An initiative by Humana (NYSE: HUM) that addresses social determinants of health posted positive results in five of seven target communities in 2018. On average, Humana Medicare Advantage (MA) members in participating communities saw a 2.7% reduction in “unhealthy days” experienced in 2018, according to the insurer’s 2019 Bold Goal progress report.
Unhealthy days are tracked using a U.S. Centers for Disease Control and Prevention (CDC) assessment tool called Healthy Days, which measures self-reported mental and physical health for people over a 30-day period.
That 2.7% dip is compared to numbers from 2015, when the Louisville, Kentucky-based Humana first announced its “Bold Goal” initiative. The goal of the program is to improve the health of select U.S. cities 20% by 2020 by focusing on members’ clinical and social needs alike.
For Humana, decreasing unhealthy days has also meant a decrease in health care costs. Each unhealthy day comes with the potential of $15.64 per member per month in higher medical costs, according to Humana data highlighted in the report.
While 2.7% is a far cry from the insurer’s 20% goal, the initiative is steadily improving outcomes.
Comparatively, MA members who weren’t part of the Bold Goal program saw a 0.6% increase in unhealthy days experienced in 2018, according to the report.
“It’s just the beginning,” Caraline Coats, Humana’s vice president of Bold Goal and population health strategy, told Home Health Care News. “We’re learning more and more every year [about] what it takes to go into these communities and improve health. We continue to see positive improvement and take the learning from our designated Bold Goal markets and apply it to other populations and communities we serve.”
Results by city
Humana’s seven original Bold Goal communities include Tampa Bay, Florida; Broward County, Florida; Louisville, Kentucky; Knoxville, Tennessee; Baton Rouge, Louisiana; New Orleans and San Antonio.
Four years in, San Antonio is halfway toward achieving a 20% improvement in member health. Since 2015, Humana MA members in San Antonio have experienced a 9.8% reduction in unhealthy days.
Meanwhile, Baton Rouge saw a 5.1% reduction in the number of unhealthy days its members experienced, followed by New Orleans (3.9% reduction), Tampa Bay (3.8% reduction) and Knoxville (1.5% reduction).
However, Humana Medicare Advantage members in Louisville and Broward County saw more unhealthy days last year than they did in 2015, increasing 1.5% and 3.6%, respectively.
Mental health was largely to blame, Coats said.
“We saw some movement forward in physical, but mental health proved to be a headwind, so [it’s] not something that we’re necessarily down on, but more of an insight,” she said. “Mental health is not just clinical health and a diagnosis, it’s also anxiety and stress related to aspects of folks’ social health.”
As a result, Humana is taking a deeper dive into addressing diagnosed mental health conditions, in addition to social determinants of health such as stress, Andrew Renda, corporate strategy director for Humana’s population health division, told HHCN.
Humana is also exploring further expansion of its supplemental in-home care services offered under Medicare Advantage.
Earlier this year, the Centers for Medicare & Medicaid Services (CMS) announced it’s widening the scope of supplemental benefits MA plans can offer in 2020 and beyond.
The 2020 rules give MA plans permission to cover benefits that “have a reasonable expectation of improving or maintaining the health or overall function” of beneficiaries with chronic conditions, opening the door for a more comprehensive treatment of social determinants of health.
Although Renda declined to discuss specifics, he said the new rules open the door for exciting opportunities.
“We’re definitely exploring those options,” Renda said. “We like having the permission space because ultimately we believe that addressing social determinants should be part of a comprehensive health plan and part of a clinical strategy.”
Strategically, Humana has an internal advantage compared to other major insurers when it comes to addressing social determinants of health and understanding what is going on inside the homes of its members.
Last year, the insurer and its PE partners — TPG Capital and Welsh, Carson, Anderson & Stowe — acquired Kindred at Home, the single largest U.S. home health company, and Curo Health Services, one of the largest U.S. hospice providers, for about $4.1 billion and $1.4 billion, respectively.
Also highlighted in the progress report, Humana screened 500,000 people for social determinants of health in 2018, with the goal being to address the needs of those screened and ultimately reduce spending and improve health.
The insurer aims to screen 1 million people by the end of 2019.
Humana releases its financial results for the first quarter of 2019 on May 1, with a conference call scheduled for the following morning.