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.

Read Full Article

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.

Read Full Article

Humana has ranked No. 2 in its industry – the company’s highest-ever ranking – in Fortune magazine’s 2018 listing of the World’s Best and Most Admired Companies. Humana was No. 3 last year in the category of Health Care: Insurance and Managed Care.

The Fortune annual ranking is the worldwide gold standard for the measurement of corporate reputation. Humana ranked No. 1 in the category of Social Responsibility, and also ranked high in areas such as Innovation and People Management.

To conduct the survey, Fortune and partner Korn Ferry started with about 1,500 candidates: the 1,000 largest U.S. companies ranked by revenue, along with non-U.S. companies in Fortune’s Global 500 database that have revenues of $10 billion or more. The list was pared to the highest-revenue companies in each industry, a total of 680 in 29 countries. The top-rated companies were picked from that list of 680.

To determine the best-regarded companies in 52 industries, Korn Ferry asked executives, directors, and analysts to rate enterprises in their own industry on nine criteria, from investment value and quality of management and products to social responsibility and ability to attract talent. A company’s score must rank in the top half of its industry survey to be listed.

Read Full Article

As the world’s population ages, and chronic conditions become epidemic, healthcare leaders around the world “must shift from reactive, episodic care to managing health holistically, where the focus is helping people change their lifestyles so they can live healthier lives,” Humana President and CEO Bruce Broussard wrote in a World Economic Forum blog post.

Bruce’s blog, in advance of this year’s World Economic Forum Annual Meeting, noted that for decades health professionals have reacted to health problems, rather than addressing their causes.

“America’s costly, fragmented healthcare system, known for isolating and confusing people, is not sustainable in managing a growing population of ageing people living with chronic conditions,” he wrote.

“But it’s not just a US problem. The global population of the oldest seniors, 80 years of age or older, is expected to triple, to 446.6 million people, by 2050. Combined with the 50% of the world’s population that lives with chronic diseases today, this will certainly challenge healthcare systems around the world.

“Healthcare leaders worldwide must shift from reactive, episodic care to managing health holistically, where the focus is helping people change their lifestyles so they can live healthier lives.”

He offered suggestions to hasten change, from addressing the social determinants of health, to moving toward value-based care, to adopting interoperable workflows and systems. Together, such initiatives can slow chronic disease progression across the world.

Read the entire blog entry here.

Read Full Article

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.

Read Full Article