Humana CMO: Why the insurer is so bullish on global payments
Skip to main content
MDHC_Logotype_white
Subscribe
  • My Account
  • Login
  • Subscribe
  • News
    • This Week's News
    • COVID-19
    • Providers
    • Insurance
    • Government
    • Finance
    • Technology
    • Safety & Quality
    • People
    • Regional News
    • Digital Edition
    • Encompass Health reports minor gains in fourth quarter, predicts 8% growth in 2021
      Lab stakeholders welcome Biden moves on COVID-19 testing, suggest additional steps
      Humana names first chief equity officer
      Amid COVID health worker shortage, foreign-trained professionals sit on sidelines
    • Lab stakeholders welcome Biden moves on COVID-19 testing, suggest additional steps
      Amid COVID health worker shortage, foreign-trained professionals sit on sidelines
      J&J 4Q sales rise despite pandemic, but charges cut profits
      Biden administration to boost vaccine supply amid shortages
    • Ascension’s St. Mary’s Hospital Surgery Center at Towne Centre and Allegheny Health Network’s Bethel Park surgery center
      Hospitals see opportunity, risk in ambulatory surgery centers
      Health suffers as rural hospitals close
      Medicare ACO participants fell in 2021
      Louisiana gets reports vaccine providers are discriminating
    • Billing, antitrust exemption changes upend negotiations between insurers and providers
      MAIN-Health Bill_iStock_i.jpg
      Insurance-tech firm MultiPlan makes $155M buy after blank-check deal
      Last-minute COVID costs cut into UnitedHealthcare's $396 million operating income
      CMS approves rule forcing insurers to ease prior authorization
    • CMS pauses three Trump-era proposed rules
      Biden administration to boost vaccine supply amid shortages
      It's a secret: California keeps key virus data from public
      lacewell_linda_supertinendent_dept_of_financial_services_8.47.jpg
      New York state investigates drug price spikes during pandemic
    • KPMG says deal activity will stay high in '21: 10 takeaways
      By the Numbers: 20 largest healthcare investment banks in 2020
      Providers await new HHS coronavirus grant reporting deadline
      Operation Warp Speed Dr. Moncef Slaoui, Pfizer Group President Angela Hwang, Moderna CEO Stephane Bancel, CVS Health Executive Vice President Karen Lynch and McKesson CEO Brian Tyler participate in a panel discussion on the COVID-19 vaccine.
      Hospitals, drug companies strive to stand out virtually at JPM
    • Studies extend hopes for antibody drugs against COVID-19
      Google to convert office space for COVID-19 vax clinics
      Dr. Karen DeSalvo
      Next Up Podcast: What to expect with telehealth and healthcare technology in the next four years
      Next Up Podcast: What to expect with telehealth and healthcare technology in the next 4 years - Transcript
    • Amid COVID health worker shortage, foreign-trained professionals sit on sidelines
      China pushes conspiracy theories on COVID origin, vaccines
      An older man wearing a mask receiving a vaccine.
      Want more diversity in clinical trials? Start with the researchers
      Avocado
      Avocado a day keeps the doctor away
    • Humana names first chief equity officer
      WEb_i.jpg
      Q&A: Dr. Cliff Megerian, University Hospitals' soon-to-be CEO
      ZentyWeb_i.jpg
      Tom Zenty is leaving a legacy of transformational growth at University Hospitals
      Cerner names Erceg as new CFO
    • Midwest
    • Northeast
    • South
    • West
  • Insights
    • ACA 10 Years After
    • Best Practices
    • InDepth Special Reports
    • Innovations
    • The Affordable Care Act after 10 years
    • New care model helps primary-care practices treat obesity
      doctor with patient
      COVID-19 treatment protocol developed in the field helps patients recover
      Rachel Wyatt
      Project to curb pressure injuries in hospitals shows promise
      Yale New Haven's COVID-19 nurse-staffing model has long-term benefits
    • Modern Healthcare InDepth: Breaking the bias that impedes better healthcare
      Videos: Healthcare industry executives describe their encounters with racism
      Michellene Davis
      Healthcare leadership lacks the racial diversity needed to reduce health disparities
      Dr. James Hildreth
      How medical education can help fight racism
      Quotes from rebadged employees
      Outsourcing IT, revenue cycle takes toll on internal culture
    • A phone screen showing the question, "Mary we hope this information was helpful and we'd like to keep guiding you. Are you interested in knowing when it's your turn to receive the vaccine?"
      Chatbots, texting campaigns help manage influx of COVID vax questions
      A woman with a wearable sensor talking to her provider.
      Wearable sensors help diagnose heart rhythm problems in West Virginia
      self service station
      COVID-19 pushes patient expectations toward self-service
      Targeting high-risk cancer patients with genetics
  • Transformation
    • Patients
    • Operations
    • Care Delivery
    • Payment
    • Highmark Health inks six-year cloud, tech deal with Google
      Study: 1 in 5 patients report discrimination when getting healthcare
      HHS proposes changing HIPAA privacy rules
      Android health records app launches at 230 health systems
    • California hospitals prepare ethical protocol to prioritize lifesaving care
      Amazon, JPMorgan Chase, Berkshire Hathaway disband Haven
      Digital pathways poised to reshape healthcare continuum in 2021
      Healthcare was the hardest hit by supply shortages across all U.S. industries
    • A phone screen showing the question, "Mary we hope this information was helpful and we'd like to keep guiding you. Are you interested in knowing when it's your turn to receive the vaccine?"
      Chatbots, texting campaigns help manage influx of COVID vax questions
      A woman with a wearable sensor talking to her provider.
      Wearable sensors help diagnose heart rhythm problems in West Virginia
      New care model helps primary-care practices treat obesity
      How hospitals are building on COVID-19 telehealth momentum
    • Regional insurers bet big on virtual-first plans
      MedPAC votes to boost hospital payments, freeze or cut other providers
      Most Next Gen ACOs achieved bonuses in 2019
      Congress recalibrates Medicare Physician Fee Schedule after lobbying
  • Data/Lists
    • Rankings/Lists
    • Interactive Databases
    • Data Points
    • Health Systems Financials
      Executive Compensation
      Physician Compensation
  • Op-Ed
    • Bold Moves
    • Breaking Bias
    • Commentaries
    • Letters
    • Vital Signs Blog
    • From the Editor
    • Wellstar CEO calls adapting for the pandemic her bold move
      Howard P. Kern
      Recognizing the value of telehealth in its infancy
      Dr. Stephen Markovich
      A bold move helped take him from family doctor to OhioHealth CEO
      Dr. Bruce Siegel
      Why taking a hospital not-for-profit was Dr. Bruce Siegel’s boldest move
    • Barry Ostrowsky
      Ending racism is a journey taken together; the starting point must be now
      Laura Lee Hall and Gary Puckrein
      Increased flu vaccination has never been more important for communities of color
      John Daniels Jr.
      Health equity: Making the journey from buzzword to reality
      Mark C. Clement and David Cook
      We all need to 'do something' to fight inequities and get healthcare right, for every patient, every time
    • The missing piece in our fight against COVID-19: primary care
      Ambulatory surgery centers offer extraordinary value in a high-cost healthcare system
       Alan B. Miller
      Looking ahead with optimism as we continue to transform healthcare
      Dr. Bruce Siegel
      By protecting the healthcare safety net, Biden can put us on the path to a stronger country
    • Letters: Eliminating bias in healthcare needs to be ‘deliberate and organic’
      Letters: Maybe dropping out of ACOs is a good thing for patients
      Letters: White House and Congress share blame for lack of national COVID strategy
      Letters: VA making strides to improve state veterans home inspections
    • Sponsored Content Provided By Optum
      How blockchain could ease frustration with the payment process
      Sponsored Content Provided By Optum
      Three steps to better data-sharing for payer and provider CIOs
      Sponsored Content Provided By Optum
      Reduce total cost of care: 6 reasons why providers and payers should tackle the challenge together
      Sponsored Content Provided By Optum
      Why CIOs went from back-office operators to mission-critical innovators
  • Awards
    • Award Programs
    • Nominate
    • Previous Award Programs
    • Other Award Programs
    • Best Places to Work in Healthcare Logo for Navigation
      Nominations Open - Best Places to Work in Healthcare
      Nominations Open - Health Care Hall of Fame
      Nominations Open - 50 Most Influential Clinical Executives
    • 100 Most Influential People
    • 50 Most Influential Clinical Executives
    • Best Places to Work in Healthcare
    • Health Care Hall of Fame
    • Healthcare Marketing Impact Awards
    • Top 25 Emerging Leaders
    • Top 25 Innovators
    • Top 25 Minority Leaders
    • Top 25 Women Leaders
    • Excellence in Nursing Awards
    • Design Awards
    • Top 25 COOs in Healthcare
    • 100 Top Hospitals
    • ACHE Awards
  • Events
    • Conferences
    • Galas
    • Webinars
    • COVID-19 Event Tracker
    • Sponsored Content Provided By NTT DATA
      Webinar: Mistakes I’ve Made — Confessions of a Healthcare Cybersecurity Expert
      bright.md logo lockup webinar
      Sponsored Content Provided By Bright.md
      Webinar: Enabling a hybrid care model — Streamlining the patient path to both telehealth and in-person care
    • Leadership Symposium
    • Healthcare Transformation Summit
    • Women Leaders in Healthcare Conference
    • Workplace of the Future Conference
    • Strategic Marketing Conference
    • Social Determinants of Health Symposium
    • Best Places to Work Awards Gala
    • Health Care Hall of Fame Gala
    • Top 25 Minority Leaders Gala (2022)
    • Top 25 Women Leaders Gala
  • Listen
    • Podcast - Next Up
    • Podcast - Beyond the Byline
    • Sponsored Podcast - Healthcare Insider
    • Video Series - The Check Up
    • Sponsored Video Series - One on One
    • Dr. Karen DeSalvo
      Next Up Podcast: What to expect with telehealth and healthcare technology in the next four years
      Carter Dredge
      Next Up Podcast: Ready, set, innovate! Innovation and disruption in healthcare
      Next Up Podcast: COVID-19, social determinants highlight health inequities — what next?
      Next Up Podcast: Saving Rural Health
    • Beyond the Byline: Regulators aim to boost value push with fraud and abuse law updates
      An older man wearing a mask receiving a vaccine.
      Beyond the Byline: Verifying information on the chaotic COVID-19 vaccine rollout
      doctor burnout
      Beyond the Byline: How healthcare supply chain struggles contribute to employee burnout
      Beyond the Byline: Covering race and diversity in the healthcare industry
    • Leading intention promote diversity and inclusion
      Introducing Healthcare Insider Podcast
    • The Check Up: Dr. Joseph Kerschner
      The Check Up: Dr. Joseph Kerschner of the Medical College of Wisconsin
      The Check Up: Chip Kahn
      The Check Up: Chip Kahn of the Federation of American Hospitals
      The Check Up: Trenda Ray
      The Check Up: Trenda Ray of the University of Arkansas for Medical Sciences
      The Check Up: Dr. Kenneth Davis
      The Check Up: Dr. Kenneth Davis of Mount Sinai Health System
    • Video: Ivana Naeymi Rad of Intelligent Medical Objects
  • MORE +
    • Advertise
    • Media Kit
    • Newsletters
    • Jobs
    • People on the Move
    • Reprints & Licensing
MENU
Breadcrumb
  1. Home
  2. Insurance
November 09, 2020 12:30 PM

Q&A: Humana chief medical officer details why the insurer is so bullish on global payments

Matthew Weinstock
  • Tweet
  • Share
  • Share
  • Email
  • More
    Print
    Dr. William Shrank

    Humana Chief Medical Officer Dr. William Shrank

    Humana is one of the nation’s largest players in the Medicare Advantage market, with more than 4 million lives covered under those plans. Roughly half of those members see a primary-care physician who is engaged in some form of a value-based contract. According to its annual report assessing value-based contracting, Humana found that those members are getting preventive screenings at a higher rate than seniors in traditional plans and their overall cost of care is lower. Modern Healthcare Managing Editor Matthew Weinstock recently spoke with Humana Chief Medical Officer Dr. William Shrank about the drive to value-based care. The following is an edited transcript.

    MH: What are some of the things that stand out to you from the annual review of value-based arrangements? Preventive screenings are up and some of the costs are lower, right?

    Shrank: One important thing to recognize is that we at Humana and Medicare Advantage, in general, have been able to adopt and move more rapidly to progressive, value-based contracts than we’ve seen in other parts of the healthcare industry.

    About two-thirds of our patients are now seen by providers in value-based arrangements, and nearly half of them are seen by providers taking meaningful downside risks and (who are) deeply aligned with us, financially, and with the patient financially, to deliver better care, more efficient care, more coordinated care, more preventive care, deliver better outcomes and at lower costs.

    The other key thing to realize is that these transitions are hard. It’s not as though you flip a switch and providers can immediately transform how they deliver care, but we’re seeing now in these relationships that we’ve had for years and years … continued improvement in terms of the quality of care, in terms of outcomes and fewer hospitalizations, fewer visits to the emergency room. We’re seeing more and more savings, and we’re seeing our patients are having better experiences.

    MH: The shift to value-based arrangements is sporadic. Given Humana’s experience, what are the biggest pitfalls that you see? What are some of those things that the provider community is having the hardest time adjusting to?

    Shrank: It’s hard for providers who are straddling both a move toward value and continued participation in fee for service. Those providers that we see trying to be successful in both—it’s hard to do both at the same time. The providers that we’re seeing that have really great results are those that make the commitment, that make the jump.

    Then overwhelmingly across the populations that they serve, they apply the same approach, the same philosophy, the same orientation, which is caring for the population with the aim of keeping people healthy, providing more care coordination, providing more touch points, focusing on quality and prevention in order to make sure that patients are staying as healthy as possible.

    MH: How much do you nudge them and how do you do that in a cooperative way?

    Shrank: The best way for us to participate with providers is to meet them where they are. Not to push them, but to understand that there’s a continuum. There are two ends of the spectrum, but providers can fall anywhere on that continuum of readiness and preparedness. It depends a lot on what the market in which they operate looks like and what other payers and what other arrangements are available to them. It’s our job … to understand where they are and where they’re comfortable today and where they’re willing to go.

    Then it’s also our job to be responsive and nimble and flexible in terms of providing them with the data they want, in the way that they want it, to provide them with wraparound services that address the needs of our members, their patients.

    If a provider says: We’ve got all the care-coordination services we need, that’s great. However, if they’d like us to provide more of those care-coordination services, that’s available. We can be more nimble. We can provide more services to the home. We can work to be true partners in how care is being delivered and how we support providers to fill in any gaps that they have, in terms of managing the health of our population that they serve.

    MH: You’re doing some work on wraparound services on social determinants, right?

    Shrank: Yes. That’s an area where we’re doing that pretty systematically across the markets in which we operate, and we’re eager to be a partner and to help facilitate our members, the patients of our physician partners, to get those referrals that they need.

    MH: CMS officials talk about the inconsistent performance of some of the value-based initiatives the agency has rolled out. How can the industry get to a more consistent approach to value-based contracting nationally?

    Shrank: It’s a challenge. What we saw (the Center for Medicare and Medicaid Innovation) do at the outset is offer a whole host of different models, a whole host of ways that providers can engage with the goal of both learning which are the models that are most effective, but also to build that sort of wildfire of opportunity and a sense of some inevitability that there is going to be this movement from volume to value.

    However, there’s a lot that the private sector and private payers are in a better position to do. We can be a lot more nimble. We can be a lot more responsive. We can offer a whole host of different kinds of services that CMS is just not organized to do. CMS isn’t organized to be able to deliver networks of community-based organizations to address social needs. They’re not organized to deliver home-based care or care-coordination services. They’re not organized to wrap in utilization management as needed by providers or for prior authorizations seen by providers.

    In a lot of ways, what we’re seeing is while CMS and the Innovation Center play this incredible role in helping to move the industry forward and to continue to educate and create a sense of urgency and inevitability of moving toward value, the models that are maturing are maturing faster in Medicare Advantage. We’re able to create deeper and more meaningful partnerships with providers.

    A part of it is that we’re seeing more movement toward prepayment—global payments—the kinds of fundamental shifts in incentives where providers are oriented around the health of the population in a very deep way, and that CMS … has a lot of different steps along that continuum. That idea of moving providers to arrangements where they’re prepaid, where there’s some global capitation—there’s no question that’s where we’re seeing the most clinical innovation, the most clinical transformation, the most meaningful changes in how care is being delivered.

    MH: We don’t know what’s going to happen at the Supreme Court and with the entire Affordable Care Act, but if the law is overturned then the work the Innovation Center has done would presumably go away because the underlying law would be gone. How worried are you about pullback on the federal level if some of these programs go away?

    Shrank: It’s hard to comment on what would happen at a federal level, but I can say with complete confidence that from the perspective of Humana, and I’m going to say with very high levels of confidence from the perspective of other payers in the Medicare Advantage space, the partnerships we’re creating with providers, the alignment we’re creating and the richness of benefits that we’re seeing for our members, are all the proof we need. We’re not going to turn around based on the results of any legal cases. Our providers aren’t asking to go back either.

    Our providers’ … work is much more aligned with why they went to medical school in the first place. They’re focused on taking the best care of the people that they’re serving, listening to their patients, understanding their patients’ needs, being more consumer-centric and more focused on really just optimizing health, rather than focusing on visits and our views.

    MH: While there aren’t many silver linings to the pandemic, one thing people keep saying is that it has shown the necessity to accelerate the drive toward value-based arrangements. Can you talk about what you’re seeing among the providers you work with and what the pandemic has done in terms of the underlying metrics you may have in place for contracting?

    Shrank: It is hard to talk about silver linings at a time that so many people are suffering. We are just all overwhelmed with gratitude around how providers, nurses, front-line healthcare workers have stepped up.

    The partnerships that we’ve developed throughout this pandemic have really been gratifying, as is that sort of alignment around the mission. We have seen that those providers that were in arrangements where they’re prepaid, were unbelievably nimble.

    Healthcare changed unbelievably in a matter of weeks. We saw doctors who were taking care of patients (where) 1% of their visits were telehealth, go to 95%. Care in the home was being delivered very differently. The types of contacts changed literally on a dime. Those providers that were in global payment arrangements had the financial stability to … not worry about the impact of doing the right thing for members.

    Those stories are compelling as providers didn’t have to take risks to do the right thing. Others saw that the financial sustainability, the resilience that comes from a value-based contract, looks even more appealing.

    There have been higher rates of conversations (with) providers coming to us and saying, “What can we do in the shorter term to address some of these resiliency issues, and try to move more rapidly to value-based care?” It’ll be really interesting as we go into next year to see how those numbers turn out.

    Letter
    to the
    Editor

    Send us a letter

    Have an opinion about this story? Click here to submit a Letter to the Editor, and we may publish it in print.

    Recommended for You
    Billing, antitrust exemption changes upend negotiations between insurers and providers
    Billing, antitrust exemption changes upend negotiations between insurers and providers
    Insurance-tech firm MultiPlan makes $155M buy after blank-check deal
    Insurance-tech firm MultiPlan makes $155M buy after blank-check deal
    Sponsored Content
    Get Free Newsletters

    Sign up for free enewsletters and alerts to receive breaking news and in-depth coverage of healthcare events and trends, as they happen, right to your inbox.

    Subscribe Today

    The weekly magazine, websites, research and databases provide a powerful and all-encompassing industry presence. We help you make informed business decisions and lead your organizations to success.

    Subscribe
    Connect with Us
    • LinkedIn
    • Twitter
    • Facebook
    • RSS
    • Instagram

    Stay Connected

    Join the conversation with Modern Healthcare through our social media pages

    MDHC_Logotype_white
    Contact Us

    (877) 812-1581

    Email us

     

    Resources
    • Contact Us
    • Advertise with Us
    • Ad Choices Ad Choices
    • Sitemap
    Editorial Dept
    • Submission Guidelines
    • Code of Ethics
    • Awards
    • About Us
    Legal
    • Terms and Conditions
    • Privacy Policy
    • Privacy Request
    Modern Healthcare
    Copyright © 1996-2021. Crain Communications, Inc. All Rights Reserved.
    • News
      • This Week's News
      • COVID-19
      • Providers
      • Insurance
      • Government
      • Finance
      • Technology
      • Safety & Quality
      • People
      • Regional News
        • Midwest
        • Northeast
        • South
        • West
      • Digital Edition
    • Insights
      • ACA 10 Years After
      • Best Practices
      • InDepth Special Reports
      • Innovations
    • Transformation
      • Patients
      • Operations
      • Care Delivery
      • Payment
    • Data/Lists
      • Rankings/Lists
      • Interactive Databases
      • Data Points
    • Op-Ed
      • Bold Moves
      • Breaking Bias
      • Commentaries
      • Letters
      • Vital Signs Blog
      • From the Editor
    • Awards
      • Award Programs
        • 100 Most Influential People
        • 50 Most Influential Clinical Executives
        • Best Places to Work in Healthcare
        • Health Care Hall of Fame
        • Healthcare Marketing Impact Awards
        • Top 25 Emerging Leaders
        • Top 25 Innovators
        • Top 25 Minority Leaders
        • Top 25 Women Leaders
      • Nominate
      • Previous Award Programs
        • Excellence in Nursing Awards
        • Design Awards
        • Top 25 COOs in Healthcare
      • Other Award Programs
        • 100 Top Hospitals
        • ACHE Awards
    • Events
      • Conferences
        • Leadership Symposium
        • Healthcare Transformation Summit
        • Women Leaders in Healthcare Conference
        • Workplace of the Future Conference
        • Strategic Marketing Conference
        • Social Determinants of Health Symposium
      • Galas
        • Best Places to Work Awards Gala
        • Health Care Hall of Fame Gala
        • Top 25 Minority Leaders Gala (2022)
        • Top 25 Women Leaders Gala
      • Webinars
      • COVID-19 Event Tracker
    • Listen
      • Podcast - Next Up
      • Podcast - Beyond the Byline
      • Sponsored Podcast - Healthcare Insider
      • Video Series - The Check Up
      • Sponsored Video Series - One on One
    • MORE +
      • Advertise
      • Media Kit
      • Newsletters
      • Jobs
      • People on the Move
      • Reprints & Licensing