Bold Goal

Integrating patient care and social determinants of health (SDoH) — the conditions in which people are born, grow, live, work and age – is vital to improving population health, according to a recent article in Managed Healthcare Executive that uses Humana’s work as an example.

The author spoke with Humana’s Caraline Coats, MHSA, vice president of Bold Goal and Population Health Strategy, and Andrew Renda, MD, MPH, associate vice president of population health.

Humana “has made strides in incorporating SDoH into their population health strategies with their Bold Goal initiative, a unique program to help better care for patients with chronic medical conditions,” the article said. “Humana aims to improve the health of the communities they serve by 20% by 2020. Part of that strategy is considering SDoH factors like food insecurity and social isolation in their population health programs.”

“We understand that food insecurity, social isolation, transportation security, and housing are all directly related to health,” Andrew said.  “This program allows us to bring those things into the mainstream of healthcare so we can start treating SDoH for what they are—clinical gaps in care.”

Caraline said healthcare has been too medically focused for too long. “Today, as an industry, we only spend 4% of every healthcare dollar on social health. Everyone knows it’s important to health outcomes, particularly the clinicians. But we needed to find a way to provide the data and resources providers needed so they could treat social health factors too.”

The article said, “After only a few years, Bold Goal is seeing clinical gains. The integration of SDoH information helped to increase the number of self-reported “healthy days” by Medicare Advantage members in Humana communities by 2.7 days. While 2.7 days might not seem like much, Medicare Advantage beneficiaries in communities who did not participate in the Bold Goal program saw a decrease of 0.6 healthy days for the year.”

Read the full article here.

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Imagine going to get your hair done and also being able to get your blood pressure checked at the same time at no extra cost. It is possible now at 15 salons and barbershops across Kansas City. The new “More Healthy Days” Barbershop and Beauty Salon Tour creates a one-stop shop for hair and health serving people living in Kansas City with limited access to care.  In partnership with the Black Health Care Coalition, Humana is tackling barriers to care like cost and accessibility at the local level. 

Earlier this month, Humana and the Black Health Care Coalition hosted a panel discussion and health screenings at Diana’s Hair Care and Styling in Kansas City. The discussion highlighted how meeting people where they are and leveraging relationships between stylists and customers encourages people to take steps toward better health.

“This initiative makes screening for a few common health issues — like high cholesterol, diabetes and hypertension — accessible for anybody in the community,” said Marvin Hill, Corporate Communications Lead for Humana.  “Improving population health is a long-term investment, so partnering with local grass-roots organizations is essential.”

This effort is part of the Bold Goal initiative and brings healthcare to people who have not always had easy access in the past. It is a step toward addressing the significant health disparities that currently exist in minority populations. Each stop on the tour will provide free medical screening and wellness resources at participating salons in the area, including biometric testing, Parkinson’s screenings, social determinants of health screening, exercise classes and more.  Part of Humana’s Bold Goal is screening 1 million people by the end of 2019.

This arm of the “More Healthy Days” campaign will also address other social determinants of health, such as social isolation and food insecurity, which are associated with adverse health outcomes. Click here to view the list of participating barber shop and beauty salon locations.

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Research published in the American Journal of Health Promotion shows evidence that health coaching can support healthy changes in lifestyle, reduce health risks and increase Healthy Days. Healthy Days is the U.S. Centers for Disease Control and Prevention assessment tool that Humana uses to track the mentally and physically Unhealthy Days of their members over a 30-day period.

To better understand how to support the health of our members, Humana sponsored a study which found significant reductions in average total Unhealthy Days across all goal categories.

Healthy Days is a reliable, validated assessment tool, designed to measure perceived health-related quality of life. Healthy Days provides a holistic view of health and well-being that reflects both  physical and mental domains and can appropriately capture the complex and subjective experience of individuals in health coaching programs.

As Humana explores ways to help members achieve their best health, health coaching and navigation is one way they are seeing success in reducing hospital admissions and improving medication adherence.   

Humana’s Bold Goal, a business and population health strategy to help improve the health of the communities the company serves 20 percent by 2020 and beyond, uses Healthy Days to track and trend progress at the local level.

Read the study here.

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A group of physicians and healthcare leaders at a recent event convened by Humana aimed to to understand what the medical practitioner’s role should be in addressing food insecurity as part of improving patient outcomes. This article appeared in Healthcare Innovation.

By Drs. Toyin Ajayi and Andrew Renda

It’s an unfortunate truth that in our current healthcare system, too-short, too-packed appointments often mean that providers do not have time to understand all that is going on with their patients beyond the walls of their practices.While the treatments we prescribe address their physical symptoms, we know little about the social, economic and environmental challenges our patients face that impede their health. These social determinants of health (SDoH)—like reliable transportation, nutritious food, stable housing, community and human connection—are critical to health and well-being. Yet, the way that medicine is still widely practiced, especially in lower-income communities, is extremely costly, fragmented, and fails to produce the health outcomes and cost efficiencies we all want.

One of the most prevalent and harmful barriers to good health is lack of access to enough nutritious food. Food insecurity leads to higher rates of chronic disease, emergency department visits and hospitalizations, driving $77.5 billion in related healthcare costs. We cannot expect to improve health and reduce costs if we do not first ensure that patients eat well. This is no small issue: adults experiencing poverty, who presumably lack consistent healthful food, have a higher risk for diabetes, heart disease and stroke, depression, disability—even premature mortality.

So why is food insecurity not considered a clinical gap in care? Shouldn’t all providers have a responsibility to diagnose social determinants of health, as they would other medical conditions?

These were the questions posed to a group of physicians and healthcare leaders at a recent TEDMED event convened by Humana, aiming to understand what the medical practitioner’s role should be in addressing food insecurity as part of improving patient outcomes.

This will require a major restructuring of the roles and responsibilities of healthcare providers. Beyond that, we need to implement interventions using technology platforms, validated screening tools and referral sources, as well as new code sets and payment models, to enable physicians to make it standard practice.

How do we make this work?

Community provider-driven care teams. For physicians to feasibly address SDoH requires a significant shift to a team-based approach that reaches well beyond the walls of the medical practice and into the communities where patients live.

This team-based, flexible approach is the foundation that Cityblock Health is built on. Multidisciplinary care teams are led by Community Health Partners – individuals from within the community who understand the experiences of people living there. Community Health Partners meet members where they are, taking time to understand what is going on in patients’ lives and connecting them to the right resources. They enhance the clinical team’s understanding of members’ realities and design interventions for their specific needs. Team-based models necessitate a significant role change for physicians, one that embraces working closely with non-medical, community-based partners.

Value-based care. Few reimbursement systems are currently set up to adequately pay medical practices for time and resources spent treating social determinants of health like food insecurity. Value-based models, where reimbursements depend on patient outcomes, encourage and allow room for care teams to address all aspects of health—from medical and behavioral health conditions to social needs— as equally critical in every patient’s care.

In value-based care models, we then need to develop clear measures tied to addressing social determinants of health and their impact on outcomes.

Evidence and outcomes. Currently, there is limited evidence of which approaches are most effective at improving health outcomes and providing a return on investment. However, one example showing real benefits are medically-tailored, home delivered meal programs for the elderly. These programs have been shown to improve clinical outcomes including blood pressure and diabetes control, and help to curtail emergency department visits and inpatient admissions for adults who are dually eligible for Medicaid and Medicare.

It’s critical we establish methods and metrics to expand evidence-based programs and measure various approaches that address SDoH. As part of that effort, Humana is currently working with the National Quality Forum to define quality measures around food insecurity. This will enable us to standardize benchmark measurements and expectations to help physicians effectively address food insecurity; and to incentivize and reward based on validated measures tied to patient outcomes.

We’re in the early stages, but there is growing momentum for treating these issues as clinical gaps in care. To make real progress toward that end, decision-makers across healthcare—from policymakers to health plan and health system executives— will need to align on a shared vision and efforts to address patients’ comprehensive health and social needs. Physicians alone cannot cure food insecurity; but we can be powerful partners in holistically addressing the needs of our patients and communities.

Toyin Ajayi, M.D., is the chief health officer at Cityblock Health and Andrew Renda, M.D., is the corporate strategy director, population health, at Humana.

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Healthy, nutritious food fuels healthy lives, giving people the energy they need to exercise and move their bodies. The support of an encouraging community makes it easier to stay on the path to well-being.

Funded by a grant from the Humana Foundation, the San Antonio Food Bank’s Senior Wellness Intervention Model (SWIM) addresses food security and social isolation for local seniors who screen positive for social determinant of health needs. Healthcare providers screen for social determinants of health and refer at-risk seniors to SWIM’s Nutritional Navigators, who connect them with nutritious food, cooking and exercise classes and other wrap-around programs to address their needs.

Watch this video and meet Frances, a San Antonio senior. She and her friends take a healthy cooking class and exercise class with Nutritional Navigators, learning new ways to eat better and move more. They often eat dinner together, cooking for each other and sharing what they’ve learned about healthy eating and exercise.

Describing how she feels after eating well and exercising, Frances says, “And it makes you happy. You come, and the blood is running. It’s healthy for you!”

Together, Humana, the Humana Foundation and the San Antonio Food Bank are helping seniors access nutritious foods, move more and build relationships.

For more information on Humana’s CSR efforts, read the 2018 CSR Report.

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