King rul­ing won’t change road to con­sumer-based health sys­tem

Modern Healthcare - - Q & A -

Bruce Brous­sard has served as pres­i­dent of Louisville, Ky.-based Hu­mana since 2011 and as CEO since Jan­uary 2014.

Hu­mana recorded $48.5 bil­lion in rev­enue last year, mak­ing it the fourth-largest pub­licly traded health in­sur­ance com­pany by rev­enue. The com­pany is one of the na­tion’s largest Medi­care Ad­van­tage in­sur­ers, with more than 3 mil­lion Ad­van­tage mem­bers rep­re­sent­ing about three-quar­ters of the com­pany’s rev­enue. Brous­sard pre­vi­ously served as CEO of McKes­son Spe­cialty Health, and chair­man and CEO of US On­col­ogy Hold­ings. Mod­ern Health­care re­porter Bob Her­man spoke with Brous­sard at the re­cent Health­care In­for­ma­tion and Man­age­ment Sys­tems So­ci­ety con­fer­ence about his com­pany’s use of mo­bile health in­for­ma­tion tech­nol­ogy to help providers man­age pa­tients’ care, the move­ment to­ward greater con­sumer choice in health­care, and re­cent CMS pay­ment and pol­icy changes for the Medi­care Ad­van­tage pro­gram. This is an edited tran­script.

Mod­ern Health­care: What is Hu­mana do­ing to en­gage pa­tients through mo­bile tech­nol­ogy?

Bruce Brous­sard: We look at three parts of health­care that need to change: One is around value-based re­im­burse­ment, the sec­ond is around con­sumer choice, and the third is around in­te­gra­tion of in­for­ma­tion. Mo­bile de­vices play a key part in all three—whether it’s en­gag­ing with the pa­tient around a health out­come, be­ing able to ser­vice them and give them the trans­parency of choice, or the abil­ity for physi­cians to make a de­ci­sion about care on the fly with a mo­bile de­vice. We see all three of those as part of the mo­bile evo­lu­tion we’re un­der­tak­ing.

MH: What is Hu­mana do­ing to fur­ther those goals?

Brous­sard: Tran­scend In­sight is a great ex­am­ple of an ap­pli­ca­tion that can help physi­cians man­age their pa­tients with a mo­bile de­vice, iPad or mo­bile phone. They can see gaps in care and data an­a­lyt­ics, al­low­ing them to rec­om­mend the next best ac­tion for their pa­tients. Tran­scend and Tran­scend In­sights are geared to­ward physi­cians. It re­ally gets down to help­ing the physi­cians with their work­flow and care co­or­di­na­tion, and ul­ti­mately help­ing them with pop­u­la­tion health.

MH: The CMS re­cently said it wants to move more pay­ments to­ward value-based care. What is Hu­mana do­ing on that?

Brous­sard: To­day, about 55% of our mem­bers are on value-based pay­ments. We want to see that con­tinue to grow. We are ex­cited about what HHS is do­ing in bring­ing pop­u­la­tion health and value-based re­im­burse­ment to the in­dus­try. We want to be a part­ner with providers. Tran­scend pro­vides the as­sis­tance in al­low­ing providers to tran­si­tion from a fee-for-ser­vice to a val­ue­based re­im­burse­ment.

MH: How much of that 55% rep­re­sents cap­i­ta­tion?

Brous­sard: We be­lieve physi­cians and hos­pi­tal sys­tems need to walk be­fore they run. So they start out with a re­im­burse­ment re­la­tion­ship with us that’s around qual­ity and cost bonus pay­ments. Over time, that tran­si­tions to a full-risk cap­i­ta­tion level. We have about 30% of our mem­bers to­day in a full-risk re­la­tion­ship with a provider, and we see that grow­ing as peo­ple be­come more com­fort­able mov­ing from a qual­ity-bonus re­la­tion­ship to a deeper re­la­tion­ship around risk.

MH: How does Hu­mana as an in­surer co­or­di­nate care be­tween the pa­tient and doc­tor?

Brous­sard: We have a very strong Hu­mana at Home plat­form, and we em­ploy about 10,000 nurses. We as­sist peo­ple when they tran­si­tion out­side of the hos­pi­tal to the home.

MH: How did Hu­mana do in the sec­ond open-en­roll­ment pe­riod of the Af­ford­able Care Act ex­changes?

Brous­sard: We con­tinue to see growth there. But what’s re­ally im­por­tant about the ex­change is that it gives con­sumers the abil­ity to choose a com­pet­i­tive prod­uct, and that drives in­no­va­tion.

MH: Do you see the trend to­ward high-de­ductible plans on the ex­changes con­tin­u­ing?

Brous­sard: There are high­d­e­ductible plans, but there are also low-de­ductible plans. The abil­ity for an

Medi­care Ad­van­tage is “a per­fect ex­am­ple of where the con­sumer is mak­ing the choice.”

in­di­vid­ual to choose what is most im­por­tant to them as they con­sider their health sta­tus and their risk tol­er­ance is a great op­por­tu­nity.

MH: Does Hu­mana have any con­tin­gency plans if the U.S. Supreme Court strikes down pre­mium sub­si­dies on the fed­eral in­sur­ance ex­change?

Brous­sard: We ob­vi­ously have con­tin­gency plans and they are de­tailed in na­ture, but I don’t think that’s ap­pro­pri­ate to share. I don’t know what’s go­ing to hap­pen, and spec­u­lat­ing around that will drive you crazy. No mat­ter what hap­pens, this tran­si­tion to a con­sumer-based health­care sys­tem is the road we’re on. It might change a lit­tle bit depend­ing on what hap­pens in June with the King rul­ing. But long term, you’re go­ing to see a con­tin­ued in­volve­ment of the choice of the con­sumer.

MH: What does Medi­care Ad­van­tage mean for Hu­mana?

Brous­sard: It is a very im­por­tant part of our busi­ness be­cause Medi­care Ad­van­tage en­cour­ages com­pe­ti­tion, value-based re­im­burse­ment and look­ing at in­di­vid­ual mem­bers holis­ti­cally. It’s a per­fect ex­am­ple of where the con­sumer is mak­ing the choice. Providers are in­cen­tivized around qual­ity and cost, and that forces in­te­gra­tion. We think about Medi­care Ad­van­tage both as a growth sec­tor and as an ex­am­ple of where health­care is go­ing.

MH: Is Hu­mana us­ing at-home tech­nolo­gies with its Ad­van­tage mem­bers to help them with bet­ter co­or­di­nated care at home?

Brous­sard: We’re testing high-tech per­sonal de­vices, whether it’s scales, blood pres­sure cuffs or mon­i­tor­ing move­ment. In­ter­ac­tive voice re­sponse is an op­tion where we com­mu­ni­cate with mem­bers and are more proac­tive in re­spond­ing to their needs.

MH: What’s your re­ac­tion to the CMS’ re­cent Medi­care Ad­van­tage rate re­lease for 2016?

Brous­sard: The CMS changed the rate a lit­tle over 2% be­tween the pro­posed rate no­tice in Fe­bru­ary and the fi­nal no­tice in April. It re­ally was around the cost trend, and it’s just fol­low­ing his­tor­i­cal in­for­ma­tion.

MH: What are your thoughts on the CMS’ de­ci­sion to up­date their risk-scor­ing method­ol­ogy?

Brous­sard: We weren’t too happy about that. The most in­te­grated care is in mar­kets that will be the most im­pacted by that change. We look at it as re­vers­ing where the progress has been. Those par­tic­u­lar pa­tients that are coded in those risk scores are prob­a­bly the ones who are the sick­est. So un­in­ten­tional con­se­quences could hap­pen from the point of view of value-based re­im­burse­ment and in­te­grated care for th­ese sicker pa­tients.

MH: The CMS said that this might lead to more ac­cu­rate cod­ing and that in­sur­ers have had a cou­ple years to get ready for this.

Brous­sard: The CMS was very thought­ful and did give us fore­warn­ing. But it’s still a large change for the in­dus­try, and no mat­ter how much you pre­pare for it, it’s still a change. I be­lieve the cod­ing ac­cu­racy was proper be­fore, so I don’t know if this helped in that.

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