Integrating payer and provider

One of the things that really attracted me to Humana was our model, which integrates the payer and the provider around patients in the home. A big focus of my work prior to Humana was about understanding how the payer and provider can better integrate – how to align incentives to foster deep partnership. I spent time at CMS in the Center for Medicare & Medicaid Innovation working on value-based payment models; at a large, vertically integrated health system with a health plan; and at a retail pharmacy partnering with risk-bearing providers. I think our model – to deliver more patient-centered, convenient care in and around the home – is the right one, and we are poised to meaningfully disrupt the marketplace.

One of the things that is cool about working for a Medicare Advantage plan is that we have a lot more flexibility concerning how we engage and support home healthcare and how we work with our network physicians. Providing actionable data and promoting data interoperability are essential so that physicians and other healthcare providers can have an expanded view of their patient’s health picture. At Humana, we’re able to be more creative and cooperative in supporting physicians working to improve the health of their patients.

Right now, part of that expanded health picture includes understanding the breadth of patients’ social, behavioral and physical health needs. We’ve heard a lot of discussion about social determinants of health (SDoH), and many of you are likely already incorporating these facets into your practices. Medscape and the American Academy of Family Physicians (AAFP) recently surveyed primary care physicians around SDoH and the results were pretty interesting.

For me, it’s clear that by working closely with our physicians, community partners and other healthcare providers within the flexibility of a Medicare Advantage plan, we can be most innovative and nimble to meet the needs of those we serve, improving health while reducing cost.

William Shrank, M.D.
Chief Medical and Corporate Affairs Officer