When Humana screened 100,000 of its Medicare Advantage members and 30,000 Medicaid members, 41 percent reported having financial strain, 29 percent described themselves as lonely, and 26 percent are food-insecure. Andrew Renda, M.D., M.P.H., population health officer for Humana, called those numbers shocking and a call to action.
Speaking recently at the annual Population Health Colloquium, Renda and Nwando Olayiwola, M.D., M.P.H., Humana’s chief health equity officer and senior vice president, outlined why it is important for large health plans like Humana to address population health and equity issues head on.
Humana calls its long-term effort to address social determinants of health its “Bold Goal” program. It is broadly focused on addressing the needs of the whole person by co-creating solutions to address social determinants and the health-related social needs for its members and communities. Humana uses the U.S. Centers for Disease Control and Prevention (CDC) “Healthy Days” assessment tool to measure the mentally and physically unhealthy days of individuals over a 30-day period, covering Humana member populations through lines of business such as Medicare Advantage, Group and Medicaid.
“The Bold Goal is really about whole-person health, about holistic health,” Renda said. “When I think about that, I think about a full and complete bio-psycho-social model of health — it's physical health is mental health, and its social health. I think about social health or health-related social needs as rate-limiting factors as to why a lot of people don't achieve their best health outcomes,” he explained. “A lot of what we do is very focused on individual and immediate health-related social needs, and that term health-related is really important. We focus on food insecurity, loneliness, transportation, housing, and financial security, and we do that because they are the most prevalent needs in our memberships.”
Renda said Humana has done some innovation on interventions on social-related healthcare interventions. “What we're really about now is scaling, and operationalizing our social needs work, because we have to create the proof points to justify bigger investments that leads to the sustainability of the work and allows us to help more people over a longer period of time.”
Prior to joining Humana, Olayiwola was the chair and professor in the Department of Family and Community Medicine at The Ohio State University College of Medicine, where she was also the founding director of the Center for Primary Care Innovation and Transformation and Co-Chair of the OSU Wexner Medical Center’s Anti-Racism Action Plan.
Panel moderator David Nash, M.D., founding dean emeritus of the Jefferson College of Population Health, asked Olayiwola to talk about some of the ways large payers such as Humana can address equity issues.
“We know that health inequities are very, very costly from a social justice perspective, from a health and clinical outcomes perspective, and also from an economic perspective in our in our country,” Olayiwola said. “We know that health disparities in the United States cost us about $93 billion in excess medical costs every year, and $42 billion in lost productivity. We have the opportunity to think about health equity broadly at one of our nation's largest payers. We are thinking through the role of a health plan in addressing and tackling health inequity.”
Olayiwola identified five different ways that health plans could prioritize their work that could lead to some scalable, sustainable change for the millions of patients and members they serve.
The first one involves the prioritization of prevention and wellness. “This is a population health conversation we're having,” she said. “We want to make sure that the plans are being creative in the way we think about care delivery, and how we organize our benefits.”
The second involves thinking about how they prioritize the work, the skills, the expertise, and the mobilization of communities that surround them. “While many health plans have responsibilities to members and the members who are part of their plans, I believe we also have responsibility to the communities in which our members come from, so we are figuring out how to best align with underserved communities that have been made to be vulnerable, learning from diverse voices in our communities to leverage change.”
The third aspect involves thinking about how Humana can leverage “analytical tools, collaborations, and the massive amounts of data that we have to think about our populations as a whole,” she said, “to think about how we look at data differently to understand the needs of different populations, but then also coupling that with the focus on digital health and expanding the opportunity to provide more solutions that gave people an option to get care, or access to their plans in ways that are creative and new, while not worsening what is well known as a digital divide.”
The fourth one is for health plans to build collaborations with academic partners that can yield mutually beneficial relationships and can build a workforce and help develop the next generation of healthcare professionals, public health leaders, and population health leaders. “What tools can we give them to so they're prepared to tackle some of the challenges that we're going to see?” she asked, add that research partnerships generated through those academic collaborations can be highly fruitful for health plans.
Finally, Olayiwola spoke about using data to drive action and accountability. “It’s interesting to me that so many of the organizations across the country that take care of members and patients do not yet have the ability to understand differences in their populations, to understand disparities that might exist to be able to disaggregate or stratify their data by a number of different social, racial, ethnic, other demographic variables,” she said. “How are we able to look at and understand their experiences? I think that the next frontier for our work in the healthcare environment is to understand how to look at populations differently. How do we understand what disparities may be driving some of the outcomes that we're seeing, so that we can be accountable for resolution and finding the right partnerships and collaborations that are essential to making progress?”