American healthcare does not need more technology, but leaders to think about systematic problems and how to create solutions for consumers, argues the CEO of Humana.
American healthcare needs to transition from a supply-based to a demand-based system, with patient choice at the center, said Bruce Broussard, Humana's president and CEO, at the HIMSS15 Annual Conference & Exhibition.
"The problem is in this room, with all of us," Broussard said at the massive gathering of health IT professionals. "We have to be bold leaders in changing healthcare, because the consumer is looking for us to change."
Interoperability, the broad act of digitally sharing health information, "is a great place to start," Broussard said, less than a week after the federal government's health IT office issued a scathing report on data blocking practices at hospital systems and EHR vendors. "Information should be a shared asset, not a proprietary asset."
The issue of interoperability is of concern to Humana, the large Medicare Advantage and managed care insurer, because of its need in the implementation of value-based health payments. Volume-based care is not long for the world; a value-based reimbursement system is the unavoidable future, Broussard argued.
"Eighty percent of healthcare costs are related to chronic conditions. But our current system was not designed for chronic care management. It was built for episodic care. Both consumers and providers are victims of the system."
Broussard acknowledged that health insurers have been "part of the problem," perpetuating the currently misaligned system. But he argued that Humana is trying to help drive transformation, along with competitors.
"Insurance companies must make the healthcare system simpler for consumers," he said. "We have to change from an underwriting business model to a health improvement model."
Industry transformation, Broussard noted, can be painful for all involved--the workforce, executives, consumers, shareholders, taxpayers.
But he said the difficulties in moving away from volume-based care would ultimately yield improved health outcomes and cost control. He praised the U.S. Department of Health and Human Services for its stated intention to tie 30 percent of fee-for-service Medicare payments to quality or value through alternative payment models, such as accountable care organizations or bundled payment arrangements by the end of 2016.
"Value-based reimbursement and interoperability are the keys to change," he said. "The lack of both means we remain in a siloed healthcare system."
American employers know the problem well, being intimately linked to healthcare financing through a massive tax exemption and workforce benefits structure. Employers are increasingly looking for new ways to save themselves and their employees money and create incentives for better health, through value-based provider networks and health engagement programs.
Humana itself is changing with new incentives in mind, Broussard said. Compensation for senior leadership is based not only on earnings per share, but on the health engagement scores of members.
"We want to improve the health outcomes of our communities 20 percent by 2020," he said. "We're measuring this by a concept called 'healthy days.' We ask members four questions about their physical and behavioral activities, based on an approach used by the CDC. There is a high correlation between certain answers to those questions and healthy outcomes."
Broussard said Humana's experience suggested a combined "high-tech, high-touch" approach to care that will have the most impact on outcomes. "Improving the consumer experience with healthcare depends on personalization, not just data-driven personalization, but face-to-face conversation to drive better decision-making," he said.