Medicare Advantage

Forbes.com has taken note of Humana’s Bold Goal progress and the importance of addressing social determinants of health to improve well-being.

“A project by health insurer Humana to measure the health of Medicare beneficiaries by asking two simple questions about mental and physical health made progress last year in four of seven cities across the country,” the Forbes story noted. “Humana’s ‘Bold Goal’ initiative uses measures established by the Centers for Disease Control and Prevention to track an individual’s physical and mental ‘unhealthy days’ over a 30-day period.”

The story cited the 2018 Bold Goal Progress Report, which found that “Of our original seven Bold Goal communities, Humana Medicare members in Knoxville, Baton Rouge, New Orleans and San Antonio all had improved Healthy Days as well as improved clinical outcomes. Louisville, Tampa Bay and Broward County, Florida saw increases in unhealthy days, but also experienced slight improvements in clinical outcomes and in Healthy Days in Humana seniors living with conditions such as COPD, diabetes and depression.”

The story also noted that “the effort takes time and involves addressing social determinants of health going into communities with town hall meetings and addressing issues like ‘food insecurity’ or whether residents are isolated with mental illness. In the report, Humana describes social determinants as ‘conditions in the places where people live, learn, work and play (that) affect a wide range of health risks and outcomes.’”

Read the full story 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 — 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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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 seniors can beat “diseases” like loneliness and social isolation — is reprinted below. To see all of his blog posts, click here.

Tivity Health, Inc. (NASQ: TVTY) Chief Executive Officer Donato J. Tramuto and I recently teamed up to draft the following blog post.

Health is personal. You might tell yourself that you alone have the power to make the lifestyle changes to eat better, exercise or meditate.

But getting healthy doesn’t have to be a solo act, because many of us face the same challenges. Individual resolve is important, but momentum is best maintained when we have a friend to encourage us to stay the course.

For many of us with active lives, it’s easy to find people like ourselves, whether it’s at work or through a social activity. But if you’re a senior who is lonely or socially isolated, it’s not easy to find encouragement and change your health.

Seniors face many health challenges that are not just medical

American seniors face significant health challenges. Many of them are living with multiple chronic conditions they may have for the rest of their lives, from diabetes to congestive heart failure. They may be on a fixed income, struggling to pay for prescription drugs.

Despite these challenges, there is also positive momentum in aging. Advances in science are helping America’s seniors live longer and stay active. For example, the Centers for Disease Control & Prevention say life expectancy in the U.S. is 78.8 years, and that could rise.

While seniors are living longer, there are other issues that can affect their health. For example, take the impact of loneliness on seniors. One study found that “loneliness has an equivalent risk factor to health as smoking 15 cigarettes a day, shortening one’s lifespan by eight years.” Research has also shown that social isolation can limit a senior’s ability to improve their health. For example, “6 million adults 65 and older have a disability that prevents them from leaving their homes without help.”

Living with chronic conditions is hard enough. When a senior does not have a support network of friends and family – people to socialize with and share common interests – the will to improve one’s health can be compromised.

As the leaders of Humana and Tivity Health, we’ve had decades of experience helping the senior community. We’ve found that the secret to improving their health is simplicity. It starts by offering them a platform to engage in activities that not only make them healthier, but help them connect with others.

Bringing people together helps improve health

At Humana, we’re helping more than 3.3 million Medicare Advantage members nationwide age with optimism, an approach that goes beyond conventional clinical treatments. Many of our members are living with chronic conditions, but they are more active than previous generations. For Tivity Health, which manages SilverSneakers®, we’re helping millions of people age into Medicare.

Our experience has taught us that social engagement leads to sustainable change. SilverSneakers® memberships, available through countless Medicare Advantage programs, give seniors access to a nationwide network of physical locations, as well as community centers, parks and social locations, where they can meet other people and engage in fitness classes specifically designed for their demographic. One survey found that “49% of active members said they were motivated to continue exercising because they had a friend in the program.”

And it’s more than just walking. SilverSneakers offers a wide variety of exercises and intensity levels, from dance classes to yoga sessions, as well as conventional cardio and weight-focused classes. SilverSneakers has entered into partnerships with more than 14,000 fitness locations nationwide as well as at Humana Guidance Centers. At Humana, SilverSneakers is included at no additional cost to the 3.3 million Humana MA members across the country.

SilverSneakers is a key element of many Humana Medicare Advantage plans because the proactive program takes a holistic approach to capture the senior’s complete health, not just the clinical.

In MA, we take a coordinated care approach, working side-by-side with providers who are in value-based reimbursement models with Humana. That means these providers are reimbursed for the health outcomes of our members (their patients), not just the services they provide. Programs like SilverSneakers perfectly align with the health-focused nature of Medicare Advantage.

Let’s learn from common purpose

The resolve to improve one’s health starts from within, but success requires perseverance and encouragement from friends and others who share the goals. Today, millions of seniors are not getting that support because they are socially isolated or lonely, and this has had a significant impact on their health.

Helping these seniors improve their health and well-being does not always have to start with a prescription or a visit to the doctor. Platforms such as SilverSneakers, supported through Medicare Advantage programs that emphasize health outcomes, can give seniors the social support they need and connect them with others who share a common purpose. This camaraderie ensures that seniors are not alone in their health journey.

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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 — Who are the forgotten soldiers of health care? — is reprinted below. To see all of his blog posts, click here.

If I were to ask you about the forgotten soldiers of health care, you might think about hard-working nurses and clinicians, or the ER staff that works diligently through the night. While these professions are absolutely critical to our nation’s health care system, my thoughts go closer to home, to family.

Think about how difficult it is to care for someone who is over 65 and needs assistance at home. Whether it’s managing multiple medications or monitoring blood-sugar levels, in-home care for an older person living with chronic conditions takes a team approach.

Primary care physicians can quarterback care and coordinate among specialists, and nurses can make sure care is efficient and consistent.

But beyond the traditional doctor/patient relationship, there is a forgotten soldier. This person is not a doctor or a nurse or a licensed care professional. Many times the person does not work in the health care industry. But they have the most unbreakable bond with the patient: They are family. That person is the caregiver.

And this was reinforced for me during a recent visit to Houston.

Meet “George”

While I was in Houston, I was fortunate enough to participate in an in-home visit with one of our members, “George.” I also met his wife, “Mary,” their daughter, “Beth,” and several members of George’s clinical team.

George is 71 years old and is in a Medicare Advantage PPO plan. He lives with multiple chronic conditions, including coronary artery disease and hypertension, and he has undergone a coronary artery bypass.

Living with these multiple chronic conditions is not easy for George, and it also takes a toll on Mary and Beth. Treating these conditions requires a holistic approach.

For example, Humana and our partners — physicians, nurses and clinical care experts — help care for George in a number of ways. He receives occupational therapy to strengthen his upper extremities and fine motor muscles, and physical therapy, primarily for his lower extremities and gross motor muscles. Under the direction of a care professional, George also receives support for personal care and activities of daily living, like feeding, showering, dressing, etc.

The Sit Down

Both George’s nurse and his therapist led the visit. His wife and daughter were there, too.

From the start, it was evident that the nurse and therapist had a strong, personal bond with George, Mary and Beth. The nurse and therapist, both of whom I could see were an unofficial extension of the family, understood the critical care and emotional support that Mary and Beth provided to George.

At the end of the 30-minute visit, I asked George what was most important about the care he received. He said he appreciated help from people with a positive attitude; he liked the quality of the interaction and not being “rushed;” and he noted the dependability of the team members, who always show up and follow through.

The care team benefitted too, enhancing their already deep, holistic understanding of George and reinforcing the bond of trust. It was clear to me that this care team – family and clinical – had been making a difference in George’s life, and that he was thankful.

The Importance of Caregivers

November is National Family Caregivers Month, a time to recognize the critical care provided by approximately 43.5 million caregivers. Their work had an estimated economic value of $470 billion in unpaid services in 2013. And with the senior population growing, many of us are going to find ourselves in the shoes of Mary and Beth – as caregivers.

These forgotten soldiers of health care will help determine how well America copes with the rising tide of chronic conditions. I’m encouraged, having seen firsthand how Humana’s Caregivers Network Resource Group is providing resources for our employees caring for family members and other loved ones.

While George has a very strong clinical team and family support network, there are many members who are not as fortunate. They are socially isolated and don’t have family to turn to for care. Their children may live in different cities. They might not have close relatives or friends.

This is the challenge, and we must be prepared.

It’s only going to become more common

In the caregiving world, relationships matter. Technology can help, maybe by building caregiver networks to identify people who have the time to help. But it’s not going to change health.

Technology is not a substitute for trust between two people. Basic human interactions can’t be replaced with a robot, an app or some other form of technology. It’s the low-tech and human efforts that are most impactful.

Our front-line associates know they can have an impact on the health, well-being and experience of our members. They are in this together, and they know it takes a team built on trust, empathy and emotion to make life better.

Mary and Beth are the unsung heroes, the forgotten soldiers of health care. They have an amazing impact on the people they care for, and on our health care system. You may also get the call – as a wife, daughter, husband or son – to be a caregiver. We need to ensure that we’re all prepared to receive this call, and to act on it.

 

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