TEDMED: Reimagining health: a look inside the home

“Are we prepared to address what we’ll find when we step inside?”

That was the question posed to a select group of thought leaders during a Humana-sponsored TEDMED discussion that took place in Boston on Tuesday morning, March 3. The discussion was moderated by Dr. William Shrank, Humana’s Chief Medical and Corporate Affairs Officer; Caraline Coats, Vice President of Humana’s Bold Goal and Population Health Strategy; and Dr. Andrew Renda, Associate Vice President of Population Health.

Experts weigh in on what it will take

Together, participants from care delivery organizations, the federal government, technology and measurement companies, home health and social services focused on how to reduce healthcare waste by delivering effective care in the home.  Reimagining home health and shifting pre-conceived notions of reserving this care for the most chronic, complex patient was a central theme.

Dr. Shrank kicked off the discussion by talking about delivering a more personalized, convenient, less expensive and better experience in the home, which he views as a place that offers “incredible opportunity for innovation, incredible opportunity for learning, and an incredible opportunity to really drive better, more convenient, more satisfying care.”

Participants shared their personal experiences in caring for their loved ones and detailed the daily challenges their parents face as they age. The discussion highlighted the need to provide more caregiver support and the need for personalized health plans and robust data that leverage sophisticated technology to connect the whole care team. And perhaps most importantly, developing trust with the patient is the key to real engagement.

Our spend needs to reflect what impacts health

Dr. Shrank stated that “if we’re going to take really good care of vulnerable people, understanding the social barriers to health and one’s real-world circumstances is essential if we’re ultimately going to take on and address the broader health issues and health trajectories of the patients and the members that we care for.” Humana has found that social, environmental and economic factors influence about 70 percent of what makes people healthy.

During the session, there was discussion on how the U.S. is over-indexed on its health care spending and under-indexed on its social services spending. Caraline Coats stated that only four percent of our annual health care spend addresses socioeconomic challenges. She also noted how “delivering meals to people in their homes and making socials visits” can help address a person’s social health outside of the physician’s office, and develop a holistic understanding of the people we serve.

One internal medicine physician said, “The people who need this the most are very marginalized already,” and he reiterated the importance of acting immediately to reduce poor outcomes and long-term costs. Another participant wondered how EMTs and paramedics could assist.

Meeting people where they want to receive their care

Caraline also spoke to the need to meet members on their terms. “How do we change how we talk about health care?” Coats asked. “It’s not just about a pregnancy test or a CHF diagnosis. It’s about the fact that social determinants of health contribute to the majority of our total health.  We think that by getting into their world, meeting them where they are, in their homes or barbershops, how does that role change?”

Dr. Andrew Renda noted that the home has become the preferred setting for care. “We have this idea that delivering care in the home is what seniors want,” said Dr. Renda. “Through our discussions with our members and our research, we know they want self-determination and want to age in place. So, we are trying to meet them where they are – to do that.”

The discussion also zeroed in on the importance of ensuring alignment in outcomes and how personalized health benefit plans need to be designed to address these socioeconomic challenges. Said Dr. Renda, “If we don’t do this right, people get sick and end up in the hospital. But if we deliver population health – including both clinical and social services that people need, we can improve outcomes and take waste out of the system.”

Caraline closed the thought leader discussion with a challenge. “What’s it going to look like in 10 years? Health care happens outside of the physician’s office. So how can we empower the right resources now to really make a difference in the future?”

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