Healthcare Analytics, Population Health Management, Healthcare Big Data

Population Health News

Humana: Change the Conversation on Chronic Disease Management

By Jennifer Bresnick

- It’s time to change the way the healthcare industry looks at chronic disease management, population health management, and helping patients achieve their best state of health, declared Bruce Broussard, President and CEO of Humana in a keynote address delivered this week at HIMSS15.

Chronic disease management at HIMSS15

Providers, payers, and technology companies must partner to deliver high-quality care that keeps the patient’s needs at the center of the discussion, he added, with the help of health data interoperability and a deeper dive into the value-based reimbursements that will drive meaningful change.

“We have to change the conversation about what we’re doing in healthcare from a supply-based system to a system that’s on-demand, where we put the customer first as opposed to the system,” Broussard said to a packed room in Chicago.  “We have to change as leaders in the healthcare delivery system. We have to change our perspective to ask, ‘Where is the customer?’  I’m sitting here and representing an industry and a company that is part of the problem.  We realize that.  But we have to change.”

The healthcare industry spends more than $3 trillion a year, but a third of that is wasted on administrative costs, over-treatment, and red tape. “Some significant dollars are being wasted because we’re focused on the supply and not the demand,” Broussard explained.  “Today it takes two weeks for a patient to get in to see a primary care doctor. If you’re a patient diagnosed with an illness, that’s going to be a long two weeks.  Physicians spend sixteen percent of their time on non-value-added patient activities.  Our system wasn’t built for chronic care – it was built for episodic care.  It was built for one-and-done, bill-and-move-on treatment.”

Yet as the American population ages and its demographics shift towards patients with more long-term problems and more complex chronic disease management needs, neither payers nor providers can content themselves with that outdated episodic mentality.  “Chronic care management is such a different part of healthcare,” he said.

READ MORE: Leveraging the Patient-Centered Medical Home for Older Adult Care

“Today, 80 percent of our costs in healthcare are related to chronic conditions.  And to manage those conditions, you have to have the ability to help with lifestyle.  You have to help the under-resourced with access to care, but also with literacy around health.  You also have to see the holistic person and not just the symptoms.”

Payers can lead the industry into this new era of accountable, patient-centered care by encouraging healthcare providers to participate in value-based reimbursement structures that are already producing substantial results at Humana and other large insurers.

“In our experience, Humana has seen real benefits from these programs,” Broussard said. “About 55 percent of our members have some relationship with providers who are being reimbursed around cost and quality.  We see about a 25 percent improvement in HEDIS scores.  We see a 20 percent less costly care delivery model from standard Medicare fee-for-service.  We see things like a 10 percent improvement in wellness checkups and a 10 percent reduction in ER visits and readmissions.  Last year, we helped people stay at home for 500,000 more days.  So it’s not only a great alignment of interests, but it’s really doing some great things for the individual and for society.”

At the heart of all these efforts lie health information exchange, interoperability, and the opportunity to draw insights from revenue cycle and clinical analytics to support the changes at hand.  “Value-based reimbursement along with integration is so powerful,” said Broussard.  “We see today that when information is flowing freely through the system, it creates better efficiency, better decision making, and a significantly better consumer experience.”

“We need to look at information as a shared asset, not a proprietary one,” he urged.  “It’s an asset that should be flowing through our system freely, as opposed to being taxed and tolled along the way.   We all can benefit from interoperability.  As you think about the siloes in the industry and you think about value-based reimbursement and you think about customers, interoperability is really the intersection of that.  It’s the ability for us to start acting like a team in healthcare, as opposed to everyone thinking they’re a track star.”

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By collaborating more effectively across the care continuum, healthcare providers, payers, and vendors won’t just develop innovative technologies that aid chronic disease management, but will truly implement a framework for extending the delivery of patient-centered, quality-based care to the entire population.

It starts with changing the way healthcare stakeholders do business, Broussard says, by putting the patient first, leveraging big data and health IT infrastructure to generate meaningful insights, and retooling reimbursements to embrace more effective chronic disease management and ongoing care that takes into account a patient’s entire journey through the system.

“I’m going ask for your assistance in making these changes,” he concluded.  “We’re one of the most inefficient countries in the world when it comes to healthcare.  So the statistics are telling us we have to change.  As I look into the next decade, there are some great things that can happen because of technology, and we can do some wonderful things.”

“It’s going to be uncomfortable; it’s going to be painful, he acknowledged.  “We can start with interoperability as the base to bring all of us together.  We can do it with partnership, and not doing it alone.  There isn’t going to be one company that’s going to solve that problem.  Part of that is looking at how information is shared.”

“So come join all of us, and be the leaders that will stand up and make the impact on where healthcare needs to go.  Take the technology we have, and all the things we know we have to do, and let’s take the necessary steps.”

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