Mary Caffrey is the Associate Editorial Director of AJMC/Managed Care for MJH Life Sciences. Her editorial responsibilities include Evidence-Based Oncology, Chief Healthcare Executive, and Managed Healthcare Executive.
Humana's 2021 Bold Goal Report, released last week, highlights the importance of health system partnerships.
Humana has learned plenty in more than five years of running its Bold Goal program, the population health effort that now operates in 16 communities and gave the Medicare and Medicaid giant a leg up on managing the social needs that soared when COVID-19 hit.
Chief among the lessons: We can’t do it alone.
Its 2021 Bold Goal Progress Report goes beyond the annual updates on “Healthy Days,” which are measured based on a definition developed by the CDC. This year, Humana also features information on a Basic Needs Program launched during the pandemic and screenings that doubled the original goal of 3 million to 6 million in 2020.
Bold Goal is Humana's ongoing effort to address holistic health needs in key markets, in part by working with community partners—from health systems to faith leaders—to address social determinants of health. The initiative, designed to tackle barriers such as lack of food or housing and social isolation that contribute to chronic disease, proved beneficial when the pandemic fueled a need to deliver more services in all these areas.
In 2020, Humana found that Bold Goal helped Medicare Advantage members increase the number of physically healthy days; however, perhaps to no surprise, there was a decline in healthy days on the mental health side.
Andrew Renda, MD, vice president for Bold Goal and Population Health Strategy at Humana, said in an interview with Chief Healthcare Executive™ that while it’s hard to say Humana would have fared without Bold Goal in place, it is true that the program “helped position us well” when the pandemic struck.
In an interview, Renda said that partnerships for a national insurer like Humana are essential—it covers 20 million lives in commercial, Medicare and Medicaid plans—and as Bold Goal has shown, it relies on working with market-level partners, especially when managing a response to something like COVID-19.
“Partnerships are absolutely key,” he said. “Number one, we don't have all of the expertise to address all these needs, and to we don't have the resources. So, partnerships are key in a national level.
“Partnerships are really crucial on the local level as we think about building trust with people in communities in deploying interventions and getting that buy-in to participate,” Renda added. “So, partnerships are important in a number of different levels. …
Renda offered an example of building a framework to address food insecurity, which was a major focus for Humana in 2020 due to the pandemic. “If you’re going to address food insecurity, it's important that we work with key leaders in that space. So, we might work with Meals on Wheels, we might work with Feeding America, and we do work with both of them.”
On of Humana’s hallmarks: it likes to have multiple partners so that it gets different looks at how to solve a problem. If it’s testing framework, Renda said, “we want to approach that in different ways.”
Is there an ideal Humana health system partner? If so, what are the characteristics for an ideal partner for a population health initiative?
“There certainly are some characteristics,” Renda said, adding that his list might not be “as precise as you want to hear. “I look at it as creativity, willingness to partner with us openness to exploring the impact of social determinants on health and health outcomes. Because I think just that willingness to come to the table and co-create something together is really, really important. And we've done that with health systems and with providers.”
Renda offered an example of a first-of-its-kind, value-based payment innovation with a handful of providers “that were willing to jump in with us.”
“We want to incentivize primary care providers to screen for social determinants, to document a code, and to make a referral to a community based organization,” he said. “Not everybody was willing to take that leap, and certainly [not] in the middle of a pandemic.”
But some were. The inaugural participant was Ochsner Health, based in the New Orleans, Louisiana metropolitan area, with operations as far north as Shreveport, La., and as far east as Pascagoula, Miss. New Orleans and Baton Rouge are both Bold Goal communities.
Does Bold Goal provide a template for health systems to be proactive in their own communities?
Renda would say yes. The toolkits, progress reports, and resources on food insecurity, which includes best practices on validated screening practices, all offer “off the shelf” help for health systems just getting started in population health.
Population health was an “aspirational goal, a little bit nebulous, frankly,” when Humana started down this path. But Renda said that didn’t matter when Humana’s CEO, Bruce Broussard charged the team with finding ways to address it—and figuring out how to measure that progress.
“We've just made such tremendous progress. I'm proud of the team and proud of our organization, how much we've learned about health-related quality of life, about social determinants, about data and interventions, partnerships.
The next step is to take what’s Humana learned and make it scalable and sustainable, Renda said. “Now we've got to move forward, I think that the new goal if there was one is to really achieve operational maturity around social determinants—it’s the proof points that these things work that justify bigger investments, so that we can scale things,” he said.
That's really the objective now—to scale that work to get those proof points, to infuse it into a variety of aspects of our business.”