Medicare Advantage

Dr. Roy Beveridge, Humana’s chief medical officer, has again been nominated as one of Modern Healthcare’s 50 Most Influential Physician Executives and Leaders of 2017.

Cast your vote for Dr. Roy Beveridge.
Voting is open through Friday, April 28.

For the second year in a row, Dr. Roy Beveridge is in the running for Modern Healthcare’s 50 Most Influential Physician Executives and Leaders. You can vote for him now by clicking here.

We’re proud of the work Dr. Beveridge does to champion Humana’s Bold Goal and integrated model of health care. He’s been instrumental in working with others to unite physicians, business and government leaders, community organizations, medical associations and academics around population health. The unified group looks at barriers that make health hard and works together to test solutions. Then, Dr. Beveridge, on behalf of the group, shares these solutions and research findings so others in the industry can learn from what we’re doing together to make health a little easier for people.

Check out an article he published last month on Forbes.com that focuses on why investing in improved health and longevity makes financial sense for our business.

About Dr. Roy Beveridge:
Dr. Beveridge is known for his thought leadership on population health, authoring numerous articles on a range of medical topics such as medical oncology, stem cell transplantation, integrated care delivery models and standardization of quality metrics. He is board certified in medical oncology and internal medicine, practicing for more than 20 years. He is a member of many societies, including American Medical Association, American Society of Clinical Oncology, and American Society of Hematology. Previously, he has served on many boards related to medical practice, quality metrics and patient advocacy. He currently serves on Health Care Payment Learning & Action Network guiding committee.

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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 — 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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Ten thousand people are aging into Medicare every day, and many of them are dealing with chronic conditions. To serve them best, health care has to evolve away from fee-for-service transactions and toward holistic, integrated, value-based care, Humana leaders say in a new video.

And that care has to extend beyond the doctor’s office, taking into account a person’s community and the many social determinants of health.

“If we are going to actually improve the health of these elderly patients, who will be us in not too distant future, looking at outcomes and being paid based on quality is something that we should all be motivated to do,” said Dr. Roy Beveridge, Humana’s Chief Medical Officer.

According to the Centers for Disease Control and Prevention, chronic conditions cause “7 of 10 deaths each year” and account for “86% of our nation’s health care costs.”

Addressing that will require a more integrated approach and more high-quality engagement between physicians and patients.

“I lost my father when I was young because he had a heart attack and previous to that, he had a stroke… and he didn’t know how to navigate the health care system,” Said Dr. Jimmy Fernandez, Chief Medical Officer, MCCI. “We thought by him going to the emergency room – him getting the care, he’d get the resources and help he needed and truth be told, it was one piece of the puzzle. He didn’t follow up with anyone, and in a short period of time, he died. I’m here to prevent that from happening to my patients.”

Focusing on value, rather than tracking only services rendered, can go a long way.

“Here at Humana we’re making really great progress on our value-based work,” said Mike Funk, Vice President in Humana’s Provider Development Center of Excellence. Results for 2015 “showed a 19% improvement in our quality…and a 20% overall improvement in cost compared to traditional Medicare.”

Watch the full video here.

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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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Health plans and providers should work together because “the emerging winners in the healthcare space will be those who collaborate and engage in the nudge toward value-based care,” according to an article in Managed Healthcare Executive.

Humana Chief Medical Officer Roy Beveridge, M.D., and Oak Street Health CMO Griffin Meyers, M.D., spoke with the publication about navigating the transition.

“As the health industry transitions toward value-based care, Humana is collaborating with organizations such as Oak Street Health to provide quality care for members,” Dr. Beveridge said. “Value-based care generates improved clinical results, quality care and impressive patient engagement. Health plan and provider collaboration fundamentally supports high-quality value-based care, and creates a beneficial partnership.”

You can read the full Q & A here.

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