I have the privilege of serving on the Board of Directors of Humana. One of our core corporate strategies is known as the Bold Goal. In specific markets across the country, Humana will improve the health of the communities it serves in a measurable way: 20% by the year 2020.
This population-based goal is very laudable, and periodically, in key cities across the country, Humana sponsors a daylong meeting bringing together community leaders to tackle the ongoing challenge posed by the social determinants of health. One such meeting was held in October 2017 in Louisville, KY, and was considered a “town hall” meeting. I had the opportunity to be the closing plenary speaker at that meeting. What follows is an edited version of my closing remarks.
Good Afternoon. What a treat and privilege it is for me to be speaking with all of you today! I am speaking with you wearing many hats: one as a primary care doctor with more than 30 years in clinical practice, another as the founding dean of the nation’s first College of Population Health, and yet another as a Humana board member, and I’m 3 years shy of being eligible for Medicare.
In business school, I had a wonderful professor who noted that every plenary presentation could be divided into 3 sections: point with pride, view with alarm, and end with hope. I plan on using this outline here this afternoon.
First, let me point with pride at a very high level, and then bring it down to the treetops. I believe that we have a lot to be proud of here today, and that the Bold Goal is indeed just that: an awesome demonstration of the commitment of Humana to tackle the social determinants of health straight on. As board members, we have had the honor of visiting various Bold Goal market cities, including San Antonio, TX, and Tampa Bay, FL. As a result, I have seen with my own eyes the amazing level of community engagement across these markets.
The Centers for Disease Control and Prevention (CDC) tool that we use to measure our progress in achieving the Bold Goal has been described in our Journal of Population Health Management in 2017, in a very important article titled “Leveraging Health-Related Quality of Life in Population Health Management: The Case for Healthy Days.”1 I’m proud that we have a solid scholarship underpinning the work that all of you are engaged in.
At the national level, we ought to point with pride at the recent publication from the National Academy of Medicine (NAM), titled “Vital Directions for Health and Health Care,”2 by NAM President Victor J. Dzau, MD, and colleagues from around the country. This report also underscores the critically important work of the Bold Goal: specifically, the NAM report calls for better health and well-being for our citizens, refocusing on chronic disease prevention and fostering transparency in outcomes, quality, and cost. These goals should resonate with the members of our audience today.
I am also pointing with pride at the role of the Board of Directors in their support of the Bold Goal. I can say unequivocally that we are fully committed, we are all in, and we have your back! We will continue to provide the necessary resources, even when there may not be an immediate monetary return. The Bold Goal is part of a broader strategy whereby Humana seeks to invest in technology to coordinate care and drive the system from one based on the volume of services rendered to one based on the value that these services create. Humana is also committed to expanding the access points for care.
At Humana, we know that of the millions of inbound phone calls from members across the nation, 2% of patients generate nearly 16% of all the phone calls. This is not news, but behind these data lies important Bold Goal information. Using what our college calls “population health intelligence,” we need to further evaluate the social determinants that affect the health of these 2% of patients. What is it about these patients? Do they need transportation? Do they lack food? Can they not afford their medication? These are questions that, frankly, until very recently, primary care doctors did not frequently ask.
Finally, I point with pride that I have learned a great deal here today, especially about the connection between the CDC’s measure of healthy days and the increased cost and utilization on the part of patients with poor self-reported measures. In other words, it should come as no surprise that members who self-report that they are suffering from ill health are overutilizers of care. As a result, we can now create a direct return on investment from our commitment to tackling some of the social determinants of health. In a nutshell, when we pay attention to housing, food, loneliness, and depression, we can reduce unnecessary testing and hospital readmission.
With regard to viewing with alarm, regrettably there is much to worry about. Where do I begin? Whatever your politics are, here are the facts.
Our great nation spends 18% of its gross domestic product on our industry, and despite this nearly $3-trillion annual investment, we rank seventeenth in the world on almost every available measure of the well-being of our society. According to a January 2013 breakthrough report from NAM, we rank poorly and our younger millennial citizens may have a shorter life span than current baby boomers, because of the misallocation of these precious resources.3 No other industry would tolerate such a poor outcome.
In addition, as I’m sure many of you are aware, our nation suffers from the so-called diseases of despair: suicide, drugs, alcohol, and the like—most especially since the Great Recession of 2008—and multiple cuts to the public health safety net. This is something that should concern every informed American.
We know that disparities in income drive the social determinants, as well as contribute to increasing levels of loneliness, isolation, and food insecurity, especially among the Medicare population. It is true, regrettably, that geography is destiny in our country, in that one’s zip code remains the single best predictor of life span currently available.
As a primary care doctor, mea culpa, I have rarely, if ever, asked patients if they suffer from food insecurity. Having done my clinical training a generation ago, I am alarmed that we do not currently focus on the social determinants of health as a central component of education in schools of medicine, nursing, and pharmacy.
And yet, I would like to end my talk with you today on a hopeful note. I am a “glass is half full” kind of guy.
What gives me hope for the future? Well, a meeting of leaders such as all of you assembled here today. This is truly an amazing demonstration of the commitment of the Louisville community to the improvement of the health of its citizenry.
I am hopeful that our College of Population Health, the first such college of its kind in the country, will continue to train the leaders of tomorrow and support them with the best possible scholarship in our field.
I am hopeful that the words of Chief Medical Officer of Humana, Roy Beveridge, MD, in his recent interview in Modern Healthcare,4 will further resonate with all of you. Dr Beveridge called for a reexamination of the private sector’s commitment to health rather than a focus on tests, procedures, hospitalization, and the like. At our college, we have been promoting the notion of “no outcome, no income” for nearly the past decade.
Finally, I am supremely confident that new technology and a change in professional education for future doctors, nurses, and pharmacists will support the Bold Goal. I am hopeful that in 2020, we will be together again to celebrate all the progress we have made, and our work will be a shining example for other organizations across the nation.
I believe that the nearly 200 community leaders appreciated my closing comments. The work of the Bold Goal continues now in nearly a dozen cities, and more research is forthcoming. What is happening in your city to change the conversation from healthcare services to health?
David B. Nash, MD, MBA, is Editor-in-Chief, American Health & Drug Benefits, and Founding Dean, Jefferson College of Population Heath, Philadelphia, PA.
1. Slabaugh SL, Shah M, Zack M, et al. Leveraging health-related quality of life in population health management: the case for healthy days. Popul Health Manag. 2017;20:13-22.
2. Dzau VJ, McClellan MB, McGinnis JM, et al. Vital directions for health and health care: priorities from a National Academy of Medicine initiative. JAMA. 2017;317:1461-1470.
3. Institute of Medicine. U.S. Health in International Perspective: Shorter Lives, Poorer Health. Report brief. January 2013. www.nationalacademies.org/hmd/~/media/Files/Report%20Files/2013/US-Health-International-Perspective/USHealth_Intl_PerspectiveRB.pdf. Accessed October 23, 2017.
4. Q&A with Humana’s CMO Dr. Roy Beveridge on community health and how to improve it. Modern Healthcare. September 30, 2017. www.modernhealthcare.com/article/20170930/NEWS/170929892. Accessed October 23, 2017.