WASHINGTON—As the CEO of one of the country’s largest Medicare Advantage companies, Humana’s Bruce Broussard knows that what the healthcare system has done well doesn’t exempt it from where it badly needs to improve.
“Healthcare really is a tale of two cities,” Broussard said during a general session on Monday at AHIP’s national conference on Medicare.
On the one hand, modern medicine has made great strides toward prolonging life. But at the same time, he said, those advances are putting “great stress” on society in the form of rising healthcare costs.
Part of the problem is the system is built on episodic model, rather than a model that helps individuals manage their chronic conditions—both in a clinical setting and in their everyday lives. The way Broussard sees it, transitioning to such a model is one of the industry’s greatest challenges.
And for health insurers in particular, the challenge will be to move from what he called a “managed care chassis”— which focuses on transactional tasks like handling claims and processing preauthorizations—to companies that are primarily focused on enabling integration between the system’s multiple silos.
Medicare Advantage organizations are uniquely positioned to make this transition, he noted, since they must innovate to compete for enrollees and so they can can focus more on a member's long-term needs—especially since they typically keep that member for 7-10 years.
With that in mind, Broussard described Humana's three-pronged approach to improving care and lowering costs:
- Partner with providers. Like many insurers, Humana is working with providers to move away from the fee-for-service payment model. Broussard noted that the company has seen significant improvement in customer service, quality and cost when providers moves from into value-based payment arrangements. In addition, he pointed out that Humana puts an added focus on working with primary care providers to encourage members to maintain their health and prevent health issues before they become costly conditions.
- Integrate lifestyle and healthcare. This effort involves looking beyond what happens in a clinical setting and instead taking a holistic view of how to maintain and improve members’ health, Broussard said. For example, that could mean helping coordinate the installation of a ramp for a mobility-impaired member, or helping providers track a member’s medication adherence. Another critical piece is the use of predictive analytics, which enables organizations to “predict what’s going on versus responding to something that’s already happened,” Broussard noted.
- Take friction points out of the system. Put another way, Humana’s goal is to make it easier for customers to engage with and navigate the complicated healthcare system. To do so, Humana is spending a lot of time, energy and money on technology, Broussard said, but he noted that isn’t enough if the healthcare industry as a whole doesn’t learn to work together better. For example, interoperability issues are among the biggest challenges to lessening friction in the system. “We need to evolve together, not individually as companies,” he said.