Humana sees data critical to success in care transition

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Roy Beveridge, MD, chief medical officer at Humana, contends that the insurer has made great strides in leveraging data to improve care.

Louisville, Ky.-based Humana is one of the nation’s largest health insurance companies and has an extensive and growing value-based care presence, and as such, it’s looking for ways to better use its data as the healthcare industry moves from fee-for-service to pay-for-performance models.

“We’ve been on the vanguard of this for 15 years or so,” says Beveridge, noting that 66 percent of those covered under Humana’s Medicare Advantage plan are cared for by physicians in value-based care relationships with Humana, “which is very high for the industry.”

Humana has approximately 2 million individual Medicare Advantage members and about 130,000 group members who are cared for by more than 52,000 primary care physicians in more than 1,000 value-based relationships across 43 states and Puerto Rico.

In addition, Humana’s total Medicare Advantage membership includes more than 3.5 million members, who are affiliated with providers in value-based and standard Medicare Advantage settings.

“It’s hard to move into a value-based payment and care system if you’re not trusting the parties that you’re working with,” Beveridge says. “The trust happens automatically once you’ve got the payment mechanism aligned with the care. In the old fee-for-service (approach), you didn’t have the trust.

“We have feedback electronically that’s very sophisticated from a technology standpoint that helps them close all the gaps in care and ensures that they’re doing all the things that need to occur from a quality standpoint—that’s what builds the trust,” he adds. “We work with physicians and physician groups to look at how they rank around quality, and that’s really important when they’re looking at being accountable for a population.”

According to Beveridge, interoperability is critical to value-based care and payment, as is the “need for data and understanding so that the members—the patients—can be better taken care” of by removing unnecessary cost and incentivizing health outcomes.

“The technology is absolutely crucial in order for there to be an improvement in quality,” emphasizes Beveridge, who is a champion of Humana’s “bold goal” initiative to improve the health of the communities it serves by 20 percent by 2020. “Unless you arm the physician with good data in a format that they can work with and understand, they’re not going to be successful.”

Humana and more than 20 other organizations have formed the Da Vinci Project to work together to accelerate the adoption of HL7’s Fast Healthcare Interoperability Resources (FHIR) as the standard to support and integrate value-based care data exchange.

Also See: Blue Cross Blue Shield Association supports member FHIR adoption

The goal of the Da Vinci Project is to unleash critical data between payers and providers so that it can empower value-based care workflows and create a rapid multi-stakeholder process for addressing delivery use cases that can be implemented on a national scale.

“Humana has a vested interest in making the experiences of members and partner physicians the best they can be,” says Patrick Murta, Humana’s principal solution architect, business technology leadership, in a written statement. “As an industry, we don’t have a great model for the sharing of clinical data between doctors and payers. But new technologies like FHIR can allow us to integrate in new ways.”

Beveridge contends that information about social determinants of health is also becoming increasingly important to care in the 21st century, particularly for vulnerable populations. “It’s not just the data that you traditionally see in an electronic health record, but it’s also this other data—social determinants of health—that greatly impact the healthcare of the patient or the member,” he adds.

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Value-based care HIT Data sharing Interoperability FHIR Health insurance