Humana: More physicians embrace value-based pay

Humana has announced its progress toward its Bold Goal, to improve the health of the communities that it serves by 20% by 2020 by making it easier for people to achieve their best health.

As of today, the health plan expects its 50,000 associates to meet their portion of the goal by improving their overall health 20% by the end of 2017.

Beveridge

"It's a bold goal that aims to improve population health by addressing health barriers, increasing access to healthcare, encouraging healthy behaviors and promoting chronic condition prevention and management," says Managed Healthcare Executive editorial advisor Roy Beveridge, MD, Humana's chief medical officer. "We understand that we can't do this alone and that it will require partnerships and collaboration with clinical, not-for-profit, community and government leaders to be successful."

Healthcare is about providing both needed medical and behavioral healthcare in addition to preventive medical guidance, Beveridge says.

"Improving the health of a population not only takes time, but requires an integrated, holistic, localized approach to care focused on doing what's best to help the person improve his or her health," he says. "We have an awareness to not only address medical needs but also the barriers that make getting healthy and staying healthy difficult."

Next: Chronic conditions

Chronic conditions, including obesity, diabetes and heart diseass, are on the rise and much of it is due to lifestyle. To improve community health, you can’t just look at chronic condition management, Beveridge says. 

"We need to focus on prevention, lifestyle/behavior modification and underlying barriers to health: poverty, food insecurity, transportation, access and awareness of local health resources," he says. "Improved community health, through addressing health barriers, focusing on disease prevention and supporting those with chronic conditions, will manifest in lower healthcare resource use, lower out-of-pocket costs for consumers and improved business performance for Humana," says Beveridge. 

"This translates into stable premiums, enhanced benefits and increased access to care, particularly preventive care. Improving the health of a population not only takes time, but requires an integrated, holistic, localized approach to care focused on doing what’s best to help the person improve his or her health."

One of the most significant areas of progress that Humana has seen is the growing number of physicians embracing the value-based reimbursement model. There has also been widespread, enthusiastic support from communities and clinicians. 

"Additionally, seeing consumers/members begin to engage in more health programs," Beveridge says. "When you have a value-based model that supports and rewards physicians for the health of their patients, not the services they provide, we can achieve instrumental change and lower the cost of healthcare services."

The Bold Goal report looked at seven communities of learning, including San Antonio, Louisville, Tampa Bay, Broward County, New Orleans, Knoxville, and Baton Rouge.

"We chose these markets because we have a large concentration of members, associates and clinical assets," Beveridge says. "Also, through data analysis that included both Humana and external sources, we identified these communities that have highly prevalent chronic conditions and significant underlying barriers to health. We believe that by engaging these communities and catalyzing solutions with local stakeholders, we can positively impact both."

In San Antonio, for example, Humana achieved a 23% increase in the number of members who took health assessments, which enabled Humana to direct them to appropriate programs. A pilot program was launched with H-E-B grocery stores that reward Humana associates with points for purchasing fruits, vegetables, and heart-healthy foods. The health plan is actively working with H-E-B to scale this pilot to a broader San Antonio population.

Clinically, what did the report find to be the biggest barriers?

"It varies by community, but, in addition to specific chronic conditions, common themes are lack of access to care and/or lack of awareness of local care and support resources," Beveridge says.