Covid-19 has forced us all to innovate at every level. We would be wise to take the time to recognize and preserve those innovations — especially as they relate to value-based care.

The following is excerpted from an article in NEJM CatalystA Flower Blooms in the Bitter Soil of the Covid-19 Crisis — by authors Jaewon Ryu, MD, JD, President and Chief Executive Officer, Geisinger; Kristin Russell, MD, MBA, Medical Director, Humana; and William Shrank, MD, MSHS, Chief Medical and Corporate Affairs Officer, Humana.

“The rate of innovation in health care during the Covid-19 crisis has been extraordinary. The percentage of physicians using telehealth has soared from less than 20% 2 years ago to almost 50%1 today and an estimated 1 billion visits will occur virtually this year. When the need arose, clinicians quickly learned how to sterilize personal protective equipment and the U.S. Food and Drug Administration rushed to approve the technique. Ventilators have been rigged so they can be shared while research studies are completed — from ideation to publication — within weeks. And we are caring for patients where they are — in their homes — with remote monitoring, triaging health bots, and in-home hospital care.

“Examples abound, and the remarkable pace of progress has been a bright spot amidst the tragedy. In addition to celebrating this, we should think proactively about whether there are lessons that we can apply to other health care challenges. Although the need to decrease costs and waste in the health care system lacks the drama and immediacy of the current crisis, it is more essential than ever that we do this, and that we do it quickly.”

Read the full article here.

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Health happens continuously, 365 days a year, in every area of a patient’s life — most of which is outside of the doctor’s office.

Despite the development of multiple, standardized means for screening patients for social determinants of health (SDoH), leaders with health care practices across the country still spend significant time trying to decide which factors to include in such screenings, according to a new report by the Medical Group Management Association (MGMA) in partnership with Humana.

The report, “Painting a Bigger Picture of Patient Well-Being: Opportunities and Challenges in Screening for Social Determinants of Health,” found that SDoH screenings can be personal and include information patients may not relate to their health or may not want to share, oftentimes turning into case-by-case interactions without static, consistent evaluation criteria.

The report shares examples of how practices honing their efforts can:

  • Develop an appropriate SDoH screener for patients. Most practices surveyed – 59% – rely on nurses and medical assistants to conduct screenings.
  • Implement screeners into the practice’s workflows. While 61% of practices screen through electronic health records systems, many (16%) still obtain information via paper-based methods.
  • Communicate and engage with their patients to capture accurate data. Adequate training adequately can help staff effectively communicate why accurate SDoH information is important for the practice’s ability to provide better care for the patient.

Spotlighted practices, including some that see Humana-covered patients, weigh in on how they’ve overcome challenges in operationalizing SDoH screenings and where opportunities exist.

“We are able to successfully adapt and craft quick solutions to address the clinical and social needs of our most vulnerable members,” said Caraline Coats, Vice President, Bold Goal and Population Health Strategy. “We are at a time when our work has not mattered more. What we do, who we serve and how we can make a difference are all top of mind every day.”

Some medical practices began their work in SDoH by addressing a specific issue they noticed in their patient population. For example, Hatfield Medical Group in Arizona piloted a program to address patients who did not have adequate transportation and would miss appointments.

“We didn’t call it social determinants of health back then,” said Jim Schafer, vice president of health services at Hatfield. “We just called it, ‘the patient needs to be here.’ We just want to ensure access to care. How do we overcome this barrier? (Patients) need to be able to see their provider.”

Whether a medical group practice is dealing with patient transportation needs or the effects associated with homelessness, food insecurity, domestic violence or other matters, recognizing issues facing patients is a starting point for determining how to gather data from them, according to the report.

Humana routinely partners with professional organizations such as the MGMA on research to obtain important health care provider perspectives and guidance about topics relevant to their practices and patients. 

To download and view the full SDoH report, click here.

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The seismic disruption of the COVID-19 pandemic – and the rapid innovation needed to meet the moment – have permanently changed health care in ways that will make it more convenient, more accessible and more holistic, according to Humana President and CEO Bruce Broussard.

Broussard spoke during the Virtual Summit on Health System Recovery from the COVID-19 Pandemic, which assembled dozens of the nation’s top health care leaders in a first-of-its-kind event. Via virtual panels and interviews, participants discussed strategies to recover from the pandemic and the mid- and long-term implications to the future of health care in America.

Broussard was interviewed by the Summit chair, Susan Dentzer, Senior Policy Fellow, Duke-Margolis Center for Health Policy, Former Editor in Chief, Health Affairs, Former Health Correspondent, PBS NewsHour, Washington, DC.

You can watch their conversation here.

Humana has a broad role to play in this transition, he said, noting the company’s efforts to coordinate telehealth visits, provide safe home visits, make sure prescriptions are uninterrupted, and provide food to those in need. He also spoke of efforts to provide financial security by waiving numerous co-pays, co-insurance and deductibles for members.

“We’re helping them engage where they are, at home, helping them feel comfortable with the health care system, encouraging them that there is safety there, reducing the financial burden that can come from this, and continuing to work with providers to connect them with our members.”

Virtual care has rapidly transformed the landscape for the better, he said.

“I think we’re here to stay. I think telehealth is going to continue to find more and more applications in the delivery of care. We find it virtually, but also in the assisted part, where a nurse can go into a home and conduct a full physician visit – specialty or primary care – with the oversight of a physician. The ability to provide that in someone’s home is convenient. You don’t have to worry about transportation, scheduling and other complexities.”

He said such advances must apply to all aspects of health, including behavioral health stresses like loneliness, depression and social isolation. And he praised the Centers for Medicare & Medicaid Services (CMS) for quickly granting waivers that improved access to telehealth.

Broussard noted that the pandemic has highlighted the problems of a health care system that runs on volume, exposing the flaws of the fee-for-service system and showing the need for value-based payment models.

“I think we have a big obligation” to seize this moment, he said. “We are big believers in having aligned interest in health and cost, and value-based payments make all the sense in the world. Today about 60 percent of our members are in some kind of value-based payment model. Any time a provider wants to move to that, we’re here to help them.”

He acknowledged the financial strain on providers, and Humana’s bid to help, as elective procedures were canceled during the pandemic and people stayed away from doctors’ offices. “We’ve accelerated about a billion dollars of payments to providers to ensure that they can make it through this,” he said.

In closing, Broussard said the pandemic had inspired Humana employees to rally together, to innovate and work harder for the people the company serves.

 “The most impactful thing for us as an organization is keeping the customer and the provider at the forefront,” he said. “That has been a great uniter for our associates and teammates in the company, has been a great way for us to make decisions, ensuring that the people we serve every day are taken care of. The decision-making around that has been our North Star.”

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From the racial disparities exacerbated by COVID-19 to the recent spotlight on systemic racism in the United States, it’s never been more clear that we need to discuss racial inequity, especially as it relates to health. Moderated by Dr. Andrew Renda, MPH, Associate Vice President of Bold Goal Population Health Strategy at Humana, Humana’s third National Press Club virtual panel convened Dr. Patrice A. Harris, Immediate Past President of the American Medical Association; Humana’s Chief Medical and Corporate Affairs Officer Dr. William Shrank; Dr. Brandy Kelly Pryor, Senior Director of Programs at The Humana Foundation; and Shantanu Agrawal, MD, President and Chief Executive Officer, National Quality Forum, for a conversation on the health impacts of racial inequity and racism.

“The conversations we have now and the actions we take will shape our path forward,” said Dr. Renda before he introduced the panel. “We all have biases from our life experiences. To get beyond them, we need to have difficult conversations, we need to listen and learn from different opinions, and we need to make positive change.”

Dr. Harris agreed with Dr. Renda, arguing that “The current COVID-19 pandemic has brought many issues into stark reality, two of them being health inequalities and mental health. Any conversation, debate, discussion we have about health that doesn’t include equity or mental health is incomplete. Any solutions that don’t address the broader causes of health inequities is incomplete.”

According to Dr. Agrawal, it’s clear that there are structural elements of our society that affect the health outcomes of different populations. “We can see over the last 20 years a march toward improvement among a number of different quality measures, and yet, there is demonstrated data to show that these racial and ethnic minority populations – particularly African Americans and Latinos – are lagging behind the overall general improvement in quality and quality outcomes,” he said. 

Dr. Pryor discussed the Humana Foundation’s focus on health equity and the importance of its funding toward addressing the social determinants of health, such as food security, social connectedness, and sustaining employment. Last year, The Humana Foundation invested $7.6 million with 12 local organizations across eight Bold Goal communities to address these social determinants. “At the Humana Foundation, we’re focusing on health equity and how we get specific about the social determinants of health.” said Dr. Pryor. “What were the policies, procedures and practices that allowed the isms in our community to flourish in the way that some do not have the same social needs as others and those disparities between their needs are creating different life outcomes and expectancies? So when we’re talking about the funding that we give through the Humana Foundation, it really is a life or death situation.”

Emphasizing Humana’s commitment to addressing the social determinants of health, Dr. Shrank noted Humana’s Bold Goal set in 2015 to improve the health of the communities we serve by 20% by 2020. “Over time we’ve been able to make a difference, and this year we’ve had considerable improvements in healthy days in every one of our Bold Goal communities,” said Dr. Shrank. “The events of the last month have really highlighted the fact that this can’t be an implicit process, and we can’t just focus on social determinants and believe we are addressing the holistic nature of the problems we’re seeing in society today. We need to be explicit about measuring health disparities and assessing the structural racism and pursuit of health and happiness in our membership and all Americans.”

Humana is committed to working alongside our partners to address the health disparities disproportionately affecting Black and Latino communities. These difficult conversations must spur action.

Watch the full conversation here.

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Humana has released its “2020 Bold Goal Progress Report,” which details the company’s progress in its ambitious population health strategy — launched in 2015 — to improve the health of the communities it serves by 20 percent by 2020. The progress report, which can be accessed by clicking here, details the ongoing efforts to help address the impact that social determinants of health and health-related social needs, such as food insecurity and loneliness, have on the physical and mental health of the Medicare Advantage population.

  • Forbes reported the news, noting that the work “to improve the health of seniors in private Medicare plans through better management of patient populations continues to show improvement five years into the effort.”
  • The American Journal of Managed Care published a front-page story.
  • And FierceHealthcare has also posted a front-page story.

While the report focuses on Humana’s continued Bold Goal efforts in 2019, Humana President and Chief Executive Officer Bruce Broussard said the recent public health crisis of COVID-19, and the spotlight on systemic racial inequities, shows more than ever the need for personalized care for each of our members.

Highlights of the report include:

  • Humana Medicare Advantage members experienced an additional 816,000 Healthy Days
  • Bold Goal communities such as Baton Rouge, Knoxville, New Orleans, San Antonio and Tampa experienced more Healthy Days
  • 2.6 million social determinant screenings performed across Humana membership

Read the full Humana news release here.

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