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The effort highlights some of the challenges associated with social determinants of health.
A major population health management effort continues to show positive results, though the insurer-led effort is also shedding light on the difficulties posed by social determinants of health.
For the past four years, Humana has been chipping away at its goal to improve the health of the company’s Medicare Advantage members by 20% come 2020.
In the latest progress report (PDF) on its Bold Goal program, Humana said patients in its original seven target cities have seen an average reduction of 2.7 “unhealthy days” per year since the program started in 2015. The company uses “unhealthy days” as the key metric for its program. Unhealthy days don’t fit the Centers for Disease Control and Prevention’s definition of a “healthy day” due to either mental or physical ailments.
The city closest to achieving a 20% improvement by 2020 is San Antonio, Texas, where Humana’s Medicare Advantage patients have reported a 9.8% drop in unhealthy days.
Andrew Renda, M.D., Humana’s director of population health strategy for Bold Goal, told Inside Digital Health™ that local factors can make a major difference in outcomes. In Texas, for instance, Humana’s success is due in large part to its collaboration with the San Antonio Advisory Board and the city’s SA2020 city-improvement initiative.
Other cities are also demonstrating momentum.
“Tampa Bay started off trending in the wrong direction due to natural disasters such as hurricanes, but the community demonstrated a remarkable turnaround this year by addressing food insecurity (with the Hunger Action Alliance), loneliness (Papa [a senior services nonprofit]), and behavioral health conditions,” Renda said.
One of the major challenges Humana faces is puzzling: As patients live longer, their rates of unhealthy days increases. On average, Renda said, patients’ number of unhealthy days per year increases by one day with every three years of age.
Bold Goal data also make clear the burden of mental health. While the Bold Goal initiative has resulted in significant gains in physical health, Renda said, “we also saw that increases in mentally unhealthy days often outweighed those gains.”
Renda highlighted three drivers of mentally unhealthy days: the psychological stress associated with physical ailments, delayed or untimely diagnosis and stress related to social determinants of health (such as food, housing or transportation insecurity). Humana is working to address all three factors through efforts such as screening. Last year, the company referred half a million people for food insecurity.
“We also conducted a high-touch randomized control trial addressing food insecurity within primary care physician offices,” Renda said. “By addressing member, patient and community social determinants, we will improve both physically and mentally unhealthy days.”
Still, he conceded that a nationwide effort like Bold Goal will inevitably bump up against limitations driven by inadequacies or unavailability of social programs in the communities it serves.
To help address those problems, the company has turned to technological tools designed to raise awareness and link patients with services. For instance, the company created a data visualization map that allows physicians, care managers, community organizations and the public to get a visual sense of social determinants and available resources. Humana is also working on pilot projects for new community resource database platforms.
Though it faces significant challenges, Renda noted that the effort has correlated with a reduction of 2 million unhealthy days in its communities, a data point that translates to fewer hospital admissions and lower costs for customers.
“We still have a long way to go, but we are trending in a very positive direction,” he said.
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