“Healthcare is going to become democratized,” Dr. Roy Beveridge, senior vice president and CMO of health insurer Humana said Tuesday morning to open MedCity ENGAGE in Bethesda, Md.
To Beveridge, an oncologist, the transformation has already begun, as consumers are choosing retail clinics and telemedicine over traditional physician office visits. The reason? They offer convenience, which is the same reason why people bank and purchase airline tickets online today rather than go to the bank in person during regular business hours to deposit checks or call up a travel agent to book trips.
“We as a society have made health very hard,” Beveridge said, while showing a photo collage of cheap junk food, traffic jams and people lounging on couches because they no longer have to get up to change the TV channel like earlier generations did.
Beveridge then showed a Humana-produced video of people talking positively about “health” and “care,” but they turned negative when they were asked to put the words together into “healthcare.” The problem, according to Beveridge, is that the old way of doing things, fee-for-service, revolves around sick care. It is fragmented and inefficient, with little or no care coordination, so patient, clinicians and administrators alike get frustrated.
“Please remember that we have to move from sick care to health care,” he said.
Beveridge noted that Humana had a “fundamental shift” after Bruce Broussard transitioned into the CEO in January 2013 before fully taking the reins a year later. “The new world is value-based reimbursement,” he said, noting that private payers and Medicare alike are accelerating the shift to this new paradigm.
Humana wants to improve overall health status by 20 percent by 2020. “You could sit there and say Dr. Beveridge is being very aggressive in his thoughts,” the company’s CMO said. But it already is happening with the change in attitude.
A Deep-dive Into Specialty Pharma
A specialty drug is a class of prescription medications used to treat complex, chronic or rare medical conditions. Although this classification was originally intended to define the treatment of rare, also termed “orphan” diseases, affecting fewer than 200,000 people in the US, more recently, specialty drugs have emerged as the cornerstone of treatment for chronic and complex diseases such as cancer, autoimmune conditions, diabetes, hepatitis C, and HIV/AIDS.
“You start paying clinicians based on quality, then you start to change relationships,” Beveridge said. This can complicate life for clinicians, though. “In order for the system to work, it has to become less fragmented,” he said. That means care coordination and a focus on population health.
The payer no longer is seen as “obstructionist” to the physician; instead, payers, including Medicare, are becoming important part of the care team because they have so much data that patients and caregivers need. For example, through its vast data stores, Humana has determined that the single most important factor in readmission for a 75-year-old woman with a hip fracture is food in the refrigerator. If they don’t have food at home, they are more likely to be readmitted, so part of the post-discharge care plan could be to deliver meals.
Humana also has begun measuring “healthy days” and “unhealthy days,” based on a validated but underused tool from the Centers for Disease Control and Prevention, Beveridge said.
