Since the birth of the medical insurance industry roughly a century ago, insurance companies have been regarded by many as businesses first and health providers second. Claims by health insurers to the contrary have long been met with skepticism, as a company’s efforts to improve the general health and well-being of its customers would seem counter-intuitive to profit making since medical procedures and claims would likely decrease in the long run.
But in recent years, forward-thinking insurers have begun to formulate comprehensive public health business models to boost the health of the population at large, in order to both keep costs down and to strengthen the social fabric. On this episode of Kentucky Health, host Dr. Wayne Tuckson talks with the corporate medical director of Humana, one of the nation’s largest insurance companies, to learn about its multi-faceted, collaborative initiative to create a healthy community in Louisville.
Dr. Bryan Loy is a pathologist by training, and is the corporate medical director at Humana, which is headquartered in Louisville. The insurer is leading an effort in the Derby City to make the population 20 percent healthier by 2020 – a “Bold Goal” indeed.
“It’s specific to Louisville,” Loy says, “but I’m a Kentuckian, and we’re really looking for that ripple effect… we believe we don’t live in a vacuum, and we’re looking to improve the health of all Kentuckians and any lives that we can touch.”
Targeting the Social Determinants of Health
According to Loy, Louisville has a lot of good health care providers and a long history of championing public health. Such a network is needed to help mend what Loy says is a “fragmented system” of insurance coverage and inconsistent access to providers that in many cases keeps people from receiving the health care they need.
“We’ve asked ourselves, are there areas where we can go beyond just the delivery of health care and dealing with sick care needs?” Loy says, “and then can we expand a bit to begin to think about, ‘How do we keep people at their best health?’”
Loy says that Humana began their initiative around three years ago by using a Centers for Disease Control questionnaire to establish a baseline level of health statistics for Louisville. The questions covered both physical and mental/behavioral health, and individual results were compiled and extrapolated to the greater population.
Loy says that Humana’s research has isolated a group of health problems among Kentuckians that are commonly known. “Diabetes, for example, and access to mental and behavioral health,” he says, “and in this state, we have lung disease and cardiac disease and high cancer rates.” But Humana’s inquiries went beyond tabulating disease incidence rates.
“We started to look at the other areas that are social determinants of health, like health care disparities, like access to care, like food insecurity, like clear air, access to safe places, and coordination of care,” Loy says. “We quickly realized that we can get the care right, we can finance the right care… and yet, if you send folks home and they have an empty refrigerator and they can’t come back for their follow-up appointments, we’re not likely to get the outcome that we want.”
To gain a better understanding of these social determinants for health required Humana to expand beyond its traditional role as insurer and collaborate with Louisville’s government agencies and the myriad social service nonprofit organizations in the city, as well as hospitals and other providers.
After making contacts with these stakeholders, “We learned two things,” Loy says. “One: we didn’t know what we thought we knew; and two: there’s a lot of overlap that’s out there. We said, ‘Boy, if we could eliminate some of the duplication and create some acceleration around these initiatives and provide support, we could do a great thing for this community.’”
Loy says that these collaborative efforts have identified several diseases and social determinants of health that the Bold Goal initiative has prioritized. They include upper respiratory health/asthma, diabetes, behavioral health, food insecurity, and transportation.
In the behavioral health arena, Loy states that one of the working groups decided to focus on reducing Louisville’s suicide rate to zero. “If you look at 50 peer cities, along with Louisville, you’d recognize that we’re eighth out of 50 in suicide rates, and that’s not tolerable” Loy says. “Folks said that zero percent wasn’t achievable, but we said that we should have zero tolerance – we should not quit this work until we can achieve our goal.”
Working Together to Develop Community-Tailored Health Care
Humana’s initiative has been successful in bringing more organizations aboard, Loy says, and that has helped the company expand its scope of understanding about the building blocks of a healthy community. Humana has conducted clinical town halls over the past three years, and they led to the creation of a Health Care Advisory Board, of which Loy serves as co-chair along with Louisville’s public health director Dr. Sarah Moyer.
“If this is starting to feel like collective impact, or if it’s starting to feel like a public-private partnership, well, you’re exactly right,” Loy says. “We’re working to bring the folks together to help co-create the initiatives and prioritize initiatives that we can take action on.”
One might assume that companies and nonprofits that have similar goals and organizational frameworks would seek to protect their turf, but Loy says that he has been pleasantly surprised by the stakeholders’ sense of social mission and their willingness to cooperate.
On Humana’s end, Loy says that a breakthrough in research came after visiting specific areas of Louisville to learn more about what he calls “the out-of-delivery experience” – in other words, what patients do during their time away from the doctor’s office to maintain good health. Humana found that what constitutes a healthy day for a resident in any particular neighborhood varies city-wide. For some folks, it could be paying their utility bills; for others, it could be living in an area where good jobs are offered.
Armed with this information, Loy says that Humana’s goal is to then formulate health and wellness playbooks designed for different communities in Louisville that recommend best practices for the citizens’ specific needs. Preventive care is emphasized. An example of this is the issue of food security, which is lacking in certain neighborhoods. Loy says that by working with other social service organizations such as food banks and poverty reduction nonprofits, Humana can help reduce food insecurity’s impact on health in communities where it exists.
“It’s more than writing checks, it’s more than rolling up your sleeves and actually participating in the work,” he says. “Sometimes it’s being able to check in on folks to make sure that they can even get food from their cars to their upstairs apartment, or that it can be prepared, or that they can consume it. So, there’s a lot of steps between here and there in terms of solving problems.”
Ultimately, Loy believes that re-conceptualizing heath care in the United States as a project focusing on establishing healthy communities will benefit Humana financially in the long term because its main customer base – senior citizens – will become healthier and live longer in the years to come. Furthermore, he envisions the current compensation structure for insurance companies and medical providers – a fee-for-service system – changing in the future to one where compensation is based on providers’ ability to meet benchmarks set for each patient’s overall health and wellness. By adopting a collaborative framework and an all-encompassing vision, Humana’s Bold Goal initiative anticipates this shift.
“The day has come,” Loy says, “where we are now beginning to ask the question, ‘What can we do to incent the doctor and the health care team to play that lead and to be able to keep their patients, our members, their fellow human beings, at their best state of health?’ You have to go beyond the delivery system and you have to collaborate with them.”
Learn more about Humana’s Bold Goal initiative.