‘Un­less we come to­gether as a com­mu­nity to im­prove the health of the com­mu­nity, we can’t suc­ceed’

Modern Healthcare - - Q & A -

Hu­mana set a goal of hav­ing 75% of its in­di­vid­ual Medi­care Ad­van­tage mem­bers cov­ered un­der value-based re­la­tion­ships by 2017. The in­sur­ance gi­ant now has 1.8 mil­lion lives, or 85% of that pop­u­la­tion, in value-based care. As a re­sult, costs de­creased by 19%. Dr. Roy Bev­eridge, chief med­i­cal of­fi­cer, is re­spon­si­ble for the

com­pany’s clin­i­cal poli­cies and over­all clin­i­cal strat­egy and joined Hu­mana in 2013. Board­cer­ti­fied in med­i­cal on­col­ogy and in­ter­nal medicine, he pre­vi­ously was chief med­i­cal of­fi­cer of McKes­son Spe­cialty Health, a sub­sidiary of McKes­son Corp. He spoke with Mod­ern Health­care pub­lic health reporter Steven Ross John­son. The fol­low­ing is an edited tran­script.

Mod­ern Health­care: How has the tran­si­tion from fee-for-service to val­ue­based re­im­burse­ment driven your pop­u­la­tion health man­age­ment ef­forts?

Roy Bev­eridge: In the tra­di­tional fee-forser­vice realm, you’ve got al­most an ad­ver­sar­ial re­la­tion­ship be­tween fee-for-service providers and the payer. Once you’re look­ing at out­comes, you have this phe­nom­e­nal align­ment. For ex­am­ple, if I’m a physi­cian and I’m man­ag­ing a pa­tient with di­a­betes, I don’t know whether the pa­tient has got­ten all of their pre­scrip­tions filled. I don’t know whether they’ve had their eye ex­ams done by some­one else. I don’t know whether they’ve had their kid­ney check done by some­one else. The payer ac­tu­ally has all the data, but the provider needs it to man­age the pa­tient. And it’s not just for di­a­betes. It’s the same thing for every health con­di­tion. And if the pa­tient is go­ing to be in the hos­pi­tal less, if they don’t need as much medicine, I’m still get­ting paid. There are not many things in the world where every sin­gle per­son’s in­ter­ests are ac­tu­ally aligned, and that’s what’s hap­pened in this val­ue­based world.

MH: Then why has it taken us this long to get to val­ue­based care?

Bev­eridge: When I started my train­ing, I would see some­one who came in with di­a­betes. I’d write a pre­scrip­tion for in­sulin. I’d give it to the pa­tient. I’m done. I’ve just treated your di­a­betes. Now, what do you think the like­li­hood that the pa­tient’s di­a­betes ac­tu­ally was op­ti­mally con­trolled, given what I just did? It’s not. And so, what we’ve done now with the use of tech­nol­ogy and rec­og­niz­ing that we need to have clin­i­cal out­comes, higher qual­ity, now I give the pa­tient a pre­scrip­tion for in­sulin, but I say, “Hey, do you have the re­sources to pay for it, and if not, let’s get the phar­ma­cist en­gaged. Do you know that there is a class over here that helps you with di­a­betic cook­ing. Do you know that there’s a gro­cery store over here that has classes every Thurs­day so that you’re go­ing to learn not to have starchy, high-glu­cose foods?” So there’s more work on my part, and I’m ac­tu­ally be­ing com­pen­sated more now that this pa­tient’s health­ier.

MH: How do you see tech­nol­ogy help­ing your pop­u­la­tion health man­age­ment?

Bev­eridge: From an IT stand­point, it’s not just who got their re­fill of their in­sulin. It’s also the an­a­lyt­ics to un­der­stand whether Mrs. Sanchez has a high like­li­hood of fall­ing. From a scale stand­point, we

“So there’s more work on my part, and I’m ac­tu­ally be­ing com­pen­sated more now that this pa­tient’s health­ier.”

ac­tu­ally have the an­a­lyt­ics that come in from their records and from our claims and all the ven­dor stuff to know whether this 83-yearold lady in the next year has a high chance of hav­ing a fall. And we can give her an ac­celerom­e­ter that warns her if there’s a prob­lem.

If you’re a smaller provider, you don’t have that scale. We buy th­ese things in tens of thou­sands. It tells us who’s at high risk for some­thing, and that’s the fun­da­men­tal change that’s oc­cur­ring. So, not that we should be the tech­nol­ogy com­pany, but we should be the com­pany that un­der­stands the risks that peo­ple have. We should be go­ing out to get what’s best in Sil­i­con Val­ley and bring that in so that our doc­tors, our providers have the best tools based on the in­sights that we can help bring our doc­tors.

MH: What role does Hu­mana play in terms of ad­dress­ing so­cial de­ter­mi­nants?

Bev­eridge: We looked at pa­tients who had be­hav­ioral health is­sues. If you’ve got a be­hav­ioral health is­sue and you’ve got di­a­betes, your costs are four times higher if you’ve got di­a­betes by it­self.

We’re fo­cused right now on so­cial iso­la­tion as prob­a­bly the great­est de­ter­mi­nant of in­creased costs. We worked with the Robert Wood John­son Foun­da­tion and asked what per­cent­age of peo­ple are food-in­se­cure? We guessed in one area in Florida that it was 25%. The num­ber was 50%. Now, let’s think this one through. If I’m your sur­geon and you have the hip surgery done and I do the surgery—I’m a great sur­geon and do ev­ery­thing per­fectly—send you home, and you don’t have food at home and you’re so­cially iso­lated, what’s the chance of you be­ing read­mit­ted? Astro­nom­i­cally high.

So in that case, we ac­tu­ally ship food to cer­tain pa­tient pop­u­la­tions. You can say, well, that’s a so­cially nice thing to do. No, it’s ac­tu­ally the med­i­cally right thing to do. If we want to just think about it from a cost stand­point, we should be ad­dress­ing those (is­sues). If you want to do it from a so­cial stand­point, even bet­ter.

MH: On the is­sue of high drug costs, are there op­por­tu­ni­ties for col­lab­o­ra­tion among sec­tors of the in­dus­try to en­sure that pa­tients have greater ac­cess to med­i­ca­tions?

Bev­eridge: Yeah. We’re blessed in be­ing in a coun­try where we’ve got phar­ma­ceu­ti­cal com­pa­nies that have in­vested tremen­dous amounts of money in com­ing out with things that, when I was train­ing for on­col­ogy, I never thought I’d see.

The payer world needs to spend more time with the man­u­fac­tur­ing world to fig­ure out where th­ese in­cred­i­bly, won­der­fully great drugs should be used, be­cause some­times ex­pen­sive drugs don’t work in cer­tain peo­ple or are not as great as peo­ple want them to be.

So we’re very, very com­fort­able us­ing those drug break­throughs and liv­ing in a so­ci­ety where there’s a lot of in­no­va­tion, which is great. Make sure you use the right thing at the right time at the right price point, too.

MH: How have you seen part­ner­ships evolve around pop­u­la­tion health ef­forts?

Bev­eridge: Three years ago, we started some­thing called Bold Goal. We’ve now done it in 17 cities, but in San An­to­nio, we work with the lo­cal gro­cery store. We work with a lo­cal YMCA. We work with the lo­cal gov­ern­ment. We work with (more than 100) not-for-profit groups. We work with the big univer­sity groups, be­cause we ba­si­cally said, “Un­less we come to­gether as a com­mu­nity to im­prove the health of the com­mu­nity, we can’t suc­ceed.”

There’s not one en­tity here who can do it them­selves, and if you think you can, you’ve got more hubris than you should.

So we came in and said we will fund this col­lab­o­ra­tion, this dis­cus­sion amongst everyone, and we can get you the ac­tual data, but we have ac­tu­ally im­proved the net health of the com­mu­nity as a whole sig­nif­i­cantly in the last three years. Now, I don’t think that’s hap­pened

“We have ac­tu­ally im­proved the net health of the com­mu­nity as a whole sig­nif­i­cantly in the last three years.”

any­where else be­fore. So we are us­ing a Cen­ters for Dis­ease Con­trol and Preven­tion measure called Healthy Days and we’ve been able to demon­strate an im­prove­ment in the pop­u­la­tion health by do­ing this col­lab­o­ra­tion. It’s not Hu­mana.

It’s not the food bank. . . . HGB is the big gro­cery store down there. They ac­tu­ally have di­a­betic classes. They’ve got nutri­tion classes for the pop­u­la­tion. So we’re a par­tic­i­pant, but we’re a com­mu­nity par­tic­i­pant with everyone else, and that’s how it has to hap­pen.

MH: How has that move to­ward a greater fo­cus on pop­u­la­tion health man­age­ment changed your com­pany’s busi­ness model?

Bev­eridge: It makes us re­al­ize that our sin­gu­lar strat­egy is im­prov­ing the health of th­ese pop­u­la­tions that we work with through all the things I’ve just talked about, and it’s a good busi­ness model.

If we im­prove the health, if we fi­nan­cially do bet­ter, and the pa­tients do bet­ter, our mem­bers do bet­ter, the com­mu­nity does bet­ter, I think that’s a won­der­ful align­ment of re­sources, and it re­ally al­lows us as a com­pany to get up in the morn­ing and go, “Hey, I’m here. Everyone is here im­prov­ing the health of the peo­ple that we work with.”

That’s a great way of get­ting up in the morn­ing and that’s a great busi­ness model from my stand­point. I’ll do that all day long.

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