Humana Inc. (NYSE: HUM) is trying to solve the U.S. health care puzzle by piecing together everything from non-medical home care focused on social determinants of health to palliative care designed to improve members’ end-of-life comfort.
Communication, culture and data will be the glue holding those pieces together, according to Dr. William Shrank, Humana’s new chief medical officer. The continued expansion of the Medicare Advantage (MA) program — which Humana is uniquely positioned to capitalize on — will likewise play an important role.
Previously in leadership positions at the University of Pittsburgh Medical Center (UPMC) and CVS Health, Shrank took over as Humana’s chief medical officer on April 1. Home Health Care News caught up with Shrank — also a CMMI vet — Tuesday at our Chicago headquarters.
In addition to broad health care integration, HHCN chatted with Shrank about a potential hospice MA carve-in and the Primary Cares First Initiative unveiled by the Centers for Medicare & Medicaid Services (CMS) last month. Other topics of conversation: the integration of Kindred at Home, the shift toward value-based care and the rise of the “payvidor” model.
You can read HHCN’s conversation with Shrank below, edited for length and clarity.
HHCN: Before joining Humana, you were with UPMC. Before that, you were with CVS Health and also spent some time at CMMI. How did that background prepare you for your role with Humana and where the company is heading in terms of in-home care?
Dr. Shrank: The thing that really attracted me to Humana is this model that integrates the payer and the provider around a member and the home.
A lot of the work that I had been doing leading up to this was around understanding how payer and provider integrate, how they partner. I was there when CMMI started, so I had the good fortune of being around when we were standing up some of the new payment models: ACOs, bundled payments, the Comprehensive Primary Care Initiative. All of those were about aligning provider payment with the outcomes you’re trying to produce.
At CVS, my work was largely around community-pharmacy partnering with providers taking risk, trying to align population health and community-based efforts to support patients between doctor visits. And at UPMC, payer and provider are already integrated.
What made me most excited about joining Humana was the focus on integration around the home — around where patients live and the very personal, contextual features of their lives. That’s how we’re going to get the biggest impact and holistically improve the lives of the people we serve.
I imagine it’s a fun time to be part of a big Medicare Advantage player.
One of the things that is cool about working for a Medicare Advantage plan is that we have a lot more flexibility around how we engage and support home health care. As you know, we’ve made a big investment into home health with Kindred at Home.
We’re not as hamstrung by some of the rules of traditional Medicare. We’re able to be more creative and cooperative.
These days, I think we’re more typically talking about MA and non-medical home care. MA, of course, is becoming more flexible in that space as well. What are your thoughts on that expansion and what it means for Humana?
That’s where the magic is — trying to reach people where they are. You need to understand the breadth of their social, behavioral and physical health needs.
Some of the flexibility that [CMS] has afforded MA plans in supplemental benefits is a huge opportunity for us to be much more proactive around meeting patients where they are — literally and figuratively. It’s meeting them where they are in terms of the home, but also meeting them where they are in terms of personal challenges and barriers they face.
That could be understanding if they’re isolated, depressed or have problems with transportation. It could be knowing that they don’t have healthy food to eat. Those are all pieces of a broader puzzle.
That’s our focus right now: How do we pull all those pieces together and try to really help our members.
Has Humana seen a bump in the home care providers out there trying to work with you?
I’ll say that I’ve been with Humana for two months, so I can’t really give you a good historical perspective. But I can tell you from being close to our colleagues at Kindred at Home, there’s tremendous enthusiasm. For them, there’s this sense that they’re unshackled.
Fairly recently, CMS made some moves suggesting that hospice may one day be carved into Medicare Advantage. I think policymakers announced in January they could test that idea through the Value-Based Insurance Design (VBID) model in 2021.
That is still not entirely clear — what the parameters will be. But you can imagine that is an area we’re really interested in, carving hospice into MA.
Right now, there’s this forced choice. You can either say, “I’m getting curative treatment,” or, “I’m getting palliative treatment.” Then the payment for that treatment comes from different sources.
That forced choice delays care and creates a great deal of anxiety around helping patients with advanced illness manage their symptoms. The idea is that, if you can carve in hospice, you can have more seamless transitions.
So theoretically, over time, I would be able to stick with Humana from home care, to home health, to palliative care and hospice?
That’s exactly right. You don’t go through the inconvenience of having to change payers. But more importantly, you don’t have the issue of having to change providers because of networks and other things. Also: You’re not forced to make these decisions and feel like you’re giving something up.
Humana finalized its deals with Kindred at Home and Curo Health Services in July 2018. Can you talk a little bit about the integration of those assets and where things currently stand?
It’s one of the places we’re investing our most resources. It’s the integration that’s going to be the difference. Owning a bunch of different components — but having them operate as silos — is not helpful.
We’re making a real investment internally to create what we call the “enterprise clinical operating model,” which allows us to integrate data, integrate on a platform and ultimately have all the different parts of the team coordinate with each other. As we think about priorities, that’s a very top priority for the company.
What do you think about some of the recent things we’ve seen from CMMI, namely the Primary Cares First Initiative?
It’s new — and there’s still much to learn. There are a couple of parts that seem to be an extension of the Comprehensive Primary Care Initiative. Then there are a couple called “direct contracting,” one of which is kind of poorly defined and related to taking geographic risk.
They’re of great interest for us — both on the payer and provider side. We’re going to participate in some way, but we’re still trying to figure that out.
I think this movement toward more risk in the primary care setting is only going to accelerate more relationships between primary care docs and home health.
What else is important to touch on in regard to social determinants of health?
Breaking down silos and making sure there’s integration is critical for changing the way we care for people in the home. Medicare Advantage is uniquely positioned to be able to support this.
When it comes to the move toward value-based care, in fee-for-service, you have providers taking risk. A primary care doc or a health system taking risk is going to have a hard time building all of the infrastructure at the community level to support social determinants of health.
We need infrastructure at the community level to better create care transitions, care continuity programs between the hospital and the home. We need programs that integrate pharmacy and different components. Providers are not going to go out and employ huge numbers of care managers that telephonically interact with their patients.
As a health plan — because of our scale and our geographic coverage — we’re far better positioned to do that. It’s what we’ve been doing for decades, this focus on population health. As an MA plan, we can really help providers with so many different pieces.
We think we can wrap around and be a much better value-based partner, a better provider of coordinated care.
Home care, home health, primary care, pharmacy. What are the keys to tying all these different pieces together? Is it data? If so, that seems like a challenge on the home care front, in particular.
I couldn’t agree with you more.
Data is at the core. Having a platform that allows everyone to communicate is absolutely critical. It’s also the ability to use that platform to help manage workflow. The platform has to have some intelligence to it.
The other critical part, though, is culture. There needs to be this mindset of, “I’m not looking at my responsibility as a home care provider, or as a care manager, or as a primary care doc.” I’m not just looking at my silo. I’m thinking, “How do I help manage that health of my patient or my member? Who’s on my team? How do I communicate with them so we’re all working together?”
That cultural piece is a big deal.