Why Humana is on the ‘bleeding edge’ of integrated care

In an increasingly complex world, one major healthcare provider is attempting to bridge the gaps of a fragmented healthcare system. Louisville, Kentucky-based Humana has recently brought on board a new chief medical officer, William Shrank, MD, MSHS, to advance the healthcare company’s clinical strategy and lead the industry as a champion of integrated care.

Shrank, who replaced former CMO Roy Beveridge, MD, after his retirement earlier this year, sat down with HealthExec for an interview at our headquarters to chat about all things integrated care, why "social determinants of health" has become a buzzword and what keeps him up at night. He officially took over the role on April 1.

According to Shrank, Humana is on the “bleeding edge” of care coordination through its role as a managed care provider and Medicare Advantage plan, which has more than 3 million members. The company has undoubtedly been among the leading providers to continually bring healthcare services together under one roof, including with its massive acquisition of one of the biggest in-home care companies, Kindred Healthcare’s home division, and hospice provider Curo, last year. Plus, its efforts in value-based care are starting to pick up steam, according to a recent company report.

Now, through its Bold Goal initiative, a major population health management program that being in 2015, Humana is setting its sights on gathering resources from every corner of the communities it serves. Bringing together local resources, Humana members in Bold Goal markets are seeing the effects of integrated care, with an improvement in their “healthy days,” which are tied to lower overall costs.

HealthExec: Humana acquired Kindred at Home in 2018. Where are you in the integration process now?

That is one of the very top priorities of the company. It’s not just Kindred, but how we integrate all our solutions and assets. We have lots and lots of telephonic managers, case managers. We have our own pharmacy benefit manager delivering prescriptions to patients in their home and calling them and talking to them about their medication use. We are partnered with a lot of primary care doctors around the country. [We have] home care, we have behavioral health. The idea is how do we pull all of those into one team-based approach that is integrated, coordinated, where everyone is talking together to best meet the needs of our members.

Coming into your new role, what was your biggest focus or what were you most excited to get to work on?

I am excited about this notion that we’re thinking much more broadly about one’s health to include these social context features. If someone doesn’t have healthy food to eat, if someone is really lonely and doesn’t leave the house, if someone is depressed or has no transport, all of those are things that are viable and it’s just the right thing for us to be doing [to address those needs].

In managed care as a Medicare Advantage plan, we’re really the only ones that have a sort of financial incentive to say, “let’s make an investment in social determinants of health.” We can make a financial case as well as [hold] the genuine belief that it’s the best thing to do. And we can have those investments in social services offset healthcare services.

We’re in a unique position to redistribute healthcare dollars to social services and do the right thing for the person.

Can you give me an update on the Bold Goal? What are some of the successes over the past few years?

It started four years go officially. Our most mature market is San Antonio, and we have been adding markets since. [There are] seven today, and we will be expanding this year. It’s awesome. The bold goal is the stuff that makes it hard to go to bed at night because you’re so excited and jazzed about it. The focus of it is improving healthy days. We survey our members to get a sense of both their physically and mentally healthy days over the last 30 days.

Our job now is to get better on the data, understand what are the more specific, targeted interventions where we’re seeing the biggest lifts? Is it more certain targeted populations focused on social isolation or geographic regions that are food deserts where we’re doing more around healthy food? From there, we’re figuring out how to make that fully scalable. The goal is not to march out one by one over 30 years. The bold goal is to figure out how to scale this. We think were on to something that really, really valuable to our membership.

What we’ve got in each of the big markets is a directory, if you will, of all the local resources. So, we’re screening [members] for food insecurity, loneliness, social isolation, transportation issues. And were creating a registry of all that social determinant data, and all that data is very valuable because you almost never know who is having these sorts of issues. Then we have the places identified where there aren’t appropriate resources, and we’re making meaningful investments in making sure if there’s an area with a food desert, we create a food pantry, or we put a farmers’ market there with opportunities to make food affordable. We tailor the programs to the very specific needs. We have different, testing different things in different markets.

But that seems hard to scale, putting in very specific solutions to localized problems.

I don’t think so. I think it’s more about understanding what partnerships work best. One we’re testing were testing is with Papa Pals. Papa has relationships with college kids, and they have a platform for our members that are socially isolated. They go out to [a member’s] house, they spend a prescribed amount of time with the member, help with light housework, bring groceries in if they need it, do little things around the house. Our members love it. That’s a scalable model. We’re working with a couple different companies to try to have a really comprehensive registry of local resources to make sure we are referring our members to the right place to get their social needs met.

Where do you think, on a broader scale, the future of paying for these programs that address SDHs is going?

I think about it differently. Historically health plans have looked at return on investment. But health plans are spending lots and lots of money on healthcare and most of the things they spend money on don’t save money. They pay for it because it the right thing to do, it improves the health of their members. If I’m paying for a specific drug for a patient because it’s going to make them healthier, I don’t demand, ever, that by paying for that drug it actually saves money.

We should be thinking the same way about all aspects of the health of our membership. We don’t need to necessarily save money on every intervention. We need thoughtful thresholds around where our investments create the most health and where it’s most valuable for our membership. There’s more research needed. We’re in the early phases of this work and Humana’s at the bleeding edge of this work with the Bold Goal effort.

We will learn a lot about the ROI, and we will be transparent and publish that––and hope the industry learns from these experiences and share their own experiences. But I don’t think we need this hard and fast rule that says we’re only going to invest in social services if we can demonstrate within one year that it saves money.

There are some more gives from the government lately, with managed care being allowed to provide some in-home care. Do you feel more support from HHS and CMS in this area?

Yes, I think there’s a lot of momentum in this space right now. Social determinants have become a bit of a buzzword. Whenever you have a buzzword you, see some momentum building, but there’s years and years of evidence that people’s social context has a meaningful impact on their health. So, to some extent it’s a bit surprising that there is so much attention now. That said, were seeing a lot of movement, more flexibility in terms of benefit design to cover stuff. CMS, in addition to us, we’re all studying this, and we’ll be able to learn more and more. We will all get better at this.

What is the biggest impediment to achieving the goals of integrated care?

I think we’re getting better. Some of the challenges come from [the fact that] we live in a fragmented health system. Our job is to figure out how to create the right infrastructure, with financial alignment and tools, partnering with docs and providers, and create the whole array of clinical services our members need. Then, we integrate them for a seamless experience. If we can get to a seamless experience for our members, the fragmentation in the market isn’t that important. And we’re making as hard a sprint at that as we possibly can.