health-care system

Humana has released its “Bold Goal – 2017 Progress Report,” showing the strides the company has made – along with physicians and local community nonprofit, government and business partners – toward improving the health of the communities it serves nationwide.

As stated nearly two years ago, Humana’s Bold Goal is to make the communities it serves 20 percent healthier by 2020 by making it easy for people to achieve their best health.

The latest numbers show that nationwide, more people are experiencing Healthy Days, a U.S. Centers for Disease Control and Prevention (CDC) measurement that reveals how a person is feeling holistically, including his or her mental and physical health. The report shows a 2 percent improvement in Healthy Days on a national basis among Humana’s membership.

Humana continues to work with targeted Bold Goal communities to support local public health and care-intervention programs. This collaboration has helped improve Healthy Days by a margin of 3 percent in these communities. Six of Humana’s seven Bold Goal communities have seen improvements in Healthy Days.

And Humana’s 50,000 associates (employees) are still on track to improve their overall Healthy Days by 20 percent by the end of 2017. Associate experiences found to be particularly successful will be replicated in local communities.

Creating lasting behavior change in the communities Humana serves requires highly local and holistic care solutions that focus not just on clinical measures but social determinants of health. This demands a deep understanding of the fabric of local communities.

This approach, which Humana has emphasized in its Bold Goal communities, specifically addresses how social determinants such as food insecurity, health literacy and transportation can significantly impact an individual’s health.

Collaborating with local entities has been key, and the latest report details Humana’s work with physicians and community partners in places such as San Antonio, Louisville, Tampa Bay, Broward County (Florida), New Orleans, Baton Rouge and Knoxville.

San Antonio, Humana’s first Bold Goal community, experienced a 9 percent decrease in the number of Unhealthy Days, partly by addressing barriers to health in the community such as food insecurity and limited access to behavioral health services. Through a telepsychiatry pilot program and food insecurity screening implemented in primary care offices, these health barriers were directly addressed. Improvements in diabetes management were also achieved through collaboration between Humana, the San Antonio Health Advisory Board and the American Diabetes Association.

The community of Tampa Bay, one of Humana’s largest Bold Goal communities, has been working to address the issue of food insecurity through initiatives led by primary care physicians. The Tampa Bay Health Advisory Board and Humana, in partnership with Feeding Tampa Bay, the University of South Florida and other community partners, developed the Hunger Action Alliance to confront this issue.

In Louisville, Humana and community partners addressed respiratory illness, depression and behavioral health, including the Bold Moves Against Suicide Summit, which brought together more than 200 thought leaders, physicians and community partners to address the issue. While Louisville has the fewest number of Unhealthy Days compared to other Bold Goal communities, the city did not see an improvement in Healthy Days from 2015 to 2016. Humana has a number of initiatives planned for 2017, including intervention programs in partnership with the Louisville Health Advisory Board, to help accelerate Louisville’s progress.

Through its Bold Goal program, Humana has found that making communities healthier demands an integrated approach.

“Improving the health of an entire community is difficult, and no one person or organization can do it alone,” said Bruce D. Broussard, Humana President and CEO. “The progress we’ve made is encouraging, and we owe a large part of that success to the many different physicians and community members who have come together to make Humana’s Bold Goal a reality. Putting a stop to preventable diseases and improving the health and the lives of the people we serve are efforts worth fighting for, and we will continue to take what we’ve learned to add more Healthy Days into people’s lives.”

This year, the company is expanding the Bold Goal to other communities, focusing on strategies with the most impact on health outcomes. Humana plans to quickly determine what initiatives are effective and then scale them to achieve a community-level impact on health and Healthy Days.

Read the full report here.

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Humana has again been honored by Becker’s Healthcare and is among the “150 Top Places to Work in Healthcare” for 2017. The list “recognizes hospitals, health systems and organizations committed to fulfilling missions, creating outstanding cultures and offering competitive benefits to their employees”

“The organizations included encourage professional development among their employees and promote tomorrow’s leaders,” Becker’s says. “Many members of this list have implemented employee recognition programs, mentorship and offer competitive benefits. The organizations coordinate employee and family outings as well as volunteering opportunities and provide community support.

“The Becker’s Healthcare editorial team determined the organizations included on this year’s list. Organizations were able to submit nominations, and final decisions were made based on previous recognitions, awards, employee benefits, culture and workplace excellence. The editorial team also considered diversity, employee satisfaction and retention when developing the list.”

You can see the Humana page here.

Read the full list 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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It’s common for people to look at New Year’s Day or birthdays as a chance to start a healthy behavior. But do those behaviors last? Humana recently conducted a study to test if these “fresh start days” were an opportunity to help people improve their medication adherence.

We partnered with researchers from Washington University in St. Louis and the University of Pennsylvania for the first-ever randomized controlled trial to test whether sending medication reminders around the time of fresh-start dates could boost their effectiveness.

Contrary to our expectations, the study found that reminder letters sent near fresh-start dates did not increase medication adherence. Even framing the fresh-start dates as an opportunity for positive changes did not increase reminder effectiveness, according to the study, which was published in the medical journal JAMA Cardiology.

“Medication adherence is a crucial issue when it comes to population health,” said William Fleming, president of Humana Pharmacy Solutions. “Finding what doesn’t work, can help us make progress towards finding what does work to improve medication adherence.”

The researchers, led by Hengchen Dai, PhD, of the Olin Business School at Washington University in St. Louis, contacted more than 15,000 Humana members to encourage them to take their cholesterol, diabetes, or blood pressure medications. These people were under commercial or Medicare Advantage programs and has 40-80 percent medication adherence during the previous 12 months. Some were sent reminder letters the week of their birthdays. Others were sent reminder letters three weeks after New Year’s Day. A control group was sent the reminder letters on a random day.

Researchers used pharmacy refill history to see how frequently people filled their prescriptions in the 90 days following the reminder. Contrary to our initial hypothesis, the people who received the Fresh Start reminder letters didn’t show a statistically significant improvement in their adherence compared to a control population. The timing of the reminder made no difference.

The study authors encourage further study be undertaken on how the psychology of fresh starts relates to medication adherence.

“Finding effective ways to improve members’ ability to take medication as prescribed has the potential to dramatically improve the health of individuals and communities,” said Laura Happe, director of Research and Publications at Humana. “Research like this is crucial to helping Humana serve its members while also contributing to the larger body of knowledge regarding population health.”

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New research by Humana and Boehringer Ingelheim Pharmaceuticals Inc., a global pharmaceutical company with nearly a century of experience in respiratory health, will make it easier for physicians to help Humana members adhere to their medications.

The two companies have announced the publication of a new study showing an association between non-adherence to medications for many chronic diseases and non-adherence to COPD medications. This new study was published in Volume 12, 2017, of the academic journal, International Journal of COPD.

“These findings are important, because they help guide physicians on how best to support COPD patients with historically low adherence in taking their medications so they can achieve optimal health outcomes,” said Dr. Andrew Renda, M.D. MPH, Bold Goal Director for Humana. “Rather than focus on the number and type of comorbidities with COPD, holistic adherence improvement efforts should address access, affordability, and most importantly, education on how these medications improve symptoms and quality of life while reducing the risk of exacerbations.”

COPD is a progressive respiratory disease characterized by increased breathlessness, frequent coughing, wheezing and tightness in the chest. Although there is no cure for COPD, healthcare providers often choose to prescribe daily maintenance medications to treat symptoms and reduce the risk of exacerbations, which are a sudden onset of COPD symptoms that can lead to hospitalizations or even death.

Read the news release here.

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