The Pulse spoke with Dr. Roy Beveridge, Chief Medical Officer of Humana. Dr. Beveridge will be joining our conference panel, “The Other 50% of Health: Bending the Health Care Cost Curve via Wellness & Behavioral Economics.” We asked for a preview of what we can expect to hear at the upcoming Wharton Health Care Business Conference this February.

Key takeaways:

• Payment mechanisms will be the driver behind changes in how the healthcare system approaches basic wellness (e.g., diet, exercise, sleep, stress). As we shift towards value-based care, the whole system has more incentives to promote wellness.
• Payers need stability in the populations they are covering so that there is a financial return to investing in wellness. It’s hard to invest a lot of time and money into someone’s long-term wellness if you’re only insuring them for a couple of years.
• Basic social factors, like your ZIP code or education level, can determine a massive part of your health and wellness, and payers need to partner with civic leaders and community organizations to improve the health of socially-disadvantaged communities.

Pulse: Basic lifestyle choices surrounding diet, exercise, sleep, and stress predict a significant portion of health status. What role do you believe an insurer like Humana should play in encouraging individuals to make healthy lifestyle choices?

RB: Approximately 75% of our health care spend is related to chronic disease, including obesity, heart failure, and dementia. Some of this is ultimately related to exercise, diet, and smoking.

Dealing with chronic disease isn’t just the role of the doctor or the insurer. It’s a collective responsibility we all have. We’ve done a pretty good job with this before as a society with tobacco use. In the ’50s and ’60s, everyone was smoking in the movies. Now it’s socially unacceptable for someone to be blowing smoke in your face. We’re also making it very easy as a society for people to stop smoking with things like nicotine gums and Chantix.

In the future, instead of smoking, we’ll look more at exercise and caloric intake. It’s not just the responsibility of the payer or government to change this mindset, it’s everyone’s.

Pulse: What incentive do insurers like Humana have to promote wellness if they may only be insuring an individual for a short portion of their lifetime?

RB: Most of the people we cover are in Medicare Advantage (MA). Their average length of membership is more than 7 years, which is very long in the industry. So, when we have a senior sign up for coverage, we become very engaged in their health because we’ll probably have them for the rest of their lives.

It’s good business for us to do that. The healthier we can help our MA population be, the better it is for the patient without question, and we reduce our costs of taking care of that person. If we have someone who’s 65 years old and newly diagnosed with diabetes, and we work with them to lose 10 pounds and start exercising and eating better, they might not even need insulin and their hospitalization rate will decrease.

Pulse: How will providers help in encouraging better lifestyle choices for patients?

RB: I practiced medicine for over twenty years, and I recognize that the engagement of the physician is crucially important.

The medical world has switched from the fee-for-service (FFS) mentality to value-based care (VBC), which means that doctors are no longer paid just for a treatment, but for outcomes. This creates a huge change in doctors’ treatment plans for their patients, including a big focus on educating the patient; for example, helping them understand why taking insulin is important. The payment mechanism is driving this behavior change, and this behavior change is making people healthier.

Pulse: It sounds like Humana has had a lot of success with value-based payment models under its MA plans. Why did this work so well?

[Note to readers: According to Humana’s first-ever Value-Based Care Report, published this past November, Humana’s value-based care models for Medicare Advantage members outperformed fee-for-service models on both quality and cost.]

RB: If you start with a payment mechanism where the doctor or institution is paid more for an outcome, everyone will be aligned to help the patient improve their health. In the old FFS world, there was always an antagonism between the payer and the provider. In the VBC world, everyone is aligned – the payer wants the physician to see the patient more because it improves outcomes. That economic alignment is crucial. That’s why you see these great results with Medicare Advantage plans: everyone wants the patient to be healthier.

Pulse: Social factors, such as socioeconomic status and food security, can also have a significant impact on health status. For populations that may be economically or socially disadvantaged, how is Humana supporting patients in making the right health choices?

RB: One of the biggest causes of readmission to a hospital after surgery is whether or not a patient has food in their refrigerator. We’re finding that food insecurity is a huge issue for a great number of American seniors, and we have programs where we ship food to patients post-surgery.

[Note to readers: According to a Humana press release, 5.4 million U.S. seniors are food insecure.]

As a different example, if someone has diabetes and a behavioral health issue, their costs are four times greater than if they have diabetes alone. It’s too simple to just say, “Lose five pounds.” You have to think about if a patient can afford food; afford exercise, even if the local government is providing enough streetlights outside at night. To be successful, it’s not just about the payer – you have to work with local civic leaders as well to improve the health of a community.