How an Insurer Meets Members' Needs During COVID-19

[MUSIC PLAYING] Welcome, everyone. You're watching Coronavirus in Context. I'm Dr. John Whyte, Chief Medical Officer at WebMD. Today I'm joined by Dr. William Shrank, he's the Chief Medical Officer of Humana. Dr. Shrank, thanks for coming on.

It's really good to see you again. Great to be here.

Let's start off with how has the pandemic impacted insurers? Everyone's talking about the transition to telehealth, but let's go deeper than that, how have you mobilized, how has it impacted resources, how has it totally changed your day to day?

Well, our day to day couldn't be more different in the setting of the pandemic. One of the most notable features of the pandemic is the notion that it's really personal how everyone's being impacted. And I don't think anybody will say, well, it hasn't really impacted me much.

Everyone really is being touched in a profound way by the pandemic. Whether it's the way you work, whether it's the way you go to school, whether it's the way you care for a parent, care for a child, whether it's your ability to see friends, whether it's how it impacts your mental health, your perception of community, even your ability to access healthy food. All these things are really deeply impacted by the just uncertainty and the nature of the mitigation effects of the pandemic.

And as a health plan we spend our time figuring out how to optimize the health of the members we serve, we've really had to take a very different tact in terms of how we interact with our members and it's far less reactive and far more proactive where we were calling our members at the outset of the pandemic and talking to them about their chronic conditions and they were telling us that they haven't left the house in a week and they didn't have a way to get food. Or that they were really, really, really depressed because they hadn't seen their kids. And it really changed the nature of how we interact with them. So that we could really focus our outreach, our resources, our efforts, to address those very personal needs of our members.

What's been the response? Because most of us don't get called by our insurers, let's be honest, and we don't answer our phones on numbers that we don't recognize and that's not the traditional relationship. What's been the reaction from your members?

I think in Medicare Advantage in general, where we care for vulnerable, often frail members and who generally stay with us for a long time, we do create a deeper relationship. And I think if you look at what our members are saying about us over the course of the pandemic, they're appreciating the fact that we're listening to them.

And I'm sure there are some people who don't answer the phone and we've all been there but people are hurting right now and people are struggling in really, really profound ways and I think folks are really appreciating it when someone's listening to them and someone's trying to address those basic needs.

So let's talk about some of those needs to address. We've been talking on this show about social distancing. I've been saying we should be like Canada, those Canadians are always clever, they call it physical distancing, but you've been talking about medical distancing and how we need to get patients to come back into clinic. We need to have them at times come back for care and not do everything virtually and it's hard, because for a long time we've been telling people don't come in. They see the news in their local area, they have to make that calculus of risk versus benefit. So tell us about your approach where you don't want to have medical distancing.

Yeah, well I mean, it's not as though the argument is that everyone has to go to see their doctor in person. And in fact, we've eliminated all cost sharing for virtual care over the course of this year since the outset of the pandemic for just that reason, to make sure that our members have easy access to care. We've also eliminated cost sharing for primary care and behavioral health. Again, with the real focus and goal here of making sure that there are no administrative reasons or financial reasons why patients are not staying close to their usual sources of care.

That said, there are a number of reasons why you'd need to see a provider in person. And our goal is really to make sure that every one of our members is staying close to, is communicating with, is interacting with their clinicians, to really understand what their needs are. And if they need to be seen in person, we've sent out 15 million masks to make sure that all of our members feel safe and confident when they go in to see their physician or their provider. And our goal is really to figure out how to get the right level of care and at the site for all of our members.

Over the years you and I have talked about social determinants of health. You've been saying lately that there's no better time than now to address inequality and disparity. Why is now the best time in the middle of a pandemic that occurs once a century?

Well, I think to some extent it's because the pandemic has really shined a light on the problems in ways that are more focused and visible and motivating than ever. And I say this with a great deal of humility, the health care system is one of the many structural reasons why there are inequities in the health of Americans. And that is a source of structural racism in the country. And it is the recognition that people of color have been disproportionately impacted economically, and from a health perspective by the pandemic. That suffering has not been experienced in a equitable way across this country during the pandemic.

And the other sources of structural racism have obviously taken, have taken a front seat, we've seen more and more of the-- it's been more and more visible with the murder of George Floyd with so much that's happening in sort of social unrest surrounding inequity, it really has highlighted the fact that we have to do something.

And the notion that we don't use this as an opportunity to galvanize our efforts and our energies to really make a difference, to try to set much more explicit measures and goals and around what the disparities are and how we reduce them, that we're not-- we don't move towards more of a culturally sensitive way of interacting with our members, that would be a real miss. And where we, along with many others, are trying to really take a great step forward now and address these issues much more intentionally.

Give us some concrete examples of things that we need to do because the argument could be made people have talked about this in the past, there's been a little bit of interest, then it's gone back to the way it's always been. So if there's one or two things, wave your magic wand, Dr. Shrank, what would you change, what needs to be changed now to have a real impact, not something that we can wait 10 years down the road?

It requires really a multi-factorial, multidisciplinary approach. Health inequities will not be solved through better health care alone. Better health care is important, equitable health care important. We must be more culturally sensitive in terms of how we encourage behavior change, how we encourage people to use chronic medications, how we provide much more thoughtful sort of reinforcement and feedback, using the kinds of language that folks understand and that folks react positively to. But ultimately, we have to address the basic, the context in which people live.

And getting back to your original question about social determinants, very hard to manage your diabetes or your congestive heart failure if you don't have a safe, stable place to live. And ultimately we have to address this issue by focusing on so many different parts of the continuum of the lives of our members, the lives of the patients, the lives of all Americans.

You've also been talking about loneliness and some people could argue is that the role of plans, is that the role of an insurer, where we're spending premium dollars to address loneliness? Someone else can manage that. So tell us why you're interested in addressing loneliness.

Well, it's a really good question sort of about how do you think about premium dollars because I would argue that in the US we are wildly over indexed on health care and under indexed on social services. And I think in particular, our Medicare Advantage, where we're paid a risk adjusted amount to manage the health of the population we serve, we're in a unique position to redistribute or reallocate some of those dollars that are earmarked for health care services to go upstream to keep people healthier, to prevent disease, and ultimately in a cost neutral or even cost diverting way, improve the lives and the health of our members without adversely affecting the bottom line. So there is a business context for doing the right thing.

In the area of loneliness, it's really clear that our members who complain or who express that they feel socially isolated, they're sicker, they go to the ER more, they go to the hospital more. They have worse health outcomes across a whole number of chronic conditions. And by intervening in a thoughtful way, whether it's by leveraging resources that already exist in that person's life or whether it's by adding resources.

So an example would be Papa, which is a company that we work with that they hire college kids, to serve as sort of grandkids on demand. They visit seniors in their home, they help them with simple light housework. And our early evaluations of pilots with them as shown that not only are members less isolated, do they feel more connected, they're less likely to go to the ER, they're less likely to go to the hospital.

We, in the setting of the pandemic, services like Papa, and we've got another service called the Friendship Line, which is a service from the Institute on Aging, we're doing it all telephonically or all virtually. But still those interactions--

How does that work? Tell me how the Friendship Line works.

Well, if somebody we call, we're calling all of our members, asking them about what issues they're struggling with and those that-- and we ask them explicitly about social isolation, of loneliness. Those that do express they have a problem or a challenge, we have a number of interventions that are available in our toolbox in terms of who can interact with that patient and how we can get that patient engaged in a more sociable connected. The Friendship Line is a validated Nat Institute of Aging service that is just that, we give them the number and they call a line and there's a really sort of a positive feedback reinforcement loop that gives more options to questions, the solutions to our members.

What are the one or two things that are keeping you up at night relating to health care? Is it concern about vaccine confidence, is it delayed medical care? There's a lot going on as you've talked about. What are the one or two things that keep up Dr. Shrank at night?

Well, I have a 10-year-old that keeps me up a lot of nights.

That's why I said health care. I knew you'd try to divert.

[INAUDIBLE] like to know what's going on with us. So averted health care I think is something that we're doing everything we can to try to make sure we understand who has averted essential care over the course of the pandemic and trying to facilitate re-engagement, make sure that those who have missed an opportunity of preventive care, we're sending home testing kits for colon cancer, for diabetes. So that we're trying to make it easier for our members to re-engage.

There are-- I am also worried about the vaccine. I'm worried that it's going to be hard to get vaccine to everyone who needs it in the time frame they're ready and that just the organization of the distribution process I think is a little unclear at this point. But I'll say that it is great to see a light at the end of the tunnel. And this notion that a vaccine is here or it's coming soon is really, really reassuring.

Well, you mentioned distribution, but to be fair, Dr. Shrank, haven't we had challenges with testing, we're still having issues with testing. I mean, you know, we've had issues with PPE distribution. So it's not just confidence in the vaccine's efficacy and safety, but confidence in the logistics of how do we distribute this in a responsible and equitable way that's also timely. Do you feel we're making progress on that or what are your thoughts?

I couldn't agree more. I think everybody recognizes this is one of the great challenges but also such an important opportunity for us to get right. And I am really hopeful that we can create the right kind of expectations, communication, education, infrastructure, to make sure that we, in a thoughtful and organized way offer vaccination to all Americans.

Let's end on a positive note. And you have this unique perch sitting on top of a plan, you're a physician, you worked at CMS, what do you think are going to be the one or two long lasting changes, positive changes that the pandemic has accelerated in terms of the delivery of health care? Is it literally bringing care into the home of the patient? Is it addressing determinants of health? What are the one or two in your mind that actually are going to persist when we finally are past this pandemic?

The one, I think all of what you just said. When we trained as residents, there wasn't a lot of focus on, the focus was really on the workflow and the efficiency, how do you really sort of optimize the use of your time as a clinician in terms of delivering services. And I think over the course of the pandemic we are thinking way differently about. We're thinking about the workflow of the patient.

What's convenient, what the patient as a consumer, a patient as someone with really important and meaningful personal struggles, how do we get the care to them that they need? Whether it's virtual, whether it's care in the home, whether it's better leveraging data and analytics to understand who needs it best and what are the best channels for communication, that notion that we're changing sort of health care really on a dime, to be able to be much more focused on the needs of the patient rather than the needs of the provider, is I think incredibly exciting.

Well that's a good point, because in many ways in our training and early on and even recently, we were really rewarded or a gold star for the number of patients that we can see in a day and not necessarily giving the time that they need, but rather on almost in some ways being an efficient production line and we need to rethink how that process works.

Well, Dr. Shrank, I want to thank you for your insights today. I want to thank you for all that you're doing to help people survive during this pandemic and not delay their care and address issues of loneliness and social determinants. So appreciate you taking the time today.

I'm grateful for the opportunity to speak with you. And I'm grateful to see how we've all banded together to try to be part of the solution during this really challenging time.

And I want to thank our viewers for watching. If you have any questions about COVID-19, you can send them to me, at [email protected], as well as on social at Instagram, Twitter, and Facebook and even Pinterest. So thanks for watching.

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