senior health

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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In 2015, Humana committed to a Bold Goal to improve the health and communities it serves 20 percent by 2020 by making it easier for people to achieve their best health. Humana is working with local physicians and community organizations to address physical and mental health conditions as well as social determinants of health (food insecurity, social isolation and loneliness) in seven Bold Goal communities. Four of these communities demonstrated improvements in health over the past year.

Humana measures Bold Goal community progress using the U.S. Centers for Disease Control and Prevention (CDC) population health management tool known as Healthy Days, which takes into account the whole person by measuring both mentally and physically Unhealthy Days over a 30-day period.

• Bold Goal markets, on average, managed to reduce their number of Unhealthy Days. Knoxville, Tennessee; Baton Rouge and New Orleans, Louisiana; and San Antonio, Texas all had improved Healthy Days as well as improved clinical outcomes. Humana attributes this, in part, to strong relationships between physicians, communities and patients.

• Seniors living in Bold Goal communities continued to make improvements in physical and mental health. Despite the fact that many of these Medicare members are living with multiple chronic conditions, a reduction in Unhealthy Days was achieved.

• Humana employees reduced their number of Unhealthy Days, improving overall by 18 percent. Over the past five years, Humana employees were able to gain 1.8 million more Healthy Days in total.

Read the full 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 — 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 — 5 Lessons from Davos — is reprinted below. To see all of his blog posts, click here.

To help my company reach its bold goal – to help the communities we serve be 20 percent healthier by 2020 because we make it easy for people to achieve their best health – I spend a great deal of time in these communities. I want a localized, firsthand understanding of the best practices that my company can take to address and solve health challenges.

I’m an avid reader and a strong believer in lifelong learning. I also think leaders should look for new venues to gain perspective from those outside their immediate circles but facing similar obstacles. That’s what led me to Davos, Switzerland, last week for the World Economic Forum (WEF).

At WEF, I connected with a wide variety of leaders in government and business from around the world. I participated in a panel – “The New Health Paradigm” – where I discussed addressing chronic disease progression and how the value-based payment model can support the member experience. As a member of WEF’s Health and Healthcare Governors Community, I also spoke about my company’s role in its Atlanta Heart Failure Pilot program, which is designed to improve how congestive heart failure is treated in the Atlanta region.

Listed below are some of my lessons learned and takeaways from Davos:

1. We have many reasons to be optimistic about 2018. It was uplifting to see how leaders from a wide variety of industries are making, or planning to make, strategic investments. For example, a recent survey by PwC found that “for the first time since we began asking the question in 2012, the majority of CEOs surveyed believe global economic growth will ‘improve.’ In fact, the percentage of CEOs predicting ‘improved’ growth doubled from last year.”

My takeaway: It’s an exciting time to be driving change in health care. The euphoria can be scary, because it raises expectations. But the biggest risk is taking no risk at all.

2. Technology is rapidly disrupting industries, even as the world tries to coexist with technology. From social media giants dealing with fake news, to the auto industry being disrupted by self-driving cars, companies are dealing with challenges that will reshape how they operate. Technologies like artificial intelligence (AI) will reshape the world and force companies to cross boundaries that they have not previously considered.

My takeaway: Be prepared to disrupt your company before someone, or some entity, does it to you. AI is going to change the way work is done, and we must help people learn new skills to adapt to this new normal.

3. Balance capital returns with sustainability. I had numerous conversations about the letter that BlackRock CEO Larry Fink sent to CEOs a week before the conference. In his letter, Fink wrote that “society is demanding that companies, both public and private, serve a social purpose. To prosper over time, every company must not only deliver financial performance, but also show how it makes a positive contribution to society. Companies must benefit all of their stakeholders, including shareholders, employees, customers, and the communities in which they operate.”

My takeaway: You don’t have to be a CEO to understand that social purpose is critical to long-term sustainability for any company. In a 21st century environment, all of the core audiences must benefit in order to balance capital returns with sustainability.

4. Davos is a unique place that draws a diverse group of people and cultures. I struck up a conversation at dinner one night with a diplomat from Oman who had been coming to Davos for 25 years. He had a fascinating story: his parents were killed when he was 5 years old, he spent the next 15 years in an orphanage, and he went on to be a fisherman in Alaska. After attending the University of Michigan, he made his way to Oman. During our chat, I thought about how Indian Prime Minister Narendra Modi’s keynote highlighted how Davos is one of those unique places that brings a diverse group of people together to work on issues that have world, business and social consequences.

My takeaway: Davos helped me see the resiliency and the passion that attendees have for solving the world’s social, business and political problems. At an event like this, you can see problems through others’ eyes. If we’re going to unite to solve the world’s problems, forums like Davos – which thrive on diversity and perspective – must become more frequent.

5. Health care has an exciting future, but technology will only take it so far. It was enlightening to see the passion that leaders from across the world harbor for building a healthier world using technology. Establishing standards in data exchange will help facilitate the widespread deployment of easy-to-access electronic medical records. And telemedicine might vastly improve health in India, where care is not easily accessible.

My takeaway: We all welcome technology that improves care, but the decades-old fee-for-service system that creates billions in waste must end. Payment reforms like value-based care – which reward physicians and clinicians for the health of the patients they serve, not the number of services they provide – will be a key element in this transformation.

While Davos is the premier gathering of world leaders, it is only four days out of the year. It’s up to us to keep the momentum and excitement going – in research labs, in boardrooms, in schools and other venues.

Leaders must channel the power of optimism to build a purpose-driven business strategy, one with long-term sustainability that goes beyond the profit model.

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