Humana, NQF argue COVID-19 spotlights need for population health evolution

The COVID-19 pandemic is putting a spotlight on why it’s critical for population-based models to consider the impacts of patients’ social needs, experts say.  

William Shrank, M.D., chief medical officer at Humana, and Shantanu Agrawal, M.D., CEO of the National Quality Forum, co-authored an analysis this week that argues social risks should be weighed alongside clinical risks in population-based payment models.

Shrank said that the coronavirus pandemic is further highlighting the impact of the social determinants of health, especially as people with social needs are particularly vulnerable. As such, Humana has adapted its population health strategy to meet those concerns, he said.

The insurer has conducted hundreds of thousands of phone calls with its members to catalog what they need and the challenges they face.

“We found very, very high rates of complaints of those social needs, and we’ve spent a great deal of our time over the last month or two trying to develop the right interventions to be able to meet those needs,” Shrank told FierceHealthcare.

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Shrank said Humana has gotten plenty of feedback from its members, who are largely enrolled in Medicare Advantage, that they’re struggling with access to food, social isolation and transport to medical appointments if it is necessary to go in person.

As a result, Humana has launched a number of initiatives during the pandemic to address these concerns. For example, its work with Papa, a platform that connects lonely seniors with a college student “pal,” has gone digital, and they’re offering a call line for members who are struggling to find ways to socially connect amid distancing measures.

Shrank added that on the initial probing calls Humana staffers are making sure to normalize members’ struggles with these issues and offer simple solutions such as asking family members for a standing call or getting out for a brief walk.

“We recognize that it’s normal and it’s understandable that they feel lonely,” Shrank said.

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And Humana’s efforts underscore the central thesis of the paper: If these models are built to consider social supports, participants will provide those tools more readily.

Agrawal said in a statement that the study shows how crucial it is for a modern approach toward risk adjustment and model design.

“To improve the health outcomes of all people, including the disadvantaged, we must consider this growing body of evidence as part of a comprehensive, 21st-century approach to risk adjustment,” Agrawal said.

Having an incentive to address social needs could also be a crucial step in adapting population health approaches as situations change. The needs that are most critical now will adjust as the country begins to emerge from social distancing.

Shrank said Humana’s holistic approach makes for a good baseline to meet members’ needs as the pandemic ends, but the insurer will still need to put a lot of effort into talking with them and hearing directly what their challenges are.

“We know that we have to get closer to them and we’re going to have to ask a lot of questions,” he said. “We need to continue to build on some of these really important areas of innovation that we’ve experienced over the last couple of months.”