Medicare Advantage

Bruce Broussard

In 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 — Our journey for change…— is reprinted below. To see all of his blog posts, click here.

In every part of the business and public community we are all striving to find ways to improve our physical and mental health. Often I comment, no one organization will solve this problem, but working together – private and public organizations. In the context of working together, I thought it would be interesting to share some of our learnings over the last year. 

 In April 2015, my fellow Humana employees and I announced a Bold Goal: improve the health of the communities we serve 20 percent by 2020. Yet the Bold Goal is not just a journey; it’s become a passion that supports our Integrated Care strategy. We experience our Bold Goal every day. It challenges us to do our best, to rethink what we’re doing to address health, and to discuss what we’ve learned in these communities.

Sharing our learnings

The Bold Goal is aspirational, but it’s deeply accountable because we’re measuring our progress. We’re using the Centers for Disease Control and Prevention tool called Healthy Days, asking Humana Medicare Advantage members how many mentally and physically Unhealthy Days they’ve had in the last month.  

I’m motivated by this measurement as it provides a holistic view of how we’re doing in assisting our members. Rather than just providing a view of a member’s physical/clinical health, Healthy Days provides a glimpse of their level of happiness and life satisfaction, which ultimately is the underlying purpose of health—to live a full and happy life. 

At Humana, our strategy is to assist members in their journey of health by simplifying the experience and being proactive in helping them with their day-to-day health care and life needs. The core of our approach includes integrating five areas that are the most impactful in influencing health outcomes – Primary care, Pharmacy, Behavioral Health, Home Health and Social Determinants of Health.  

We’ve seen firsthand the impact of focusing on these areas and have also learned that it’s critical to address them through a holistic approach to health. For example, we have 2 million individual Medicare Advantage members who are being cared for by primary care physicians in value-based agreements, and through a holistic focus on health, they’ve had the benefit of more Healthy Days. In Knoxville, this holistic approach led to a 1.5 Unhealthy Days reduction since 2015 by addressing poverty and diabetes. Another good example: Last year we helped our MA members have 89,000 fewer days in the hospital, or said differently—more days at home.

What we have also learned most in our Healthy Days measurement is the impact that social determinants of health have on an individual’s happiness. More specifically, the most impactful – affordability, loneliness, social isolation and food insecurity – can have a serious effect on a person’s health. That’s why we’re working directly with local organizations in our Bold Goal communities to address those needs.

The best way to explain the work of our Bold Goal—and what Humana stands for as a company—is to share with you our learnings about how we’re working to make a difference in the lives of our members.

Meet “Betty”

I would like to share with you our experience helping “Betty,” a 78-year-old Humana Medicare Advantage member who is single and joined Humana a few years ago. Betty is independent and self-sufficient, and she enjoys cooking and gardening. She has children and more than a dozen grandchildren and great-grandchildren.

Yet Betty, like the majority of our members, is living with multiple chronic conditions such as diabetes, COPD and CHF. To make her situation even more complicated, Betty is caring for her adult son, who is disabled, so staying well and having more Healthy Days is a priority for her.

Based on a predictive model, we told Betty there was a high likelihood she would have a stroke within the year, but regrettably, she didn’t engage in the proposed clinical interventions. Sadly, she had a stroke and had to recover in a nursing home.

After Betty returned home, she was more open to intervention. She was enrolled in the Humana At Home telephonic chronic care management program, where she met Dawn, a Humana care manager assigned to help her. Dawn helped Betty live life on her own terms and as a result, she gained Betty’s trust and got Betty more engaged in her health.  

Betty is now independent, back in her home and taking care of her son. Dawn also helped Betty address her fear of doctors, develop an action plan for COPD, find transportation resources, and enroll in Humana’s Mail Order Pharmacy. Dawn gave her the tools to take care of herself where she wants to be – at home. As a result, Betty’s story is a happy one—she’s better able to afford her medications; Social Services has helped with other social and financial resources; her A1C is down; she’s lost 15 pounds; her blood pressure is in normal range; and she has stopped smoking after 60 years.

For people like Betty, we have learned that the biggest motivating factor for engaging in their health is not necessary about seeing improvements in their physical health. Instead, it really comes down to life goals. For Betty, it’s about staying well and having more healthy days so she can be there for her son. So for us to help Betty and others, we need to understand both the health and life needs of our members.  

Medicare Advantage is the right platform

Betty’s Medicare Advantage plan helped her regain her health—and her life. We have learned that this deeply integrated, experience-based system helps remove complexity from the system and incentivizes whole-person health.

More and more seniors like Betty are turning to Medicare Advantage because, on average, it leads to better health and a better experience. In fact, seniors, including those who receive their health care through their employer, are choosing Medicare Advantage in greater numbers than ever before. The program today has over 22 million members.

In a country where everyone is looking for ways to solve our nation’s health care challenges, Medicare Advantage is a proven public/private partnership that’s helping people like Betty live healthier lives.

If you would like more details on what we’ve learned and have shared serving our members in the communities we serve, please check out our annual 2019 Bold Goal Progress Report.

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Humana’s value-based care report has shown how physician practices in value-based agreements are increasing preventive care, improving health outcomes and quality measures, and lowering overall health care costs for Humana Medicare Advantage (MA) members.

This video features a panel discussion of care professionals discussing the report.

Written by physicians, the report details the clinical and economic impact of integrated care delivery, examining patient care and the experience of physicians. The report, which can be accessed here, also details physician progress controlling blood sugar, blood pressure and medication adherence for people with diabetes.

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Forbes has taken note of Humana’s latest Value-Based Care Report, writing about how the shift from fee-for-service medicine to value-based payments for physicians is reducing costs and improving quality of care for seniors in Medicare Advantage plans.

Read the Forbes article here.

“Medical costs were nearly 16% lower for seniors enrolled in Humana Medicare Advantage plans that paid physicians via value-based models in 2017 compared to costs of those in traditional fee-for service Medicare,” Forbes said, citing the study.

“In the value-based approach, insurers reimburse providers for services plus additional pay if they meet quality measures, control costs and improve health outcomes of their patients. The traditional fee-for-service system pays for the volume of care delivered.”

The article quoted Dr. Laura Trunk, Humana medical director of provider development, who wrote in the report: “While we know that all physicians are committed to patient health, those in value-based care agreements have access to additional resources and capabilities to build the infrastructure they need to expand their reach outside the practice. Focusing on prevention and the whole health of their panel population allows physicians and their care teams to work more strategically to improve the care of their patients, thus keeping them home and out of the hospital and emergency room.”

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Work has changed in America, and our notion of work is evolving along with society.

Thanks to advances in science, from antibiotics to vaccinations, life expectancy in the U.S. has increased. In 1900 it was 46 years for men and 48 for women; it’s now 77 years for men and 81 for women.

Today’s work environment is less dangerous and taxing, thanks to a century of new safety laws, machines and computers that have transformed offices and factories. The demands on our lives and our bodies are not what they once were.

People also have more opportunities due to advances in transportation, with breakthrough ideas like ride-hailing apps and rapid light rail. Such options within cities are enabling many, particularly seniors, to get out of their homes more often.

But our views on retirement — a concept introduced in 1935 with the passage of the Social Security Act — have not kept pace. There is still a negative bias in how we view people over the age of 65. That needs to change, because there is nothing but disruption on the horizon when it comes to aging.

It’s a “Booming” World

Baby boomers are demanding better, in all aspects of their lives, and businesses will have to find new ways to market to these new “seniors.” That’s why I turned to an expert on how the U.S. business community is missing the mark when it comes to helping boomers age into retirement.

I recently asked Joe Coughlin, author of “The Longevity Economy,” to speak at a company leadership meeting. Coughlin says the older adult market is misunderstood, and he cites several examples, both good and bad, of how companies try to serve them.

Here are some of my observations from the book and Coughlin’s visit with our team.

Product design needs to address the needs of seniors. One of the main takeaways I had from the book, and from my talk with Joe, is the importance of respectfully designing products that address the needs and desires of older adults. That means treating them not as a set of problems but as “full-fledged members of society with recognizable wants, needs, and ambitions,” as Joe puts it.

In many cases, products are designed by young engineers who don’t understand or account for the needs of seniors.

Coughlin cites BMW’s 2001 debut of “IDrive,” a joystick designed to simplify dashboard controls. Coughlin says many people hated it, especially seniors. That’s an issue because older people are a big part of BMW’s customer base. Although BMW fixed the problem, it’s a great example of older adults not being part of the design process.

65 is no longer the real retirement age for baby boomers and countless others. More and more boomers are remaining in their current jobs or choosing others, which is a good thing when you consider the brain drain. When we think of retirement, we traditionally think of age 65 (Medicare eligibility) with Social Security now kicking in at age 66. . But let’s be honest: For many, age is only a number; it’s not an indication of ability.

A few years ago, I wrote on LinkedIn about how my own father got bored in retirement and went back to work as a network engineer (Update: he stills loves doing it and feels it’s given him a real boost in his life).

It’s clear that my father and tens of millions of others are not going to fade away, but live life on their terms. More and more boomers are raising their grandchildren, going back to work, and starting their own businesses.

A bias in how seniors are portrayed in the media is not helping matters. Coughlin explored the misperceptions around older adults and how many of us “expect older people to live apart, quietly sequestered away in retirement communities, assisted living facilities, and nursing homes, surfacing to shop and dine only when everyone else is at work.”

This negative perception reminded me of how my company sponsored research examining the negative stereotypes of seniors in the 100 highest-grossing movies of 2015. The research showed that seniors were ridiculed, as well as “underrepresented, mischaracterized and demeaned by ageist language.” Findings also showed that “out of 57 films that featured a leading or supporting senior character, 30 featured ageist comments.”

At Humana, we’ve done our own research which shows that aging with optimism improves a person’s health. We also firmly believe that older adults are solid contributors to the workforce because of the proven skills, capabilities, and experience they bring.

Every stage in a person’s life needs to have a clearly defined purpose, especially the last one. Coughlin writes that there are four “chunks” of life, each of which is composed of roughly 8,000 days. The first covers birth to college; the second, college to midlife; the third, midlife to retirement; and the last covers retirement and beyond.

An 8,000-day chunk is about 20 years. Yet while it’s easy for many of us to plan for the first three “chunks,” we need to realize that the last one could go on much longer than two decades. We as a society need to embrace retirement as useful longevity.

Today’s 65-year-old is very different from today’s 85-year-old. That’s why personalization and understanding the stages in 8,000 days is critical. With Baby Boomers now aging into their unique and dynamic version of retirement, just imagine what this new generation of seniors will be able to accomplish from ages 65 to 85, and beyond.

As a person’s health, financial and social needs increase with age, there is an opportunity not just to guide people through the fourth “chunk,” but to help them live life to its fullest potential.

The path forward

We need to look at older adults as a very active, very participatory segment of our society. They’re going to retire the term “retirement.” And that’s a good thing.

At Humana, we’re committed to addressing the needs of our 3.3 million Medicare Advantage members. Every one of our members is unique, and they certainly do not intend to fade into the background at age 65.

The Baby Boomers will change the concept of retirement, and the American business community will have to innovate in ways that meet their needs. Let’s harness the power of imagination to help seniors live their best lives.

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