In many of my previous blogs, I have discussed the importance of lifestyle on health outcomes. Historically, our health care system has been oriented toward episodic treatments, and we have seen significant advancement in science allowing more effective treatments for complicated conditions, like cancer, Hepatitis C and severe cardiovascular disorders. These treatments are extending life; however, without assisting patients with their lifestyle needs, the advancement in science will be diluted. This is especially true in population segments that are more impacted by social determinants of health.

I am excited to see the increasing sophistication of health care policy that’s encouraging the integration of social determinants into health care.  Recently, CMS has taken two large steps in the integration, including: 1) the interoperability of health care information through their recent efforts in Blue Button and the Interoperability and Patient Access Proposed Rule and 2) the addition of new supplemental benefits within Medicare Advantage (MA). 

For example, MA organizations like ours can expand offering services such as transportation for non-medical needs, home-delivered meals, fresh produce, and social benefits that address isolation. Some of these new plans will offer better rewards and incentive programs, more accessible telehealth services and – ultimately – better wellness and care planning.

In this more favorable landscape for supplemental benefits, MA plans can better tailor offerings, address gaps in care, and improve health outcomes for the chronically ill. We’re excited to see such fresh creativity in benefit design as it will make it easier to help members like “John.”

Care needs to go beyond the clinical.

John is a Humana Medicare Advantage member in his late sixties. Medicare Advantage, the private form of Medicare that John has chosen for his health care, helps seniors address their health and non-health challenges so they can focus on living the lives they want. Medicare Advantage takes a comprehensive, holistic approach to help seniors like John slow the progression of chronic diseases like diabetes.

John had a high A1C, and he wasn’t going to his appointments, increasing his chance of vision loss, a heart attack or a stroke. Our Partners in Primary Care (PiPC) clinicians proactively contacted John and found that he could not afford the $15 copay for his office visit, he couldn’t buy healthy foods, and he couldn’t cover his portion of prescription costs.

The good news for John is that his Medicare Advantage program wasn’t just designed to address the clinical aspects of his care. Through personalized interactions, his plan also revealed his lifestyle needs, which contribute greatly to overall health and well-being. The PiPC clinician team helped him fill out a Supplemental Nutrition Assistance Program (SNAP) application, and he was preapproved for up to $165 in benefits. The PiPC team also helped John get the power company to lower his monthly bill because of his low income.

At Humana, we’re privileged to help our physician and clinician teams like PiPC and others deliver quality care to people like John in the most appropriate/most preferred setting, whether it’s in the doctor’s office or his home. This teamwork helps support a comprehensive, empathetic approach that removes these barriers to better health.

I was humbled to hear John say this type of support has been “life-changing” for him.

We’re working together to build a connected system to remove barriers to health.

In addition to being able to offer more services and benefits through the Medicare Advantage program, technology is playing a key role in creating an interconnected system, helping consumers use their own smart phones and tablets to manage their health care data.

Interoperability—where information systems are connected and coordinated—is freeing up data and providing a real-time, holistic view of each patient’s health. Put simply, the free flow of data makes it easier for everyone involved to deliver the right care at the right time and in the most appropriate setting.

That’s key for seniors, because they’re often living with multiple chronic conditions and need help removing barriers to their health.

Let’s keep helping John and others improve their health and save money.

Seniors like John who participate in Medicare Advantage are spending less time in the ER and have fewer hospital stays than those with traditional Medicare, and their medical costs have been shown to be 15.6 percent lower.

There’s an atmosphere of optimism in health care around what’s possible, and the changes taking place today are certainly moving the industry in the right direction, with the ultimate goal being to help people like John live happy and healthier lives.