How Payers Scale Social Determinants of Health Goals

Payer social determinants of health strategies are moving into a new phase, as Humana’s latest Bold Goal report demonstrated.

Over the past few years, payers have gained deeper knowledge about the social determinants and conditions that bar different demographics from healthy lifestyles. In response, they have developed solutions for the problems that manifest from these barriers.

For Humana, that came in the shape of The Bold Goal program.

Launched in 2015, Humana’s chief executive officer Bruce Broussard put forward the program’s aim: to improve members' health by 20 percent in five years.

“Our CEO put this goal out there of improving the health of the people we serve by 20 percent and he sort of looked at our team and said, 'figure out what that means, figure out how you measure it, and so forth,'” Andrew Renda, associate vice president of population health at Humana, told HealthPayerIntelligence. “And that's what led us down the path of using the Centers for Disease Control and Prevention (CDC) Healthy Days tool.”

The team set out to increase members’ Healthy Days as defined by the CDC. The CDC metric observes members’ mental and physical health characteristics over the course of thirty days. Humana analyzed these characteristics in a set of 14 Bold Goal communities, which included cities such as Louisville, Kentucky where Humana is headquartered.

Since launching, Bold Goal communities have seen increases in healthy days and Humana has expanded the program beyond its original 14 communities.

This past year, Humana tracked Healthy Days for five chronic conditions—chronic obstructive pulmonary disease (COPD), coronary artery disease (CAD), depression, congestive heart failure (CHF), and hypertension. Each of these categories saw a decline in “Unhealthy Days” in 2019, ranging from 1.2 percent fewer Unhealthy Days for members with COPD to 3.2 percent fewer Unhealthy Days for members with hypertension.

Renda attributed this largely to Humana’s approach of tackling chronic conditions and social needs simultaneously. An intentional population health management strategy is key to helping members successfully pursue their chronic disease management.

For example, patients with diabetes are known to see a spike in emergency department visits and hospitalizations in the third and fourth weeks of the month. While the true cause remains unproven, many speculate that it is related to food insecurity. With that in mind, Renda said, Humana developed an intervention that delivers meals to members with diabetes in the third and fourth week of every month.

With social determinants of health being so core to their overall company philosophy, one of Humana’s aims for 2019 was to increase its social determinants of health screening rate. The Bold Goal’s new goal was to increase screenings by 1 million in 2019.

Humana not only achieved 1 million screenings last year but exceeded the target by conducting a total of 2.6 million screenings, nearly tripling its original goal.

This was a result of momentum coming from internally and also from Humana’s partners, Renda said. The payer offered the screenings in various formats through multiple channels. Consumers might be screened via a traditional direct-to-consumer approach, through an intervention, or through provider partners, to name a couple of options.

Around 100,000 of those responses came from the Medicare population alone, Renda highlighted. For this group, Humana used a comprehensive screening instrument that captured data from 10 to 12 different social determinants of health domains. Because of the study’s unusually large sample size, the insights from this study, set to be published later this year, helped confirm with greater confidence some of the widespread social determinants barriers facing seniors, including financial instability, food insecurity, and transportation.

The millions of screening responses contributed a strong, new data set for Humana’s advanced analytics tools, which is pivotal for the company’s strategy surrounding social determinants of health and chronic disease management going forward.

“We've used a lot of that data to create advanced analytics, like predictive models and natural language processors,” Renda said. “That really informs our strategy because it helps us understand number one, what the needs are, but also, how do we prioritize outreach to address needs and those people? So, analytics and data have been really important.”

In 2020, however, Humana and other payers are looking to take successful social determinants of health and chronic disease management solutions and scale them across different lines of business and alternate demographics.

“Our goal was to scale that social determinant work across our enterprise,” shared Renda. “That can either be scaling pilots organically into programs that can be integrating addressing social determinants into our current clinical operating models or by trying to integrate into our insurance benefits.”

Renda identified two key components of scaling a social determinants of health strategy across a company as broad-reaching as Humana is.

First, he noted that the vision has to come from the top.

“I really appreciate that our CEO, Bruce Broussard, has had a vision around this for a long time,” Renda said.

Broussard established social determinants of health as one of the company’s recently developed “five points of influence,” which was a pivotal decision according to Renda.

“Just having him call social determinants out as one of the most important ways that we can influence our members' health—it cascades from there: then the management team buys in, and then the people below them, and the people below them. And suddenly, when I go knock on doors, I'm not getting resistance as much because they understand it's a key part of our overall strategy and really the future of our company,” Renda explained.

However, scaling a social determinants strategy is more than just a vision or a statement. It cannot happen without real action.

“The other piece is that we need to apply the same rigor to social determinants that we've done for years for chronic conditions; rigor in terms of analytics, rigor in terms of outcomes analysis, rigor in terms of expectations around ROI,” Renda emphasized.

Taking action can be particularly complicated with social determinants of health because the data is still new and untested. While the payer space has accrued an impressive amount of information on key barriers to health across demographics, identifying the causative data is still a challenge. In some cases, it is relatively unknown whether addressing certain barriers will cause costs to decrease or if there is another source that needs to be tackled first or in tandem.

“Whenever we do pilot, we try to put a really rigorous study design behind it,” Renda said.

Pilots with community partners and an innovation mindset are also key to Humana’s social determinants of health strategy and scaling.

In order to effectively pilot solutions, the payer has had to:

• Narrow its focus to a certain set of social determinants
• Identify community providers and organizations that are willing to partner on these barriers to health
• Take an iterative approach of testing solutions

Having a strong social determinants of health strategy that is scalable and a pillar of the company philosophy has proven pivotal during an uncertain time for the healthcare industry.

“There are still some unknowns,” Renda shared. “But, if anything, it reiterates our commitment and it makes us want to double down even more because when push comes to shove, people weren't calling us about continuity of care, about medications. They were calling us about meeting basic needs. And that's ultimately what we need to help people solve for.”