Humana’s Bold Goal represents an initiative by one of the largest insurance providers in the US to address the health needs of its members and communities, focusing on social determinants of health and health disparities within these populations. The initiative’s primary focus areas include food insecurity, social isolation, and housing instability. Pulse writer Emily Wang connected with Tray Cockerell, an early leader of Humana’s Bold Goal initiative, to learn how Humana seeks to address health inequity in their members’ communities in an effective and sustainable way.

Tray Cockerell, Director of Strategic Relationships in Health Equity and Community Engagement at Humana

The Pulse: Thanks so much for agreeing to speak with us. Let’s start this conversation high-level – can you share your background and tell us how you arrived at your current role at Humana? 

Tray: I joined Humana 20 years ago. At that time I didn’t think I’d be here for 20 years, however, I’ve been fortunate to be part of a company that has grown and transformed in so many ways over that time, and created so many opportunities for me and the people we serve. I started out in employee relations and quickly moved into a business leader role in the human resources department, leading HR for our corporate groups, such as finance, strategy, law, innovation, etc. In my 20 years, I have been able to touch many parts of the Humana ecosystem, including internal communications, benefits design and development, and innovation and marketing. I also worked for our Chief Operating Officer to integrate a care delivery company we acquired. This is where we began talking about a way to begin helping communities, and how I got the chance to help start the Bold Goal. I was at the very front end of the Bold Goal team, and managed all the resources for the strategy startup team in partnership with one of my co-leaders on the operations side of the business. I spent a lot of time in San Antonio to start up this Bold Goal journey, and now it’s live in almost 20 communities across the country, so I’m really proud of how this startup initiative within Humana has grown. 

About a year and a half ago, I began focusing more directly on social determinants of health in the health equity space, and worked on a project for a ‘community of opportunity’ identified by Humana. In this type of project, we partner with a local community that has tremendous disparities in health equity and serve as a partner to address complex chronic health issues in these underserved, underrepresented neighborhoods. Even where I sit in Dallas today, there are communities two or three miles apart that have an 18 year difference in life expectancy, and this is the case in many other cities across the nation. So this is where my work with Humana’s Bold Goal has been focused for the past seven years: understanding the hurdles to healthy living in these communities, and what is stopping people from achieving their best health. What are the key barriers that we can help address through partnerships?

The Pulse: It sounds like you’ve touched many parts of Humana’s business and you have worked with different health equity initiatives. Could you speak to some of the areas of excitement and specific challenges you’ve faced along this journey? 

Tray: The most exciting part was being on the front line in determining ways to address social determinants of health. At the start, we weren’t calling it “social determinants” or “health equity”, we were just trying to help convene the right set of community stakeholders and partner with them to address the key barriers to health in their communities. When we started Bold Goal seven years ago, this was the objective – to listen and understand the key challenges in San Antonio. And when we did, we heard about multi-generational households, and how they feel pre-destined to inherit specific health conditions; for instance, something like diabetes was treated as a hereditary disease. We were in a position to help people understand that this isn’t necessarily the case – you can change your behavior, and there are organizations you can engage with that can help address these important community health issues. Identifying the Bold Goal initiative’s ability to act as a community partner and make a significant impact was the most exciting part. 

The most daunting part was finding ways to create change in long-running challenges that seemed to be systemic or had been around forever. When we find issues have persisted for decades, we know they’re not going to be easy to fix. Bold Goal’s work starts by really understanding what a community’s challenges are – for example, we held clinical town halls in San Antonio in Year 1, and there were about 250 different community-based organizations represented and several hundred people in the audience. Our goal was to get people to come to the table with what they’ve already done and what they want to do, and create a shared vision. Let’s take the example of diabetes in San Antonio: we found out there were five different groups in San Antonio (and probably more we didn’t discover), that shared a specific mission, but they never talked to one another. They’d never been in the same room to say what they were doing, and how they might collaborate to address diabetes in the community. We sparked a collaboration to attack the diabetes issue in San Antonio. We also found other community-based organizations that were talking to each other, but weren’t really interacting or talking with doctors. They didn’t have an avenue to get doctors to advise or help them. Missing that connection didn’t enable them to collaborate to improve health inside and outside the doctor’s office. These organizations might have an impact in the community, but effective health intervention should start with establishing a trusting relationship with a provider, so they can give community members guidance on where to go – if they have food insecurity, or challenges with diabetes for example, what are the resources you can take advantage of, or medications and counseling you need? There are so many resources out there, but raising awareness and getting community members to understand how they can use resources was a huge challenge.

For Humana, our number one priority is to help individuals and communities improve broad health outcomes. This is easier of course at the individual Humana member level, because there are more levers we can pull with programming, direct counseling and coaching, and other resources we can give them access to. But we want to focus on how that extends to the rest of the community on a broader level, so we created metrics to understand the value Bold Goal adds on every scale. For example, of course there is value in terms of membership retention, but there is also improvement of health outcomes measured through a “healthy days” metric that identifies a person’s self-reported physical and mental health. We’ve been able to see an improvement across this metric spanning different communities throughout the years, and that’s how we have measured the impact of this Bold Goal initiative. 

The Pulse: One of the challenges facing population health programs is determining and measuring success metrics. Do you feel like people are beginning to understand the value of these programs in the long-term due to Bold Goal’s success metrics?

Tray: 100%. Humana is focused on the whole person’s health and putting patients at the center of care, and the goal is to make it easy. We do that in a couple ways, like providing care at home, or resources to make it easy for people to achieve their best health, which was the original Bold Goal. The goal was to have something that is continuously pushing the boundaries of improving health outcomes, so “healthy days” became a core metric for us to look at how we are having an impact on communities. We also looked at the number of people we serve who are in value-based care arrangements and see a value-based care provider – and they’re focused on understanding and addressing the whole person’s health, including aspects that have historically created health equity challenges for people. That’s the difference in this integrated model now, where we bring in clinically integrated pharmacists with social workers, nurses, physicians, and other clinicians to help treat people holistically. Historically, you may have gone to the doctor and they give you medication and say, “take this with food”. But if you’re food insecure, you may not be able to take that medication. And you might get sicker, or have a side effect from taking your medication without food. And it becomes a vicious spiral and your health gets more complicated and out of control simply because you didn’t have access to food to take medication. So providers knowing to screen for food insecurity and referring patients to the right resources is the type of change you’ll see in a value-based care environment. And that’s how programs can make a big difference – it’s not just a health program, it’s an intervention for systemic improvements. 

The Pulse: You’ve mentioned a number of Humana’s different business units and initiatives. Could you speak to where Bold Goal sits within the existing Humana programs, including value-based agreements Humana has within its network of providers?

Tray: So our Bold Goal model was built early on as an integrated one. We established an internal Board of Directors in each of our markets chaired with relevant leaders as well as the representatives of all parts of our business who really understand the disparate parts of our company. This is all led by a population health leader in each community, who actually formulates the local strategy with those local leaders. It’s been an evolution to integrate with the health plan and how we deliver benefits. We offer features now like a healthy food garden, and Papa, which is a program targeted at loneliness and social isolation among elderly members. Our pilots with Papa and other companies are now being incorporated into our health plan benefits through value-based insurance design or VBID, and through special supplemental benefits for the chronically ill, also known as SSBCI.  

The Pulse: I’m sure you’ve been asked this before, but how has COVID-19 changed the priorities of Bold Goal? 

Tray: During COVID-19, when the world pivoted to virtual, we did the same thing and took our programming virtual. With partners like Papa, we were able to address what became a much more heightened loneliness and social isolation problem in our senior population. We also virtually brought care into homes, and our in-home personnel virtually kept in touch to provide the care they need. In addition, during the pandemic there were also people who had chronically complex conditions that were medically distancing, but they still needed treatment or they would become incredibly ill. So we’ve been strong advocates for getting people to see their doctors again in a safe manner and focus on their broader health. Lastly, around vaccination education and efforts, we provide opportunities for communities to be vaccinated by partnering with organizations such as Walgreens to get them out to the community partners as soon as possible. And we’ve seen great responses to these actions. 

The Pulse: Going a bit broader – what do you see as the role of Humana, or any large health plan for that matter, in improving health equity? What is the ideal way for a health plan to have the most impact?

Tray: I think Humana really put a line in the sand when we hired a Chief Health Equity Officer, Dr. Nwando Olayiwola.  Bringing her on board to establish a strategy has really focused us on how to have more valuable conversations and interventions focused on health equity. This mission is about getting rid of unjust and avoidable differences in health, and there is no reason we should not be part of the solution. It’s incumbent upon companies like Humana to lead the way, and I also think it’s incumbent upon other companies to step up and provide support, because this is not just a health care problem but a societal problem. Ultimately, if you break down most of the challenges we see today, most disparities associated with health equity issues come back to poverty and the root of poverty is how society has dealt with marginalized populations. So for example, we support a company in the west end of Louisville called AMPED, and they have an incubator where they provide wraparound services for black and brown small businesses to start up. This is just one example of how Humana and large companies can support otherwise marginalized and underserved communities that haven’t had access to capital to start impactful companies, and can make a difference in workforce development efforts. We’ve also evolved requirements for some of our employment roles from a four year degree to other experience and credentials. You don’t have to have a four-year degree in analytics to come do a job in data analytics. We can easily get someone credentialed, train them in relevant skills and techniques, and they can come in and perform well at the job.  

The Pulse: Thanks so much for your time today. My last question for you – based on your career experiences, what advice do you have for students who are looking to start or advance careers within healthcare?

Tray: The cool thing about our industry is that there are so many opportunities. And you can come from very different backgrounds – so when I talked earlier about my career and not coming from a clinical background, I’ve had the opportunity to move from multiple different business avenues and work on incredible projects. So when you’re looking for a job in healthcare, just realize that career paths are unlimited; the key is to figure out what your passion, or “North Star” is, and there will be an opportunity to help flourish that passion and idea. At Humana, we’ve built an engaged population of employees. Bold Goal is an initiative that has been a real motivator and engagement factor for our employees because it’s about being part of something that is focused on how we help people achieve their best health outcomes in a way that enables them to live their best life. 

Interviewed by Emily Wang, December 2021.

On Feb 10-11, 2022, Wharton is excited to feature more expert perspectives like this one at our annual Wharton Health Care Business Conference. This year’s conference is virtual and themed ‘A Fair Shot at Health’. Tickets available here.