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.