value-based care

“As America strives for positive changes to the healthcare system, it may find the greatest advancements for value-based care in Medicare Advantage plans,” according to an article by

Dr. William Shrank, Humana’s Chief Medical and Corporate Affairs Officer, was interviewed.

“We can be flexible, personalize, leverage, and a remarkable data source to be both precise about the needs of members, and to share that data with providers in a nimble way,” he said. “So if a provider is taking risks in partnering with us as compared to doing so directly with the government, we think there are a lot of advantages.

“As a result, we’re able to really accelerate the move towards value-based care and the likelihood that we will be successful in that endeavor.”

Read the full article here.

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In September, Misty Roberts, Associate Vice President at Humana and Clinical Quality Officer, and Faith Green, Director of Enterprise Clinical Quality, took the story of Humana’s mission to improve quality on the road. They presented their work on building a culture of clinical quality to 1,400 peers at the National Association of Healthcare Quality’s annual conference in Phoenix.

“Clinical quality is about improving health outcomes,” Roberts said. It has always been important, of course, but never more than now, as health care transitions from a fee-based system to a value-based system, where payments are based on health outcomes.

Roberts has been at Humana since 2010 and moved into the Office of the Chief Medical Officer in 2014, where she was asked to form a new department focused on clinical quality. Her role was to lead Humana’s internal response to a new national challenge to identify a set of meaningful and efficient quality standards.

“At that time, the number of quality measures was overwhelming, and reporting requirements were inconsistent,” Roberts said. She and her new team set out to transform Humana’s quality measurement process.   

They discovered that 46 groups around the organization were setting and measuring standards. The quality team knew they had to simplify.

After six months of meeting with representatives from all those groups, the team found they could pare down their combined list of 1,116 quality measures to 208 meaningful ones. That was an 80 percent reduction. “Because of company silos, associates in one area had been unaware of quality measurements in other groups,” Roberts said. “That had resulted in duplication and inconsistencies across Humana.”

Last year, Roberts and Green told the story of that process of aligning measurements in an article published in the American Journal of Medical Quality (“A Health Plan’s Journey to Identifying Meaningful Quality Measures”). They told the story again at the meeting in Phoenix but added another dimension.

The title of their new presentation was “Infuse, Empower, Lead,” and the subject was the bigger lesson they learned about creating a culture of clinical quality. The advantage of being an organization with a culture of clinical quality, say Roberts and Green, is that it will keep the excitement about improving quality alive. It will push people to be proactive. It also will lead to a holistic view of what quality is.

Here are the steps they recommend:

  • Infuse your organization’s culture with the mindset of continuous quality improvement and collaboration (communicate; spark team conversations)
  • Empower and motivate employees to make decisions and act with purpose (get them engaged; unleash their courage)
  • Lead your organization and industry in making a cultural shift (have a vision; offer guidance; inspire)

The primary measure of success, however, will always be “the impact on patient health and clinical outcomes,” Roberts said.

“Everything we do has the potential to impact patient outcomes,” she said. “Building a culture, creating a mindset – that’s how we continue to improve quality across the enterprise.”

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Reducing waste in the U.S. health care system can lower costs and allow resources to be allocated to areas of care that need it most, said Dr. William Shrank, Humana’s Chief Medical and Corporate Affairs Officer.

Dr. Shrank recently wrote an opinion piece that was published in Morning Consult.

You can read it here.

He referenced a recent study conducted by Humana and the University of Pittsburgh School of Medicine, which found that approximately 25 percent of all U.S. health care spending, or $760 billion to $935 billion, can be classified as waste.

He noted that waste could be reduced by reducing administrative complexity, addressing pricing failures, and implementing effective clinical models.

“By leveraging value-based payment models (aligning reimbursements for providers to reward higher-quality care, better outcomes and lower costs, rather than simply rewarding doctors for the number of services they offer) that align the interests of health plans and clinicians, we should be able to massively reduce this complexity,” he wrote. “Moreover, the Centers for Medicare and Medicaid Services and the industry are building momentum to deliver the data interoperability that will reduce administrative complexity, which will help rein in costs.”

On pricing, he noted: “Efforts to advocate for policies that promote greater competition in the marketplace and price transparency for patients should drive considerable savings. As we have seen with the Medicare Advantage program, competition reduces costs and improves patient health outcomes.”

He also said, “Evidence shows us that scaling effective clinical strategies and programs across the country can help achieve these savings — for example, providing care coordination, health coaching and proactive outreach to patients with diabetes or congestive heart failure.”

Read the article here.

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The Health Care Payment Learning & Action Network (HCPLAN, or LAN) is an active group of public and private health care leaders dedicated to providing thought leadership, strategic direction, and ongoing support to accelerate our care system’s adoption of alternative payment models (APMs). The LAN mobilizes payers, providers, purchasers, patients, product manufacturers, policymakers, and others in a shared mission to lower care costs, improve patient experiences and outcomes, reduce the barriers to APM participation, and promote shared accountability.

Humana supports the group’s efforts to accelerate the percentage of US health care payments tied to quality and value in each market segment through the adoption of shared accountability alternative payment models.

Since 2015, health care stakeholders have relied on the LAN to align them around core APM design components, host forums and summits to share information and inspire action, build consensus among leaders, and measure the progress of APM adoption. The LAN will continue to be a trusted partner that connects the public and private sectors, identifies and shares best practices, and guides the field in rapidly moving to value-based payment.

Learn more here.

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With a mission to address significant health disparities and unsustainably high health care costs in the United States, the University of Houston has hired an accomplished physician and leader in medical education and health services research to direct the Humana Integrated Health System Sciences Institute. Dr. LeChauncy Woodard becomes the first director of the Humana Institute, which is committed to producing high-impact research that changes policy, innovative educational programs that prepare a new generation of health care providers and novel programs that support community transformation.

Woodard is a general internist and joins the UH College of Medicine after two decades at Baylor College of Medicine where she held several faculty positions in the departments of internal medicine, family and community medicine and more. She was also the director of the Center of Excellence in Primary Care Education at the Michael E. DeBakey VA Medical Center.

“It’s a really exciting opportunity because the unique partnership with Humana provides the foundation to unite the existing health disciplines at UH with the new College of Medicine which will enable our students to collaborate and lead integrated health care teams to increase the value and quality of care for patients,” said Woodard, whose vast research portfolio includes a focus on quality of care, treatment and prevention of chronic diseases, health disparities, and the interrelated social, economic and environmental factors that contribute to health outcomes.

Woodard said she plans to harness UH’s research expertise and form cross-disciplinary teams to tackle the most pressing complex health care problems. “I’m particularly excited to work with the underserved communities of Houston because I grew up in one. I believe that if we take care of the sickest people then we can elevate the health of the entire population.”

Woodard grew up in the Acres Homes neighborhood of northwest Houston where poverty is high and access to health care is low. Her late father’s struggle with chronic illness fueled her passion for medicine and desire to improve health disparities.

“It really impacts the quality of life for the whole family and limits the things you’re able to do,” she said. “I look forward to contributing in a meaningful way to address this problem.”

“We are thrilled to have Dr. Woodard join the UH family to lead the Humana Institute,” said Tray Cockerell, Strategic Relationships, Office of the Chief Medical Officer at Humana. “Dr. Woodard’s background, experience and passion for improving the health of individuals and communities aligns perfectly with our mission. She also understands the importance of integrating the components of care delivery – medicine, nursing, pharmacy, social work and other non-traditional components of the healthcare system – to achieve value in healthcare.  She will be an excellent director of the Humana Institute.”

Along with serving on the College of Medicine faculty in the Department of Health Systems and Population Health Sciences and the Department of Clinical Sciences, she will treat patients at Lone Star Circle of Care, the Federally Qualified Health Center in UH’s Health 2 building.

“Dr. Woodard is a compassionate and confident physician, educator and researcher with an impressive track record and even brighter future. She’s the perfect fit to lead the Humana Institute and our charge to transform the health care system,” said Dr. Stephen Spann, founding dean of the College of Medicine. “Her professional and personal experiences with health disparities and quality of care will ignite development of new health care models to make the system more effective, equitable and patient-centered.”

The Humana Integrated Health System Sciences Institute was launched in September 2018 with a $15 million gift from Humana Inc. (NYSE: HUM) to help defray start-up and operational costs for the College of Medicine, as well as fund endowed chairs at the colleges of nursing, pharmacy, social work, optometry and medicine. The College of Medicine is scheduled to admit thirty students in its inaugural class pending accreditation by the Liaison Committee on Medical Education.

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