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Movers & Shakers: A Look at Humana's Integrated Health Approach
Movers & Shakers: A Look at Humana's Integrated Health Approach
Movers & Shakers: A Look at Humana's Integrated Health Approach
Movers & Shakers: A Look at Humana's Integrated Health Approach
Movers & Shakers: A Look at Humana's Integrated Health Approach
Movers & Shakers: A Look at Humana's Integrated Health Approach
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Movers & Shakers: A Look at Humana's Integrated Health Approach

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Humana Inc. (NYSE: HUM) is a leading provider of commercial health plans, specialty insurance plans, and integrated health and wellness services. Headquartered in Louisville, Ky., the company was …

Humana Inc. (NYSE: HUM) is a leading provider of commercial health plans, specialty insurance plans, and integrated health and wellness services. Headquartered in Louisville, Ky., the company was founded in 1961 and currently serves 12 million members across the US through individual and employer markets. Humana is the fifth-largest company in terms of medical membership in the country. Humana is particularly strong in the Medicare market and has developed deep expertise over its 25-plus year experience with the program. Humana currently has Medicare offerings in all 50 states and offers Medicare Advantage plans and standalone prescription drug coverage for approximately 5.8 million members. In addition to selling insurance products, Humana also delivers primary care, urgent care, wellness, and other healthcare services through its operation of medical centers and worksite medical facilities via its Concentra subsidiary, CAC Medical Centers in South Florida, wellness company LifeSynch and other affiliated businesses. Humana’s president and CEO is Bruce Broussard, who was named president in late 2011 and appointed CEO in 2013. The company reported $41.31 billion in annual revenues for 2013.

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  • 1. MOV E R S SHAKE RS A LOOK AT HUMANA’S INTEGRATED HEALTH APPROACH: A Conversation with Chief Medical Officer Dr. Roy Beveridge March 2014 “We Accelerate Growth”
  • 2. MOVERS & SHAKERS 2 www.frost.com March 2014 Humana Inc. (NYSE: HUM) is a leading provider of commercial health plans, specialty insurance plans, and integrated health and wellness services. Headquartered in Louisville, Ky., the company was founded in 1961 and currently serves 12 million members across the US through individual and employer markets. Humana is the fifth-largest company in terms of medical membership in the country. Humana is particularly strong in the Medicare market and has developed deep expertise over its 25-plus year experience with the program. Humana currently has Medicare offerings in all 50 states and offers Medicare Advantage plans and stand-alone prescription drug coverage for approximately 5.8 million members. In addition to selling insurance products, Humana also delivers primary care, urgent care, wellness, and other healthcare services through its operation of medical centers and worksite medical facilities via its Concentra subsidiary, CAC Medical Centers in South Florida, wellness company LifeSynch and other affiliated businesses. Humana’s president and CEO is Bruce Broussard, who was named president in late 2011 and appointed CEO in 2013. The company reported $41.31 billion in annual revenues for 2013. Humana says its strategy is to “offer its members access to quality, affordable healthcare services through a consistent, best-in-class member experience.” One of the key ways this is accomplished is through Humana’s “Integrated Health” approach, which places the primary care provider at the center of a coordinated care process that is “consistent, cost-effective and member-focused.” In order to operationalize this integrated care approach for members and healthcare providers, Humana has made significant investments to upgrade its information technology (IT) capabilities, particularly with the deployment of sophisticated data analytics tools that enable a high-quality and personalized care experience. In addition to new IT investments, Humana also invests in innovative strategic partnerships designed to promote lifelong well-being. Nancy Fabozzi, principal analyst with Frost & Sullivan’s Connected Health group, recently spoke with Roy A. Beveridge, M.D., senior vice president and chief medical officer, Humana, to learn about his perspectives on how the payer world is changing in response to healthcare reform, as well as to understand more about Movers & Shakers Interview with Dr. Roy Beveridge Senior Vice President and Chief Medical Officer, Humana
  • 3. DR. ROY BEVERIDGE, HUMANA www.frost.com 3 Humana’s initiatives in Integrated Health and the role of health IT. Beveridge joined Humana in June 2013 and currently serves on the company’s Management Team, reporting to Broussard. He is responsible for developing Humana’s clinical strategy and also oversees policies related to Humana employees across its various clinical organizations. Frost & Sullivan is honored to feature Beveridge and Humana as part of its Movers & Shakers series. Nancy Fabozzi: Tell us about your professional background and your current role at Humana. Roy Beveridge: I was a practicing oncologist for more than 20 years, so I come to this position with a deep and strong understanding of the provider world. Prior to my current role with Humana, I was the chief medical officer at US Oncology, a physician practice management company for cancer specialists, and then served in the same role for McKesson Specialty Health after McKesson acquired US Oncology in 2010. So I understand providers and public policy, and have been engaged in managed care for more than 10 years. This opportunity with Humana is interesting because the company is transitioning from being an insurance company to an organization that is very active in shaping population health. Humana is focused on integrated health and my background helps inform that strategy. In order for a company to really have an integrated care platform, you need to understand how physicians think, to understand how providers work, and how hospitals work with doctors and everyone else within the system. My role is to try to help bridge those connections so that Humana delivers effective, integrated, seamless care to its members. NF: What kind of frustrations did you experience as a practicing physician? How does Humana address some of those challenges? RB: When I was seeing patients I would give someone a prescription for chemo or heart meds, or something else. When the patient would come back one month later, I would have no idea whether the patient took the medication or even filled the prescription. Another common problem would be situations where the patient might have had some treatment or medicine in the ER and then not be able to recall what that was. So, as a doctor, I was often out of the information loop. Let’s fast forward to the new world. Today, payers are becoming the information hub for healthcare. For example, at Humana, we can now send vital information back to the physician in real time, including necessary data and information on whether patients filled prescriptions. Humana also has advanced data systems and very sophisticated abilities to know when and where the patient went to the ER, their diagnosis, and which doctors they saw. For lab and other tests ordered by someone else other than the primary care physician or specialist, Humana can gather that information and import them into the doctor’s electronic health records (EHR). So communication is vastly improved, and, from a primary care perspective, this is critical. Today, many physicians are in risk arrangements with Humana or other payers so the payer-provider communication loop becomes essential because that physician is ultimately responsible for all of the care that patient is having rendered. NF: Better communication is great, but what about frustrations around getting paid? We often hear about the adversarial relationship between payers and providers. What’s different today? RB: In the old days, the physician was adversarial with the payer because the only thing the payer did was pay according to contracted rate. I often had to struggle for payment if I wanted to order a scan or some other test. But the reimbursement environment is changing and that will have a huge impact on payer-provider relations. When you begin to migrate from pure fee-for-service and a pure disaggregated system into a more integrated
  • 4. MOVERS & SHAKERS 4 www.frost.com system, then all players begin to take responsibility and become truly accountable. When the various IT tools, data, and information held by the payers becomes a critical resource for physicians, then the relationship between the payer and the provider is fundamentally different. That’s what we are doing at Humana, and our message to providers is one of partnership: “We want to work with you. We have services that allow you to deliver better care and we have payment methodologies that allow you to be more responsible and accountable.” That’s what doctors are asking for. With our systems, we can allow this to occur. NF: Talk about some of the recent investments Humana has made in health IT and how these tools work to help providers and patients. RB: We have three key solutions –Anvita, Availity, and Certify–that help drive our Integrated Health approach. For clinical decision support and analytics, we have Anvita. (NF: Anvita Health is a healthcare analytics company Humana acquired in 2011.) Anvita scans all of the data Humana has access to –claims and clinical data. It’s an engine that looks for defects or gaps in care, such as tests like mammograms, HbA1c, specialists’ assessments like ophthalmology, and so on. Anvita scans the data and pushes advice right back to the physician so that it can be acted upon. This really helps address another key challenge that physicians have (and that I experienced). Say I’ve got 20 or 30 minutes to see a patient. I could easily spend 15 minutes trying to figure out when the patient last had a mammogram or flu shot. That takes away from valuable time with the patient. What the patient really wants and needs is for the data to be there in front of me so I can focus on explaining test results or why the patient needs to have a particular test. Anvita looks at gaps in care and helps physicians improve the quality of care. Availity is a secure health information exchange system that makes it easier for Humana to share information and process claims across multiple providers. Availity is our central gateway for electronic data interchange (EDI) transactions and can be used by our providers at no cost. Certify (NF: Certify Data Systems is an HIE vendor acquired by Humana in 2012.) is our clinical information exchange solution that goes across various EHR systems and is offered in multiple configurations, with cloud-based options. Certify goes into EHRs, links that data with claims data, and provides an incredibly rich data source. These three solutions work together to improve integration and care quality. Physicians can use Certify to go into an EHR to extract data so Anvita can take the data and provide information on gaps in care, and then Availity can process the claim. Humana has spent the past couple of years figuring out how to link all these things together to ensure that these connections work. And they do work. NF: Today, Humana participates in 14 of the state health insurance exchanges (HIX) mandated by the Affordable Care Act. What kind of changes/challenges does HIX bring for payers? RB: HIX is changing the landscape and it’s beginning to ensure that things are becoming more patient-centric. Humana is focused on becoming a consumer-driven company, and we completely support this. Whether we are looking at public or private HIX, what’s really happening is the move to put the patient in charge. And that’s a good thing. It’s not just the physician that’s responsible for one’s care but it’s also the patient, or the consumer, that should be responsible also. This is a big shift. NF: How is Humana building new capabilities internally around engaging consumers? RB: When Bruce Broussard became CEO, he said that in order for us to be effective, we need to be seen as a health company. That means we, Humana, along with hospitals, physicians, nurses, need to be responsible and accountable for the care of the member or the patient. For example, we recently hired Jody Bilney, who is in charge of our consumer-facing business. One of the first things that she did was to have some of our key executives spend time with people that were signing up for Medicare Advantage. We actually went to their houses and sat down with new enrollees so that we
  • 5. DR. ROY BEVERIDGE, HUMANA www.frost.com 5 really looked at things from their perspectives. It was really eye-opening. We could look at the consumer for several vantage points. For me as a physician, I am now looking at things as a consumer, which is something that we doctors don’t necessarily do so well. With efforts like these we are changing the lens of the company in terms of understanding the consumer viewpoint, because, ultimately, we’re all consumers. When that’s the lens you keep focusing in on, then the simple payment for a service becomes not very important. NF: What about price transparency as a component of engaging consumers? As consumers pay more out of pocket, there’s going to be a greater demand for this sort of thing. RB: We have to be careful in transparency not to dumb things down to the point where things become meaningless. There are lots of parameters related to pricing for healthcare services. Take surgery. Is it inpatient, outpatient, is there a need for an anesthesiologist, can it be done locally? This is why drilling down into pricing for a particular procedure becomes more complicated. This leads to determining accountability and how we pay for things in bundling. As we get away from strict fee-for-service, then those bundles become more apparent and transparency becomes increasingly clear to the consumer. But right now, in a pure fee-for-service model, consumers get incomplete information. As we continue to move toward bundles and accountability, then transparency will exponentially increase, but things are going to happen differently with different specialties. We may find that value-based care is provided to a much greater degree earlier on in primary care, and we may see that bundles are used much more in specialties. NF: What kind of strategic partnerships does Humana participate in that help your efforts around engaging consumers and driving wellness? RB: Humana is a company that is focused on being accountable and responsible for the care of our members. We have committed ourselves to the goal of improving the health of all the populations we serve. If you think about that, it’s a broad goal. But we are starting to segment this goal by specific populations, like diabetics; we should be able to do this. But we need to have a lot of partners to get our members to that goal. We would have great hubris to say that we, by ourselves, can move the needle on all things. We can’t. But by working with companies and groups that our members trust, we can get there. Patients trust their pharmacists, their doctor, and their nurse–so we need to be forging relationships with those stakeholders. Today, we have great relationships with companies like CVS, YMCA, Walmart and lots of organizations, because that’s how you’re going to touch all of your members. Our relationship with Walmart is a good example. Some of our members qualify for a 5% to 10% discount if they go to Walmart to buy healthy foods. If you think about people who are on a fixed income, if they can go to Walmart to buy vegetables and fruits, a 5-10% discount is pretty good! So we realize the way to engage people is to work with lots of groups so we can effectively address the needs of a lot of different populations. Whether it’s our Walmart program, Silver Sneakers, or getting people to use various programs so they walk more, these lead to better health outcomes. Gamification is also an important concept for wellness. We will continue to engage various organizations and companies as partners in our efforts to touch various populations that we work with. NF: Final thoughts? RB: I left the provider world for the payer/consumer world because I think that it’s really important in this transition time that we are all going through that the provider point of view is something which is acknowledged and understood and promulgated within the decision-making of how we are getting data and how we are looking at transparency. That’s my personal motivation for why I changed fields. I think doctors and caregivers have to be intimately engaged in this bigger process because things are transitioning remarkably quickly.
  • 6. ABOUT FROST & SULLIVAN Frost & Sullivan, the Growth Partnership Company, works in collaboration with clients to leverage visionary innovation that addresses the global challenges and related growth opportunities that will make or break today’s market participants. For more than 50 years, we have been developing growth strategies for the Global 1000, emerging businesses, the public sector and the investment community. Is your organization prepared for the next profound wave of industry convergence, disruptive technologies, increasing competitive intensity, Mega Trends, breakthrough best practices, changing customer dynamics and emerging economies? Contact Us: Start the Discussion For information regarding permission, write: Frost & Sullivan 331 E. Evelyn Ave. Suite 100 Mountain View, CA 94041 SILICON VALLEY 331 E. Evelyn Ave. Suite 100 Mountain View, CA 94041 Tel 650.475.4500 Fax 650.475.1570 SAN ANTONIO 7550 West Interstate 10, Suite 400, San Antonio, Texas 78229-5616 Tel 210.348.1000 Fax 210.348.1003 LONDON 4 Grosvenor Gardens London SW1W 0DH Tel +44 (0)20 7343 8383 Fax +44 (0)20 7730 3343

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