There’s a paradigm shift going on in the U.S. health care system. It’s a shift from volume to value, a shift from cost to care. And it’s being driven by consumer expectations.
To stay relevant, we have to think in terms of lifetime value, as opposed to the cost of disease management for the members we serve. We have to invest in health as an end in its own.
But the reward is big, something I like to call ROH--Return on Health.
As an industry, we need to do a better job of designing around the consumer. How do we address their human needs every day, not just the few times a year that they see their doctor? The emerging business models in healthcare are going to be realized by quality, cost reduction and deep customer empathy.
At Humana, we’ve seen this changing landscape, and we’ve set a bold goal for ourselves: The communities we serve will be 20 percent healthier by 2020 because we make it easy for people to achieve their best health. And we’ve gone even further with our own employees, vowing that we ourselves will be 20 percent healthier by 2017. We’re investing at home, and leading by example.
To make sure our approach is effective, we’re going to measure it with a proven instrument developed specifically for population health management known as "Healthy Days." Developed by the Centers for Disease Control and Prevention, the measure asks people to rate their overall health as well as recent days of physical health, mental health and activity limitation.
I joined Humana a year and a half ago with a charter to innovate to help us achieve this bold goal. It’s a daunting challenge, but also an inspiring opportunity.
Our current health system grew up to serve episodic conditions; it wasn’t designed for chronic conditions. That’s a big miss, considering that chronic healthcare accounts for 3 of every 4 dollars spent across the industry each year. But the challenge now is to innovate, to create more healthy days and to reduce cost. There’s a business model there. If we improve health, it’s irrefutable we will save cost. If we focus on costs, we may (and we may not) improve health.
To get a true return on health, we need to design healthcare differently. Through businesses like Humana at Home and partnerships with organizations like the American Diabetes Association and Omada Health, we’re learning a lot about highly personalized care, and it’s brought us a lot of insights.
We’re turning those insights into action, and we’re starting to see how new services can be integrated and aligned to fundamentally change the individual healthcare experience. We’ve developed three foundational elements to keep us on track:
Trust. Trust is critical in a healthcare system that works for everyone. We know that building trust-- especially where little has existed--is a two-way street and that it takes time. And we are painfully aware that health insurance companies have been among the least-trusted organizations in the system.
With a focus on individuals having the best experience and health outcomes possible, we are becoming a company focused on partnerships with all players in the system--doctors, caregivers, scientists, technologists--and the friendly “interface” for people, the ultimate consumers of health services.
By listening to our members--through thousands of hours of conversations--we are bringing their views inside, learning about their needs and barriers to well-being and seeing how they want healthcare to fit into their lives.
Personalization. Why don’t we have health solutions teed up just before people need them? How can we understand that a person is about to make poor health decisions, and have the system primed to step in and help? We believe it’s possible, with shared trust and great data, to make healthcare personal and holistic, immediate and adaptive, and very easy to access.
For example, we have a partnership with Omada Health, which helps people engage digitally in diabetes management programs. Omada’s “Prevent” program provides personalized, evidence-based behavioral interventions for those at risk for diabetes and other chronic conditions. It integrates information provided by participants with daily biometrics in a technology-enabled program designed to help people reduce body weight by 5 to 7 percent. Early pilot results with our Medicare Advantage members are yielding encouraging results, with 85 percent of participants active at the six-month mark, and an average weight loss of 8.7 percent after six months for Prevent graduates, dramatically reducing their risk of progression to diabetes.
Community. As one of our members put it: “Why can’t I build a relationship with providers and caregivers when I’m well, so they can be fully there for me when I’m ill?”
Research shows that keeping people in familiar settings and structures--within their communities, and near family/friends (when possible)--is important to their well-being. It is also cost-effective.
Today, our Humana at Home team, composed of nearly 20,000 care managers, nurse practitioners, home health aides and other professionals, makes it possible for nearly one million chronically ill and disabled people to live safely at home, even when faced with medical or functional challenges.
People who received Humana at Home care management have fewer hospitalizations (cut in half for those at highest risk for frequent admissions), longer life (26 percent better two-year odds of survival), as well as many more happy and healthy days at home.
Humana is taking a long-term view of health to remove the barriers between consumers and their best health. The insights we gain by getting to impact today are really important to inform how we further invest. It’s hard work, it’s passionate work and it’s purpose-driven work.
We know that if we can be the best healthcare company in the world to partner with, and truly keep customer needs at the center of what we do, we can help close the gap between health and care.