Digital transformation at the enterprise level: Humana’s chief digital officer on how the role of insurers is evolving
In the future, health insurance plans will be fully tailored to the individual.
That’s the health insurance experience that Heather Cox, Humana’s first chief digital health and analytics officer, is working to create. In her role, Heather focuses on helping Humana reimagine care delivery and provide leading enterprise analytics — with the ultimate goal of creating differentiated experiences at the intersection of healthcare and lifestyle for Humana’s 17 million health plan members.
In a recent virtual fireside chat with MATTER CEO Steven Collens, Heather shared more about what digital transformation at Humana has looked like amidst a global pandemic, how predictive analytics will help shape the future of healthcare and how she envisions healthcare delivery and health insurance to evolve in the coming years.
Watch the full recording here:
Here are our key takeaways from the conversation. Responses have been edited slightly for length and clarity.
Pandemic times bring a surge in digital engagement
“Coming out of 2019, we had laid enough of a foundation for our analytics platform that we were able to really turn up the volume on advanced analytics support for our members. All of the sudden, we had this massive use case that literally needed to be turbocharged overnight. And we had the most modern tools available to allow us to do it.
“That surge took us from just under 1,000 monthly active users in January to nearly 9,000 today. Employers are tapping into that data and creating the insights and the dashboards they need to run their businesses right now — helping them to manage the crisis itself, identify what their response is going to be, what containment needs to look like, how they’re thinking about the return to work and beyond.
“When you look at telehealth services, in January and February (which would have been indicative of our normal rate) 0.32 percent of our visits with primary care physicians (PCPs) and specialists were through telehealth. In April, at the height of all of this, we had nearly 1.5 million telehealth visits, which was closer to 35 percent of visits. Right now, still, about 15 percent of our visits for the last two months have been through telehealth.
“As payers, our job needs to be figuring out how to take that 15 percent utilization rate and build from there. With non-acute cases, this is a really great opportunity: You, the patient, don’t have to get in your car, drive 25 minutes, get out of your car in 90-degree heat, walk through the parking garage, go sit in the doctor’s office for 15 to 20 minutes waiting for them…and on and on. All of that friction is thrown out the window.”
“All of a sudden, we had this massive use case that literally needed to be turbocharged overnight. And we had the most modern tools available to allow us to do it.”
Shifts in barriers to telehealth
“Providers, having been forced to utilize telehealth technologies really suddenly, actually found it really simple and easy and a great way to better understand people. With telehealth, providers can actually see the environment their patients live in. Generally, people come to the doctor all cleaned up and ready to go. Telehealth services have given providers a better understanding of what their patient’s condition is on a daily basis. These are really important inputs into care. There’s real value in these interactions that goes well beyond just the convenience of them.
“Telehealth has been around a lot longer than I have in healthcare, and it just has never really taken off. There have been lots of barriers, including for our member population in the past, around device access and willingness to use. But that’s actually no longer the case. We’re seeing that shift in our seniors.
“Additionally, in the past, providers weren’t incentivized. There were barriers to reimbursement and structural problems with telehealth, like having to be a doctor in the state where the member lives. There is a lot of infrastructure that we have to simplify in order to make telehealth services a real opportunity. But my sense is, reading transcripts from things like earnings calls, everybody’s focused on it. I can tell you that we at Humana have a core passion around it, because we want you to have the ease and convenience of care wherever, and however, and whenever you need it — and that includes in your home.”
“There is a lot of infrastructure that we’ve got to simplify in order to make telehealth a real opportunity.”
Predictions for the customer journey of the future
“I hope in the future that we’ll be giving better real-time contextual data to our providers. So for that member, the N of 1, what is it that providers need to be looking out for? We can leverage all of the data sources that exist, EHR included, but how do we create the insights that you need to get to the right care interventions right now? And how do we hopefully gather more sources of data over time about you — where you live and how you live, maybe what groceries you buy and more.
“Technology has the potential to bring in incredible volumes of data that could actually help providers tailor their plans for you right here and right now. Upfront care and other simple stuff can be handled through digital channels. And then we pass that data to the PCP so that their record is always kept up to date. It’s not up to you, the member, to take your data from appointment to appointment or for the provider to try to go find it in some EHR. The challenge is actually creating that ecosystem where you own your data and you can take it with you wherever you want and however you want. And that same data is being fed back to us, the payer, and we’re giving it to your PCPs and your care teams so that they can actually have that contextualized opportunity to serve you.
“The actual data journey is not so easy. It’s hard to create that foundation and to get data out of silos, get it certified, make sure there’s the right governance structure around it, that it’s being updated on a normal regular basis, that it stays of high quality, that it’s getting accessed appropriately and that data products are getting built so that there are easy access patterns to that data. This is heavy lifting. It takes money. It takes human resources. It’s not sexy, but it’s really important.”
“We can leverage all of the data sources that exist, EHR included, but how do we create the insights that you need to get to the right care interventions right now?”
Challenges to democratizing health data
“Culture is a big, big component when it comes to sharing health data. Here’s what I appreciate: I appreciate that people across our enterprise are very protective of their data because they want to make sure it’s maintained appropriately and that it maintains integrity. But also, given the state of the world, where technology is taking us and the way that data fuels all of those experiences, we can’t be too protective of it. We’ve got to change from the ‘my data is mine’ and ‘I’m going to hide it over here’ mindsets. We can still govern our own personal data — we just have to trust that the enterprise can help manage that process as well. We don’t own the data, we’re just enabling it to be accessible. We’re helping you get access to tools that you otherwise wouldn’t be able to deploy on your data set alone. We’re creating the opportunity for you to have access to advanced analytics about your health — at the level that we see companies like Amazon doing every day.”
“We’re creating the opportunity for you to have access to advanced analytics about your health — at the level that we see companies like Amazon doing every day.”
The role of Humana in a decade
“In a decade, I hope that Humana will be known as an incredible partner in health, with insurance in the background — it’s the way that you finance your care, but you see us as a trusted partner. To get to that place, we’ve really got to focus on that combination of appropriate in-person human care, along with digital only tools. And all of that needs to be powered by advanced analytics — you can’t separate analytics and digital anymore. It’s embedded, ingrained, and it’s the only way we can get to the place where we’re going to have the predictive interventions and the care delivery opportunities that we envision.
“Specifically, I think the role of artificial intelligence is going to have a massive impact on how we think about care and care delivery, and it’s going to redefine healthcare just like it has redefined other industries. AI, machine learning and predictive analytics will be embedded in literally every aspect of health and healthcare. At Humana, we refer to this as augmented intelligence because it’s the combination of human intelligence and intelligence coming through analytics that is going to be the combo that wins. Embedded augmented intelligence will make it easier to make appointments with physicians for either that in person or virtual visit, it’ll be helping us to provide appropriate care at home, finding the health plan that’s right for you and your conditions, so that you get the care that you need.”
“I think the role of artificial intelligence is going to have a massive impact on how we think about care and care delivery, and it’s going to redefine healthcare just like it has redefined other industries.”
Advice for startups looking to collaborate with organizations like Humana
“Make sure you’ve got a FHIR API. Make data easy to move and show us how you can integrate seamlessly and easily to become a part of our digital health ecosystem as well access Humana’s synthetic data sets to prove that your startup can bring value to Humana’s members.”
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