health-care system

When Humana started Project San Antonio (the precursor to its Bold Goal), the company recognized Pattie Dale Tye, who was serving as president of Humana’s Large Employer Group Business, as an ideal leader. Pattie Dale’s love of community has been evident throughout her 13 years at Humana. She is now being recognized by Today’s Woman magazine as one of their “Most Admired Woman” finalists.

The award recognizes women in Kentuckiana who have excelled in their careers and community service, making them role models to many. In addition to Pattie Dale’s many contributions to Humana as a respected and admired leader and mentor, she has contributed significantly to the Louisville community through Board service roles with Metro United Way, the Louisville Zoo, Trees Louisville and the Kentucky State Chamber.

Please support Pattie Dale by voting daily between now and March 22 by clicking this link and searching for Pattie Dale in the Corporate category (one vote per email address per day). *Note that the ballot works best in Chrome, Edge, Safari or Firefox internet browsers.

Winners will be honored at an event on June 26 and featured in the June issue of Today’s Woman.

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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 — Is a Positive Nudge Better than Fear? — is reprinted below. To see all of his blog posts, click here.

Fear is used to influence how we behave, how we shop, how we save, what we eat, how much we exercise. From purchasing the safest car to baby-proofing our homes, fear drives us in many ways.

But is fear effective in health? Yes, people will lose weight because they’re afraid of having a heart attack. Yet others will lose weight because they want to have more energy to do the things they love and have a longer, more fulfilling life. When it comes to changing behaviors, is fear the best motivator?

In health care, our ability to change unhealthy behaviors – and thus improve outcomes and lower costs – will determine the sustainability of the system. According to the U.S. Centers for Disease Control and Prevention (CDC), “86 percent of the nation’s $2.7 trillion annual health care expenditures are for people with chronic and mental health conditions.”

Chronic conditions are the most preventable of health issues because they’re the result of unhealthy decisions made over time. This leads to a question: How do you “nudge” people toward positive behavior change?

I recently finished the revised and expanded edition of a book called Nudge, by Richard H. Thaler and Cass R. Sunstein. The authors offer several insights on how unhealthy behaviors can be corrected.

Here are four concepts from the book that grabbed my attention and how each can be used to change unhealthy behaviors among seniors and those living with multiple chronic conditions:

#1: Frame the choice without the negative. Thaler and Sunstein examine how a person with a serious heart disease is presented with a “grueling operation.” They state the following:

“The doctor says, ‘of one hundred patients who have this operation, ninety are alive after five years.’ What will you do? If we fill in the facts in a certain way, the doctor’s statement will be pretty comforting, and you’ll probably have the operation. But suppose the doctor frames his answer in a somewhat different way…‘Of one hundred patients who have this operation, ten are dead after five years.’” Thaler and Sunstein go on to say, “If you’re like most people, the doctor’s statement will sound pretty alarming, and you might not have the operation.” The same goes for doctors themselves. “When doctors are told that ‘ninety of one hundred are alive,’ they are more likely to recommend the operation than if told that ‘ten of one hundred are dead.’”

The Nudge: Physicians, nurses, care professionals and caregivers who care for seniors living with multiple chronic conditions have much influence. It’s natural for a senior not to want to undergo an operation where there is risk. Thaler and Sunstein note that “a good way to increase people’s fear of a bad outcome is to remind them of a related incident in which things went wrong; a good way to increase people’s confidence is to remind them of a similar situation in which everything worked out for the best.” Nudges that frame the positives, while highlighting the ideal outcome, will help people take steps to evolve from unhealthy behaviors.

#2: Don’t underestimate the power of priming. Referred to by the authors as “the somewhat mysterious workings of the Automatic System of the brain,” the concept has been proven to show that “subtle influences can increase the ease with which certain information comes to mind.” The authors write:

“With respect to health-related behavior, significant changes have been produced by measuring people’s intentions. If people are asked how often they expect to floss their teeth in the next week, they floss more. If people are asked whether they intend to consume fatty foods in the next week, they consume less in the way of fatty foods. The nudge provided by asking people what they intend to do can be accentuated by asking them when and how they plan to do it.”

The Nudge: Consistent patient engagement is essential, especially when focused on sustaining behavior change. Physicians don’t have a lot of time outside the office for helping patients make better daily decisions. But by nudging the patient, the care team shows an active interest in the patient’s health and can improve outcomes.

#3: Incentives are a better option than talking down to someone. Thaler and Sunstein describe how a simple nudge can lower the teen pregnancy rate, saying teenage mothers “often become pregnant again within a year or two.”

The two cite a “dollar a day” program, “by which teenage girls with a baby receive a dollar for each day in which they are not pregnant…A dollar a day is a trivial cost to the city, even for a year or two, so the plan’s total cost is extremely low, but the small recurring payment is salient enough to encourage teenage mothers to take steps to avoid getting pregnant again. And because taxpayers end up paying a significant amount for many children born to teenagers, the costs appear to be far less than the benefits.”

The Nudge: Sustaining action requires sustained commitment. For seniors living with chronic diseases like Congestive Heart Failure, where the heart weakens over time, life is already difficult. Positive encouragement, through nudging from the care teams, can help them stay the course.

#4: People can make good decisions when presented with non-biased facts. In the bonus chapter, Thaler and Sunstein discuss how New York City adopted a law requiring fast-food chains to display the caloric intake of each of their foods. The authors applaud the preference of mandating information vs. mandating ingredients.

The Nudge: Many of us have experienced this nudge by reading the information in fast-food restaurants. It’s a powerful influence because it doesn’t pass judgment on an option; it merely states the impact of the decision. Making someone feel guilty for his or her unhealthy decisions over a lifetime won’t change behavior.

For far too long, health in our country has been marketed through fear. Given how unhealthy our country has become, it’s time for a change.

Health is hard, especially for seniors living with multiple chronic conditions, limited financial means, and often limited support from family and friends. We have to avoid talking down to people and painting dire scenarios.

At Humana, we’re responsible for the health and well-being of 14 million Americans; 3.3 million of them are Medicare Advantage members, and many of them are living with chronic conditions. I’ve seen firsthand how a nudge – not fear – from a physician, nurse or other care team member can help a person change behavior for the better.

Let’s build a healthier country with helpful nudges, not fear.

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As chronic medical conditions continue to rise in America, the problem is made worse by a “complicated health care delivery system that’s neither consumer centric nor easy to navigate,” said Dr. Roy Beveridge, Humana’s Chief Medical Officer.

He wrote an article for NEJM Catalyst, making the case for a more holistic approach to care.

“Fragmented. Inefficient. Episodic. These terms are frequently used to describe the U.S. health care system, which was not designed to handle the fact that three out of four Americans aged 65 and older are living with multiple chronic conditions,” Dr. Beveridge wrote. “If we want this system to effectively handle the chronic disease epidemic, we must evolve our clinical mind-set and fee-for-service reimbursement structure from the episode-driven ‘one-and-done’ system to a consumer-centered, integrated care approach supported by value-based reimbursement.”

He noted that Americans have developed unhealthy habits – like poor diets and a lack of exercise – that have fueled the growth of chronic conditions such as diabetes, coronary artery disease, congestive heart failure, and chronic obstructive pulmonary disease. Combatting that requires a fresh approach and more preventive care.

“The path to value must move beyond the transaction-driven, fee-for-service approach that has been the foundation of the U.S. health care system for decades,” he wrote. “Health care professionals must spend time educating and engaging their patients, and must be incentivized to do so in a value-based agreement. A value-based approach that builds a strong relationship between the physician and the patient and recognizes that health is local and happens outside the doctor’s office is the best approach to solving the chronic-condition epidemic of the 21st century.”

Read the full article here.

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Dr. Roy Beveridge, Humana’s Chief Medical Officer, recently spoke with The Pulse, a healthcare journal associated with the Wharton Health Care Business Conference. Dr. Beveridge will be speaking at the conference later this month, on a panel titled “The Other 50% of Health: Bending the Health Care Cost Curve via Wellness & Behavioral Economics.”

The pulse noted these key takeaways from their conversation:

• Payment mechanisms will be the driver behind changes in how the healthcare system approaches basic wellness (e.g., diet, exercise, sleep, stress). As we shift towards value-based care, the whole system has more incentives to promote wellness.

• Payers need stability in the populations they are covering so that there is a financial return to investing in wellness. It’s hard to invest a lot of time and money into someone’s long-term wellness if you’re only insuring them for a couple of years.

• Basic social factors, like your ZIP code or education level, can determine a massive part of your health and wellness, and payers need to partner with civic leaders and community organizations to improve the health of socially-disadvantaged communities.

“I practiced medicine for over twenty years, and I recognize that the engagement of the physician is crucially important,” Dr. Beveridge told the publication. “The medical world has switched from the fee-for-service (FFS) mentality to value-based care (VBC), which means that doctors are no longer paid just for a treatment, but for outcomes. This creates a huge change in doctors’ treatment plans for their patients, including a big focus on educating the patient; for example, helping them understand why taking insulin is important. The payment mechanism is driving this behavior change, and this behavior change is making people healthier.”

Read the entire interview here.

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Humana’s Sam Deshpande, Chief Risk Officer, spoke late last year to about our initiative to establish enterprise risk management and reimagine compliance at Humana.

Read the Q&A session here:

In Their Own Words
Humana’s New Exec Aims to Build Culture That Manages Risk

Humana Inc. in June signaled a new emphasis on risk management with the appointment of Sam Deshpande to fill the newly created position of senior vice president and chief risk officer (CRO), heading up the company’s new “chief risk office.” He is charged with establishing policy for enterprise risk management and building a risk strategy and a culture that manages risk, and reports directly to CEO Bruce Broussard. Deshpande comes to Humana from Capital One, bringing 28 years of compliance, marketing and strategy experience.

AIS Health recently caught up with Deshpande to ask about his new CRO role.

AIS Health: In the past, CROs have not always been part of senior management, but now more companies are seeing the value in that. How important do you think it is for health plans to have a CRO at the executive level?

Deshpande: The role of a Chief Risk Officer is relatively new in the health care industry. Businesses are continuing to become more complex and fast paced, and are increasingly leveraging technology and automation. While these changes are critical in delivering great service to our members, they bring an increased risk of large breakdowns that could spread quickly. Enterprise Risk Management organizations have emerged in many industries to identify and mitigate these risks posed by operations, technology, emerging regulations and other areas. The role of a CRO enables consistent oversight and mitigation of risks across the enterprise.

AIS Health: Humana says that as part of your role, you will “drive connections and collaboration throughout the business to ensure timely, proactive discovery and faster mitigation of risks and their causes.” How critical is this to a health plan like Humana?

Deshpande: Proactive discovery and faster mitigation of risks serves two critical goals — ensuring that our members receive an exceptionally high quality of service in every interaction,
and that any issues affecting them are identified and addressed quickly and consistently. The main challenge for our team is to create a system which manages risk prudently and, paradoxically, allows us to be nimble in the market — kind of like slowing down to speed up.

AIS Health: What have you tackled since starting in June, and what lies ahead in your immediate plans?

Deshpande: A big part of the journey to date has been about learning a new industry, getting to know Humana, my colleagues and my team. I am inspired by our CEO Bruce Broussard’s vision for Humana and the Bold Goal of making the communities we serve 20% healthier by 2020; and I am excited by the role Risk Management can play in making it come true. We have taken ground in designing the overall Enterprise Risk Management framework. As we get to the holidays, we are shifting gears from completing the design to building the system in 2018.

AIS Health: What is the top federal regulatory issue that keeps you awake at night — if any?

Deshpande: Our regulators and we have the same goal — ensuring that our members have consistently great access to care. While potential changes to regulations create the need to understand and implement operational changes, this is not something that keeps me awake at night (that credit goes to being the father of two incredible daughters).

AIS Health: You have two master’s degrees: one in business administration — with a concentration in finance and business economics from the University of Chicago — and another in aerospace engineering from Virginia Tech. Is there an interesting story behind that unique combination of degrees, and/or is keeping an insurance company from risk as hard as rocket science? (If so, that’s saying a lot!)

Deshpande: After getting my Master’s degree in Aerospace Engineering, I was lucky to get a dream job as an engineering consultant who got to work on NASA projects. The work was very imaginative but I was drawn to the fast-paced world of business. While hard to compare, I can honestly say that health care and rocket science are both uniquely challenging. An interesting development is that many of the machine learning techniques we were experimenting with in the early 1990s in aerospace engineering are now being broadly applied in consumer businesses like health care.

AIS Health: Since you are somewhat of a rare breed, as a chief risk officer, what advice would you give to others who hope to follow in your footsteps at other health plans?

Deshpande: It all starts with a great, talented, passionate team — if you get that right, everything else follows from that.

AIS Health: How do you see the role of chief risk officer evolving in the industry over the next five to 10 years?

Deshpande: I see the holy grail of risk management shifting from detection and mitigation of risks quickly to anticipating and preventing them. I take my inspiration from the airline
industry’s safety record. Excited to see how the emerging technology and machine learning turn “what’s possible” into “reality” over the next five to 10 years.

Contact Deshpande via Alex Kepnes, spokesperson for Humana, at

— by Diana Manos
— Dec. 11, 2017

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