Bruce Broussard

Bruce BroussardIn a series of LinkedIn Influencer blog posts, Humana President and CEO Bruce Broussard shares insights and ideas about the future of health care and discusses the importance of working together to improve the health-care system as well as our own health and well-being. His latest — The Human Problem With Health Technology — is reprinted below. To see all of his blog posts, click here.

One of my favorite activities is taking a bike ride. It’s a wonderful way to experience nature and challenge myself. How many miles did I ride? How long did it take? Did I do better than my last time?

Cycling is traditionally an individual sport, so I use a Garmin device to answer those questions. My Garmin device provides me with details, but it’s limited when it comes to seeing how I relate to others who also love cycling. For that, I use the app Strava.

Strava is a way for me and others to see how we measure up to one another. Strava is not a device, but it’s designed to create a community by connecting fellow cyclists. You can follow anyone on it.

Despite the individuality of cycling, there is a need to connect with other people who share this experience. There’s a social aspect to the sport, and it reflects the challenge we face with technology in health care today: Technology must be easy to use and deliver the human connection to improve a person’s health.

And nowhere is this more critical than in America’s rapidly growing senior population—a large number of whom are grappling with multiple chronic conditions.

Addressing Loneliness and Isolation

America’s seniors could benefit greatly from more human-centered technology. Three out of four Americans aged 65 or older live with multiple chronic conditions, and 71 percent of the money spent on health care in the U.S. is associated with chronic conditions. And the baby-boom generation is steaming into retirement, with 10,000 people a day aging into Medicare.

But health isn’t just about the physical aspects. Research has found that 17 percent of adults age 65 or older are isolated, and 26 percent are at increased risk of death due to subjective feelings of loneliness. If a person is living alone, and dealing with multiple chronic conditions, he or she might become depressed. People also won’t eat right or be active if they’re depressed.

Our species needs to connect with other people. Yet millions of seniors are lonely; they don’t have adequate social connections. That innate need to connect, to be social, and to be loved and to love other people is not being met in a large part of the population.

Things like remote monitoring technology can help, but only if it incorporates a person’s lifestyle and the physician/patient relationship. Technology has to go beyond monitoring basic physical activity. Devices have to achieve true connections and address real chronic health problems, like the nearly five million Americans in the U.S. who have congestive heart failure (CHF).

An Example of Connected Health

In order to help our members with chronic conditions spend more time living their lives by staying out of the hospital, we launched a CHF remote monitoring pilot program to help them keep track of their condition.

When a person has CHF, his or her heart doesn’t pump strongly enough to move blood around the body. As a result, the person retains water – in places such as the lungs, legs or chest cavity – and can suffer from shortness of breath. If the person experiences a significant change in weight from the previous day, this could signal a complication, which might lead to a trip to the hospital.

At Humana, we’re all too familiar with CHF. Approximately 300,000 of our 3.2 million Humana Medicare Advantage (MA) members live with CHF, and they account for more than 40 percent of MA admissions. Here’s how the pilot program works, with a member we’ll call “Brenda.”

After being selected, Brenda met with her primary care physician and a nurse. She was shown how to use a smart scale that would send her weight to Humana every day. When Brenda weighed herself the next morning, the scale sent her weight to her nurse, who called Brenda to congratulate her on her first weigh in.

If Brenda’s weight were outside an established range, her physician and nurse would be immediately notified. The nurse could then contact Brenda to see if she needed a new prescription or a consultation with the physician, enabling Brenda to have her weight fluctuation addressed immediately without having to go to the hospital.

Ease of Use and Human Connection

Members who participated in the CHF pilot program weighed in 88 percent of the time during the first 100 days. So why has this program been successful? There are two core elements: ease of use and human connection.

The table stakes for remote monitoring is ease of use. Brenda’s scale has no plug, no buttons, and requires almost no instructions. She doesn’t need Wi-Fi or Bluetooth to use the scale, and she doesn’t need to register it anywhere. Her scale simply works right out of the box. To be certain Brenda knows exactly what to do with her scale, she used it in front of her nurse as soon as she received it.

But to keep weighing in every day, this new activity has to be bonded to something Brenda values: human connection. Because Brenda knows her nurse is on the other side of the scale, and is looking out for her health and well-being, she is more likely to weigh in each day. Additionally, we have found that group enrollment sessions help people like Brenda because they see other people with CHF taking action to monitor their condition.

The program only works if people like Brenda take a small action each day. Technology can make it easier for Brenda to take that action, but in the end she will do it because of deeper, more human motivations like connecting to others.

There are other elements that help enhance the effectiveness of health-related technology, in addition to ease of use and the human connection, such as the motivation that comes as a result of a person seeing his or her specific progress (personalized, real-time, relevant information, aka the “so what”). This can be a powerful hook for encouraging ongoing engagement and helping people become more knowledgeable, and confident, in managing their condition. For example, the CHF pilot also includes sending “certificates of accomplishment,” recognizing those who’ve reached various milestones and that receiving recognition for their effort seemed to be an effective way of keeping people engaged.

The Way Forward

Health-related technology such as remote monitoring and scales can help our aging population improve their health. But it won’t do so unless the technology brings together the lifestyle and clinical aspects of a person’s health in a way that makes it easy to get people more engaged in managing their health.

The integration of physicians and clinicians, as we’ve seen with our CHF program, is important; their recommendations carry influence, and they can ensure that the data is used to highlight moments of influence. The key is not just the utilization of the technology; it’s the design and integration of the program. There is a real need for deep clinical engagement, both in getting people engaged in their health and in helping physicians and other health care providers move beyond prevention and wellness and toward managing chronic conditions.

At Humana, taking care of seniors living with multiple chronic conditions is what we do best. The role of technology is only going to become more important. But let’s never forget that technology must make things easier and more human to make a difference in health.

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Forbes.com and other media have taken note of Humana’s Bold Goal progress, reporting on the company’s success in improving the health of the communities it serves.

“Improving the health of an entire community is difficult and no one person or organization can do it alone,” Humana CEO Bruce Broussard told Forbes, which made note of Humana’s Bold Goal communities in San Antonio, Texas; Louisville, Ky.; the Tampa Bay, Fla. area; Broward County, Fla.; New Orleans; Baton Rouge, La.: and Knoxville, Tenn.

The Forbes article noted that “health plan members in participating ‘Bold Goal’ communities decreased their number of unhealthy days by a ‘margin of 3 percent’ from 2015 to 2016. Meanwhile, Humana health plan members across the country decreased their unhealthy days by 2 percent.”

Forbes also quoted Humana’s Chief Medical Officer, Dr. Roy Beveridge, who said, “If you have diabetes and suffer from a behavioral health condition such as depression or are impacted by one of these social determinants, the outcomes are worse and the cost is much higher. When we think about what it takes to manage the health of a population, addressing these social determinants and behavioral health challenges must be done if we want to drive down costs and help people improve their health.”

Read the full Forbes article here.

Other media outlets have also covered the report, including:

FierceHealthcare
Managed Care magazine
Employee Benefit News
American Journal of Managed Care
Business First
Becker’s Hospital Review
Insider Louisville

Read the full 2017 Bold Goal progress report here.

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Bruce BroussardIn a series of LinkedIn Influencer blog posts, Humana President and CEO Bruce Broussard shares insights and ideas about the future of health care and discusses the importance of working together to improve the health-care system as well as our own health and well-being. His latest — Can Car Factories Teach Us About Health Care? — is reprinted below. To see all of his blog posts, click here.

We’ve all owned a car that went far longer than we expected. Maybe it was the extra maintenance that helped extend it to 200,000 miles. Or we just benefited from a well-built car. Or maybe it was a little bit of both.

Yet one thing is certain about a car: the longer you own it, the more things will break. To get a high-quality, long-lasting car – successfully assembled from hundreds of parts – you need integration. You have to design around a specific outcome and meet multiple production-line goals.

Despite this massive complexity, the deliverable is simple: a healthy car that runs. In the world of health care, we have a fragmented system that’s delivering uncoordinated care to hundreds of millions of people. Yet this fragmentation leads to a question: What is the goal, and why aren’t we aligned?

The Product, Not the Components

A fragmented system is an inefficient one. An interesting story in The Economist examines how “innovation and production are increasingly interwoven” in auto manufacturing and how “linking the design of both the product and its manufacturing process more closely to production can help improve all three.”

So what does an improved process in the automotive industry have to do with making a person healthier? The answer is that in the world of manufacturing, advances in technology enabled the industry to better define a finished product. The automobile industry was able to integrate highly specialized functions, from the supply chain to product design, to deliver a consistent product and a user experience specialized to the user.

In health care, the definition of a finished product, the patient’s health, is not easily defined. Is it to restore or maintain health? If so, in what context? Do you do this for the day, the week, the year, the condition, or something else? Physicians have different perspectives given the individualities of the people they serve. It’s even harder given the numerous people who serve the patient, including a multitude of specialists, and no centralized point of care.

Impact of Specialists

Let me be clear. The growth of specialists in health care has been a positive thing, and it’s enabled millions of Americans to live longer. Specialists will be absolutely critical in helping people manage their chronic conditions.

Yet primary physicians, whose role is to coordinate patient care among the specialists, account for only 30 percent of physicians in our country while specialists account for 70 percent. Some experts argue that the ideal system should be the opposite. One story also found that the “primary-care gap is particularly acute in about one-third of states, which have only half or less of their primary-care needs being met.”

Our health system has a significant number of independent specialists, but they’re not integrated to deliver the connected patient experience. When health care became more contemporary in adding value to society in the previous century, it was because the general hospital and the primary care physician started to collaborate together to serve people under one roof.

It’s the same thing with manufacturing; the parts are collected, and the car is assembled under one roof. By mastering this global assembly and integration, the automobile industry has been able to successfully and efficiently deliver an experience that represents the personality of the car a person chooses, all in an affordable manner. Can it be said that health care has this level of integration that enables a personalized experience?

Elements for Success

Helping people with their lifestyles is critical to this structural change. In the past, it was episodic care — you needed surgery for a broken arm or a heart attack. While these are obviously still critical services, the health challenges of the 21st century will be ones of chronic conditions that start to show themselves dramatically as we age.

We have an obesity epidemic and sedentary lifestyles. People have access to manufactured, less-healthy foods, and there’s the stress and strain of living in today’s fast-paced, digital environment. All that sugar you ate won’t impact you at 50, but it sure will at 70. It’s a recipe that leads to poor health.

To bring affordability to health care, we have to talk about the ineffective structure of the health care system. By focusing on health outcomes – and paying doctors based on those outcomes instead of services performed – we will bring about change. If we really seek to lower the cost of health care, we have to focus on individual health outcomes, integration of care, and provider motivation.

Achieving affordability in health care requires us to address three core principles:

 · Define the Outcomes (Products). Given the multiple specialists that will be necessary for helping treat a person’s chronic conditions, there are naturally going to be different diagnoses. The health care industry of the 21st century must focus on a consistent definition of the individual health outcome, aka the product, and provide an engaging experience tailored to the personality of the person. This outcome must reflect the person’s health and well-being, not just how the patient responds to specific disease treatment.

 · Structure for Motivation. Today, physicians are reimbursed for the services they provide (fee-for-service), which can lead to increased utilization and duplicative services. In a value-based world, physicians are reimbursed for the health of the people they serve. More than 1.6 million of Humana Medicare Advantage members, on average, experience better health and improved quality from the physicians who serve them. Value-based care will help structurally change incentives in health care to keep the focus on the health of the individual, not the services performed.

 · Integrate the System. Given the fact that 10,000 people a day are aging into Medicare, combined with the fact that “chronic diseases account for 86% of our nation’s health care costs,” our health care system must have an integrator to address these demographic changes. The primary care physician is the key to integrating the myriad of specialists who serve the individual. As advances in medicine and technology increase life expectancy, we know the “car” will eventually break down. In a health care system centered on value-based care, it’s not about the parts; it’s about holistic mental and physical well-being.

Driving affordability into the health care system requires us to go beyond health access to address cost and a fragmented delivery system. We must move beyond the fee-for-service environment that just encourages services, not measurable impacts.

We need an integrated system that is financially incentivized to reward for optimal health, not optimal utilization. Only by integrating the clinical, health and lifestyle components, with a personalized, high quality and efficient experience as the end product, can we help transform health care.

If it can be done for cars, it can be done for people.

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Bruce BroussardIn a series of LinkedIn Influencer blog posts, Humana President and CEO Bruce Broussard shares insights and ideas about the future of health care and discusses the importance of working together to improve the health-care system as well as our own health and well-being. His latest — Let’s fix the path to the ER — is reprinted below. To see all of his blog posts, click here.

 
It’s happened to you, or someone you know — a trip to the emergency room (ER). It could’ve been for a broken arm, or a life-threatening stroke or heart attack.

The ER staff probably did a great job. But was going to the emergency room the right location to receive the care? While you may have had a serious issue, people walk into the ER every day with upset stomachs and coughs.

Impacting People and Costs

As consumers, it’s never easy going through the ER system. Waiting rooms are often overcrowded, and according to the CDC, “reported average emergency department wait times (about 30 minutes) and treatment times (about 90 minutes)… add up to roughly two hours in the ER.” There is also a lack of transparency that concerns consumers.

The function of the ER is to manage life-threatening conditions, not to diagnose a non-acute ailment. Often, a complex workup with blood tests and imaging studies is performed to rule out a life-threatening condition and will require an outpatient follow-up with a specialist for a more complete workup. However, information on tests performed is rarely passed along to the patient’s primary care physician because the ER doctor has moved on to the next crisis (it’s what they do). This negatively impacts the patient.

It’s a critical issue, because ER costs are rising. The latest Health Care Cost Institute report found that the “price of an ER visit jumped 10.5 percent to an average of $1,863 in 2015.”

While overall ER utilization was slightly less, based on one analysis, costs still increased by double digits in terms of percentage. At Humana, we’ve seen firsthand the challenges of today’s ER utilization and costs among our members.

Yet in many cases, these members are going to the ER not for life-threatening emergencies, but for management of a chronic condition — for example, a prescription refill since they were unable to see their primary care physician during normal business hours.

Since seven of 10 Americans live with chronic conditions — such as heart disease, Type 2 diabetes, obesity and arthritis — the health care system needs to make sure the chronic condition epidemic is better-managed, or the ER system will be hampered in its ability to treat life-threatening matters.

Hospitals and health plans spend way too many resources debating what was classified as an admission and whether it should have been classified as an observation. Given the fact that 71 percent of ER visits could have been avoided, more emphasis must be placed on and resources devoted to alternatives that can prevent ERs from being overloaded.

Solutions to the Problem

If we want to fix the ER decision path, and rising costs, here are five initiatives that could help.

1. Enable the primary care physician (PCP) to be more proactive, not reactive. In a population-health world, the PCP is the quarterback, coordinating patient care among the specialists. Consider a PCP who has 100 patients with a diagnosis of congestive heart failure in her care and who knows that many of her patients will overindulge over the upcoming holiday season. Why can’t she work with a health plan to help educate them on tips to eating healthy over the holidays? High salt intake is directly linked to fluid retention, which can lead to a CHF exacerbation. If the PCP is not managing the patient and given an opportunity to intervene, her patient could wind up in the ER. Patients always need access to their PCP in a timely manner.

2. Secure timely specialist care when necessary. Upon PCP direction, getting appropriate specialty care can help alleviate ER usage and drive down costs. At Humana, we’ve found that when you get a member to see a specialist, it greatly reduces the chance that the member will wind up in the ER. Yet, it’s not as easy as it sounds. If someone is referred to a specialist and it takes 25 days to see that specialist, a complication might occur and the person would have no choice but to go to the ER. It’s imperative that health plans and specialists find better ways to get at-risk patients in faster.

3. Improve medication adherence. According to research cited in Health Affairs, “approximately 4.3 billion prescriptions were written in the United States in 2014, but fewer than half of patients take medications as prescribed.” Research has shown that poor medication adherence can lead to increased ER utilization. Greater resources must be invested in helping people stay current on their medications, which can also address overmedication and adverse drug reactions

4. Educate on ER vs. urgent care. It’s the age-old argument, and there’s no shortage of information available online, yet urgent care can be an option to help drive down utilization. A recent study in the Annals of Emergency Medicine found that “consumers are just as likely to go to the emergency department for low-level problems like bronchitis or urinary tract infections.” Health plans and others must continue to help educate consumers about the rationale for each.

5. Let’s utilize technology. According to a Harvard Business Review story, “40% of hospital beds lie empty, their enormous fixed costs weighing heavily on the system.” While some argue for expanding acute care options, high utilization and lower costs can be better achieved through expanding access to the PCP in communities, which will help access. If we want to keep the ER open for serving true emergencies, we need to invest more in access points and ease of care. We need to encourage telehealth solutions and predictive analytics to target patients when they are at risk for decompensating.

Let me be clear. Our country has some of the finest, if not the best, ER physicians, nurses, and other clinical practitioners in the world. These physicians and nurses save lives every day. If we want to help them focus on serving people who have actual emergencies, the health care system needs to recognize that the path to the ER is broken and must be addressed.

It certainly won’t be easy. It’s ingrained in us by the automated message you receive when you call your doctor’s office after hours: “If this is a life-threatening emergency, please go to the emergency room.” As I mentioned earlier, 71 percent of ER visits are unnecessary. We can all do better – hospitals, health plans, and consumers – to check our options before we go.

There will always be breaks in the system – people going to the ER for a cough when a call to their primary care physician or urgent care may have been appropriate – but these costs are escalating and must be addressed.

There are too many paths leading to the emergency room. That’s stressing our larger health care system, and the time has come to do something about it.

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Bruce BroussardIn a series of LinkedIn Influencer blog posts, Humana President and CEO Bruce Broussard shares insights and ideas about the future of health care and discusses the importance of working together to improve the health-care system as well as our own health and well-being. His latest — How to “Defeat” Artificial Intelligence — is reprinted below. To see all of his blog posts, click here.

The advance of artificial intelligence, via the first wave of automation, could seriously disrupt life as we know it. It’s not a surprise, considering that computing power doubles every couple of years. Can we say the same for the power of the human mind?

This technology is certainly going to have an impact on our workforce. Take a recent report from Forester Research, which found that automation alone could eliminate 8.6 million U.S. jobs by 2021, or, as one media outlet put it, “the equivalent of Florida’s entire workforce.”

Yet while the U.S. unemployment is currently 4.9 percent and has been low the last five years, many high-paying jobs, high skilled jobs have been replaced with low-paying, low skilled jobs, and this is not truly reflected in the unemployment rate.

Our nation’s population is also growing, which means more people for fewer jobs. The challenge is that many new, high-paying jobs will require new skills. And fewer workers will be required in the digital economy. We have to empower the American workforce to adapt to these changes.

Before we try to solve this challenge, let’s go back a century to the creation of the internal-combustion engine, which led to the automobile industry, which has been an economic force ever since.

Think about the impact the internal-combustion engine had on our country. It even impacted fresh foods by connecting rural markets to the city. The internal-combustion engine also created numerous jobs because it wasn’t highly technical, creating opportunities for vocational schools and programs.

When the internal-combustion engine was invented, there was a sharing of wealth and numerous touch points. On the digital side, it begins to narrow. And in the sharing of wealth in the digital world, where much of our economic growth has taken place, it’s very narrow.

For example, fast forward to today. In the digital economy, there are fewer access points. An app can be created by a small team and reach millions. Just look at the Kodak vs. Instagram comparison:

· “Kodak was founded in 1880, and at its peak employed nearly 145,300 people, with many more indirectly employed via suppliers and retailers. Kodak’s founding family, the Eastmans, became wealthy, while providing skilled jobs for several generations of middle-class Americans. Instagram was founded in 2010 by a team of fifteen people. In 2012 it was sold to Facebook for over one billion dollars. Facebook, worth far more than Kodak ever was, employs fewer than 5,000 people. At least ten of them have a net worth ten times that of George Eastman.”

If the Kodak vs. Instagram example has taught us anything, it’s that new technologies will require fewer resources and create fewer jobs. More industries will be disrupted, and the remaining jobs will require more advanced training.

Coal Mining to Coding to Call Centers

The irony is that many of the new jobs being created, in industries such as manufacturing, require people with certain technical skills that many employers simply cannot find. In a recent Wall Street Journal article about how more and more jobs are going unfilled because companies cannot find skilled workers:

· Amid anxiety about the disappearance of factory jobs, thousands of them are going unfilled across the U.S. The number of open manufacturing jobs has been rising since 2009, and this year stands at the highest level in 15 years, according to Labor Department data. Factory work has evolved over the past 15 years or so as companies have invested in advanced machinery requiring new sets of skills. Many workers who were laid off in recent decades—as technology, globalization and recession wiped out lower-skilled roles—don’t have the skills to do today’s jobs.

So what’s the answer for preparing an American workforce disrupted by technology? It’s education, training and redeployment…it’s about investing in people.

An amazing example of this retraining and redeployment can be found in the coal mining communities of West Virginia. Take Rusty Justice, who is retraining former coal miners in Appalachia to be app developers. It’s a fascinating story of an industry that has experienced massive layoffs. Mr. Justice’s program shows how someone who has solid intelligence, but who is stuck in a challenged field, can thrive with some workforce retraining.

And in Louisville, Code Louisville offers a free, 12-week training course to teach people computer software coding so they can get good-paying jobs in a growing industry. After meeting at a Code Louisville event at the Beecher Terrace public housing complex, several high school students created Beech Technologies as a venture to help small businesses improve their web presence.

Yet there are different sectors where retraining is more difficult. It’s not just industries like manufacturing and coal mining being impacted. Think about people who work in call centers. Given the automation that can impact these call center jobs there is a real need to help these employees retrain.

There’s a spiral of people trying to keep their heads above water, and their well-being is being impacted in an environment where learning and education are not easy; they start falling behind. When you start falling behind, you get left behind.

The knee-jerk reaction is to give people a raise. But when jobs get shipped over to India, or lost to automation, retraining and redeploying them to more productive opportunities is the better choice. It’s about investing in people so they are able to take new skills and training with them wherever they work or live.

For example, Comcast announced plans last year to retrain 84,000 of its call center workers who are on the front lines of customer service. In my company, Humana, we are using AI to support customer service representatives, as Forbes and the Wall Street Journal recently reported. This has required us to retrain many of our customer service associates.

We Have a Responsibility

Companies don’t always look at it as their responsibility to retrain, redeploy and move people to a different level. Some may view these positions as simply disposable, despite the fact that customer service is a highly critical function in today’s competitive economy.

We need to ask ourselves a question: what is our responsibility as an American business? American business has a responsibility to retrain its workforce. The job is not the issue; it’s the training and education and redeployment.

Some have proposed legislation that would raise taxes or distribute money to people who are impacted. This is a short-term solution. Instead, if wealth transferred through job creation and workforce education is pursued, many of these impacted people can make a long-term contribution to society and also be prepared for the next wave of disruptive technology, enabling their own long-term sustainability in the workforce.

Tsunamis generally come in three to four waves. The latter waves are usually the biggest. The wave of automation is building in the distance, and we can feel it. It’s going to disrupt entire fields. American business leadership has a moral responsibility to the employees it serves to prepare them not just for the first wave of automation, but the waves from Artificial Intelligence that will most certainly follow. Let’s do it together.

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