting from being “transactions-focused” to focusing on “relationships and health.” Making this pivot has required fundamental changes in our culture, beginning with putting members and providers at the center of all we do. We started by establishing values that guide us in how we conduct ourselves both in and outside the organization. Our values have also been the driving force for our focus on quality in both experience and clinical outcomes. Of course, our Bold Goal as I mentioned earlier has been one of our most important steps along our journey as it’s given every associate a deeper purpose to their work.
Broussard: Humana has a long history of innovation, first from our birth as a nursing home company to our evolution as one of the largest, proprietary hospital companies (performing one of the first artificial heart transplants) to one of the first vertically-integrated hospital/health plan companies to our position today as one of the leading Medicare Advantage/Prescription Drug Plan contractors. For 56+ years, we’ve risen to the challenges and opportunities where health care is headed.
Simply put, we believe that personalized integration is innovation. It’s not about individual bells and whistles and shiny new gadgets, rather it’s about how do you take all of these things and connect them to create a seamless, integrated experience in the context of an individual’s circumstances. Interestingly, we’ve found that it not always the high-tech solutions that are most effective. While we do leverage contemporary technologies like telehealth and remote monitoring to help people manage their health and stay at home longer (more than 1 million more days at home instead of the hospital since 2013 for participating members), lower-tech actions that overcome key social determinants to better health like transportation, financial services, diet/nutrition education, support groups for loneliness, etc., are critically important.
Health and lifestyle are intrinsically connected and so to truly make an impact, they must be addressed and integrated throughout a member’s health journey. In essence, the way we bring innovation and high-quality, coordinated care to our MA members is through integration—utilizing rich data to proactively predict and prevent disease progression and then pulling this information through to personalize care in the context of their circumstances, leveraging both high- and low-tech tools and capabilities.
Broussard: It’s a tremendously exciting time to be in health care. In fact, it’s a once-in-a -lifetime opportunity to make a profound and positive difference in shaping the future of health care. As is the case in just about every industry, health care is moving toward greater personalization. Health care for one vs. health care for the masses will be an important capability for health care companies of the future. On personalization, it’s interesting in observing other industries, you’ll find it’s not the product itself that drives success in many cases rather how the product is expressed/served to consumers in a way that considers the context of their circumstances, addressing a specific need. That’s where health care is headed. That’s where Humana’s headed too. Indeed, exciting times.