health-care system

Today, nearly nine out of ten doctors and virtually all hospitals have adopted electronic medical record systems (EMRs). Health care providers have more data than ever before on the health and well-being of their patients. Unfortunately, the vast majority of this data is stored in proprietary systems that make it exceedingly difficult for clinicians and patients to share health information with other providers and payers. In addition, despite extensive efforts by the federal government, patient data continues to be controlled primarily by health care providers and payers rather than individual patients.

At Humana, we fundamentally believe that every patient should be able to access, share, and control their own personal health care data. The health care industry should no longer be allowed to treat patient data as a tightly held, revenue-generating commodity. The current model has spawned a multi-billion dollar industry predicated on restricting access to patient data. We believe that the data belongs to the patient, and neither providers, EMR vendors, nor payers should profit from its sale.

The reasons for this are simple: it limits data transfer, increases patient health care costs, and adversely affects patient care. With the emergence of open application programming interfaces (APIs), we have the technology available today to empower patients to securely access and share their health information as they see fit. The only thing standing in the way is an antiquated devotion to outdated business practices.

Under the leadership of Administrator Seema Verma, CMS is proposing a new way of sharing information that leverages existing standards and technologies to empower patients to take control of their own health information. Building on the success of the Blue Button 2.0 initiative, CMS has proposed that plans be required to implement openly-published Health Level Seven (HL7) Fast Healthcare Interoperability Resources (FHIR)-based APIs that make patient claims, drug formulary, provider directory, clinical laboratory results, and other health information available to patients through third-party applications and developers. This means that a patient can access and manage their health care data via an app on their phone as easily as they manage their travel or personal finances.

This is a much-needed bold action to move the health care industry toward a consumer-mediated data exchange model rather than one controlled by health care providers and EMR vendors. In this model, the patient is easily able to access, share and control their health care data via a secure mobile app or website, similar to how they manage their finances. We strongly believe that the model envisioned by CMS will improve patient care, resulting in better health outcomes and lower costs. To that end, Humana is fully committed to implementing the open APIs proposed by CMS in 2020.

As the health care industry transitions to a consumer-mediated data exchange model, it will be critical to minimize the existing barriers to sharing health information. Under the leadership of Dr. Donald Rucker, the Office of the National Coordinator for Health Information Technology (ONC) is creating and harmonizing the standards that EHR vendors and other stakeholders must use in order to make health care data easier to share between providers and with patients. Furthermore, ONC is establishing standards to ensure that unnecessary tolls are not placed on this new road to interoperability and consumer-mediated data exchange.

As CMS and ONC begin the difficult task of finalizing their proposed regulations, we urge the agencies and the entire health care industry to adopt the following guiding principles:

Patients Should Control Their Own Health Information – All patients should have a fundamental right to access and share their personal health information as they see fit.

Rapid Implementation of Open APIs Should be a National Priority – While the development and implementation of open APIs will prove challenging, the entire health care industry must move forward without delay. To that end, we encourage CMS to adopt the proposed 2020 implementation date for open APIs, and we urge ONC to accelerate the adoption of standardized, open APIs by requiring or incentivizing EMR vendors to operationalize new open APIs before the proposed 2022 deadline.

Information Blocking Prohibitions and Enforcement Are Critical – The federal government should explicitly prohibit all business practices that directly or indirectly prevent patients from sharing their health information, including any fees for implementing open APIs and for facilitating the interoperable exchange of electronic health information. Moving forward, the inclusion of open APIs should be a core feature set of every EMR – not a revenue-generating add-on.

Patient Privacy Must Be Protected –The federal government must develop appropriate patient privacy protections for mobile app developers and other entities that are not currently subject to federal patient privacy regulations. Patients have a right to know, in plain language, how their information will be used and shared so that they can make an informed decision about whether to share their personal health information with a third-party app developer.

All regulations are iterative processes. There will be plenty of time to refine and enhance the CMS and ONC proposals in the future. However, now is the time to be on the right side of history and support implementation of these important steps toward empowering patients to take control of their health information.

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Members of Humana’s management team, as well as some of the company’s operational leaders, are in New York City for the company’s biennial Investor Day.

The event, which takes place at the New York Stock Exchange, will showcase the company’s strategic direction, operational and financial progress, as well as expectations for future performance through presentations given by many of the company’s leaders. Many of Humana’s largest institutional shareholders, as well as Wall Street analysts who cover the company, will attend.

The company last hosted a similar event in April 2017.

CEO Bruce Broussard kicked off the day with opening remarks and an overview of the company’s strategy. The meeting will be available via a video webcast on Humana’s Investor Relations page. Just sign in after clicking the webcast link after scrolling down to the Humana Investor Day entry in the Events section.

If you can’t watch today, a video replay will appear on the Investor Relations page Wednesday, March 20.

To help celebrate Investor Day, members of Humana’s management team rang the closing bell at the New York Stock Exchange on Monday, March 18.

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Dr. Roy Beveridge, Humana’s chief medical officer, writes in Managed Healthcare Executive that “value-based care is proving its worth to both physicians and patients alike through improved care, greater reimbursement levels, and lower cost—delivering on the promise of the right care at the right time at the right cost.”

He notes that physicians in value-based arrangements can expect lower healthcare costs, more shared savings, and a higher percent of the overall healthcare dollar compared to the national average.

Read the full article here, and learn more from Humana’s latest Value-Based Care 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 — Doing more with less: health care inspiration from the developing world — is reprinted below. To see all of his blog posts, click here.

I had the opportunity to attend the World Economic Forum in Davos, Switzerland. It’s always an amazing experience to learn about new ideas in health and other societal matters from around the world. As a strong believer in the importance of lifelong learning, Davos is a place where there is always something new to learn.

This year what struck me the most was how innovators in underdeveloped countries are overcoming economic challenges and lack of infrastructure to meaningfully advance health care delivery. Despite limited resources, these people are providing ingenious solutions to health care issues, some of which have actually put their countries further along than the U.S. in scaling digital health solutions.

Here’s a quick recap of three meetings I had with individuals who are advancing health care delivery through innovative approaches that leverage a wide variety of care access points, mobile technologies, and less-specialized clinicians. These solutions transcend economic and infrastructure challenges.

 

Integrated training and technology, distributed access points, and unconventional providers can be brought together to improve access to care. At the top of this blog, you’ll see a photo of Dr. Dixon Chibanda and me. Dr. Chibanda is the founder of The Friendship Bench and a psychiatrist from Zimbabwe, and he is one of just 12 psychiatrists practicing in Zimbabwe, a country of over 16 million. He’s an amazing individual whose Friendship Bench provides a relaxed and natural setting where people can speak comfortably about what’s bothering them.

Dr. Chibanda shared that he uses grandmothers as providers, using mobile apps to teach them to provide basic mental health services. He said grandmothers bring a level of empathy to the process that has been instrumental in getting people to open up about their problems. This successful program is not just in Zimbabwe; it’s been launched in the United Kingdom and New York City.

Mobile apps and transportation are changing health care in Venezuela. We’re all sadly familiar with the crisis in Venezuela. But despite the challenges they face, Venezuelans are innovating around access to care.

I sat down with Dr. Andres Gonzalez, Director of Venemergencia, which provides telehealth and a unique form of house calls to enhance care. For example, Venemergencia’s doctors and nurses, with their diagnostic equipment, use mopeds to see their patients. Combined with a mobile app, patients can schedule appointments, and doctors are able to access patients’ medical records to provide personalized care. It’s a great example of boldly delivering care locally without the constraints of brick-and-mortar clinics.

Telehealth is transforming care delivery in challenging rural markets. Sangita Reddy, Managing Director of Apollo Hospitals, is using technology to help people who live in rural parts of India and struggle to access care.

In 2018, she and her company facilitated 2.4 million telehealth visits in India and nine other countries in which Apollo operates. During my conversation with Sangita, she spoke to the benefits of telehealth as a means for specialists in metropolitan areas to connect with their patients living with complex diseases. Primary care physicians and nurses benefit as well, because the work advances their training.

 

As I reflected on these learnings, it reminded me of underdeveloped countries going directly to cellular telephone technology, skipping landline technology. I experienced this firsthand, as my father’s career began with AT&T, installing landline switches in those brown cement buildings located in every U.S. city. In the later stage of his career, he was installing cellular technology in underdeveloped countries that had no telecommunication, bypassing the less-agile and building-dependent landlines. Fast forward 20 years, and mobile has become the preferred technology.

Could this foreshadow the evolution of the traditional health care system, which is more institutional and expert-dependent, making it more difficult to access and more costly? The future system — with expanded access points through less-trained individuals aided by technology — will come, but it requires the current system to actively invest in the technology infrastructure, governments to change public policy, and companies to transition to new business models. I hope we will embrace the transition more quickly than we embraced the conversion from landlines to cellular service.

Access to care is a global issue, but solving it happens on a local level. A report from Oxfam found that “every day, 10,000 people die because they lack access to affordable healthcare.” Solving for this is a global imperative and especially hits home for those of us in the health care industry. It requires bold and innovative approaches that meet people where they are, ever mindful of the non-health challenges that impact their access to care.

I’d be interested in your thoughts. What assumptions about health care do we need to challenge? In your community, how are innovators helping to improve access to care?

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Humana and the University of Houston recently teamed up to officially launch the new Humana Integrated Health System Sciences Institute at the University of Houston (the Humana Institute).

The Humana Institute is designed to unite the existing colleges of Nursing, Pharmacy, Social Work and Optometry with the university’s new College of Medicine. Humana previously announced how its $15 million gift will help defray start-up and operational costs for the College of Medicine, as well as fund endowed chairs for each of the five health colleges.

The event, which was attended by a wide variety of UH students, faculty, and community members and was covered by the Houston Business Journal last month, commenced with a panel discussion with the following leaders from Humana and the University of Houston:

• Renu Khator, University of Houston President
• Roy Beveridge, MD, Chief Medical Officer, Humana
• Stephen Spann, MD, Vice President for Medical Affairs and Founding Dean of College of Medicine, University of Houston

“Health care isn’t a solo sport, it’s a team sport. An integrated team approach where doctors, nurses, pharmacists, social workers and more are all working together for the patient will increase the value of healthcare. We must also address major health disparities that exist today while recognizing the importance of social determinants of health,” said Spann. “This new partnership with Humana enhances the University of Houston’s ability to achieve its mission of improving the health and healthcare of our community, our city and beyond.”

Dr. Beveridge addressed the importance of moving from a fee-for-service reimbursement model to a value-based reimbursement model. “The payment model for all government reimbursement is going to an outcome-based, quality-based set of metrics.” He continued, “As we move to this world of paying for outcomes, then everything (social determinants of health such as food insecurity, social isolation and loneliness) that Dr. Spann just talked about is an imperative. If you are reimbursing for outcomes but thinking in a fee-for-service mentality, you lose efficiency and don’t bring the quality of care that each one of these patients deserves.”

UH-Humana: a strategic partnership

“I would like to thank Humana for their generosity, vision and commitment. There’s so much synergy and compatibility in our missions. How do we make our nation a better place? We are here for the people to empower communities,” said Khator. “The structure of this partnership with five Humana endowed chairs in our five health professions colleges will force collaboration. We will come together to solve problems.”

“Launching the Humana Integrated Health System Sciences Institute at the University of Houston marks a critical milestone in our strategic relationship,” said Tray Cockerell, Director, Strategic Relationships, Office of the Chief Medical Officer, who is responsible for evaluating and leading strategic relationships that further Humana’s strategy of integrated care delivery and value-based care adoption.

In this role, Cockerell partners internally across Humana to drive population health outcomes and to integrate the operations and outcomes of Humana with the University of Houston and other academic and community partners.

“We are partnering on cutting-edge projects that will have a measurable impact on health education and on population health,” Cockerell said. “The number of students and University of Houston faculty and staff who attended truly reflects the importance of this partnership and the significance of the Institute.”

“We’re extraordinarily proud and thankful to partner with the University of Houston,” said Worthe Holt, MD, Vice President, Office of the Chief Medical Officer. Dr. Holt is responsible for operations in the CMO office. “This partnership is truly a part of our vision. If we can positively impact health care in Houston, we can scale up and do so elsewhere. We’re going to implement a very innovative approach and train a whole new generation of health care providers who can take this body of knowledge and make a difference in the health of our nation.”

Driving integrated care

At the launch event, there was a second panel discussion that focused on how the Humana Institute would be designed to address today’s health care challenges.

The panel discussion, which featured Dr. Spann; Lamar Pritchard, Dean, College of Pharmacy; Dr. Holt; and Kathryn Tart, Dean, College of Nursing, focused on the future of inter-professional education, social determinants of health, and value in health care.

During the panel, Dr. Holt spoke to the increasing impact of social determinants of health; the population health approach to health care delivery; and the robust research and clinical expertise that Humana brings to the partnership.

Dr. Spann also commented on the wealth of experience that Humana brings to the table and the way Humana integrates care. Said Dr. Spann, “We will benefit substantially from the practical, hands-on knowledge our Humana colleagues have and will share with us.”

Dean Tart said the partnership will “work for the betterment of our patients while moving them toward a healthier life and a peaceful recovery.” She also said the partnership would ensure that nursing students learn to address social determinants of health, and she noted how Humana’s Bold Goal would help drive the partnership.

During the panel, Dr. Spann spoke to how the new school will address the challenges of medication non-adherence and the high costs associated with it. He also cited the importance of taking learnings to the next level and Humana’s “state-of-the-art approach to primary care” that can be leveraged to improve quality of life and health care outcomes. Representatives from both organizations also emphasized how data transparency and interoperability will be critical areas of development, as well as how technology can drive preventive medicine.

Dr. Holt envisions the partnership will help prepare students to operate in an integrated care model: “So whether it’s a doctor, nurse, optometrist, pharmacist, or social worker, we would like to see all of them leverage their expertise to change the way we deliver health care and achieving better outcomes in a more equitable fashion as well as a more cost-efficient fashion. In a value-based model, when it’s done correctly, you can improve health, cost and quality. Responsibility, accountability and opportunity will help change the health of our communities for the underserved and the disadvantaged and those who depend on federal programs.”

Students compete to improve care

The launch event also hosted a health care poster competition depicting ideas for integrated care delivery. According to Cockerell, “I was really impressed with the depth of the research abstracts and the quality of the poster presentations from the students. These young men and women are brilliant and will be foundational to the continued evolution of our health care system.”

Last September, both organizations disclosed how they also intend to collaborate on a number of other opportunities, including

• Adjunct professorships and teaching opportunities for Humana subject matter experts
• Opportunities to partner in shaping curricula in a wide range of topics, including value-based payment, home-based care, population health, data analytics and more
• Partnership on research and publications
• The establishment of value-based care clinic labs for University of Houston health sciences students and medical residents
• Internships and rotation programs to provide practical experience

While the partnership is still in its early stages, Dr. Beveridge says both parties see great potential to improve health. “When we looked at the University of Houston’s commitment to serve the people around the community, combined with their belief in education for all parts of the health care system, we knew that we had to be a part of this,” said Dr. Beveridge. “The more we can educate, we believe that it’s going to foster an unleashing of talent over the next several years. We’re very excited to see how this is going to work out.”

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