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Humana

Dr. Michelle McMurry-Heath, President and CEO, Biotechnology Innovation Organization (BIO)
Dr. Mona Siddiqui, Senior Vice President, Enterprise Clinical Strategy and Quality, Humana
Nick Stefanizzi, Chief Executive Officer, Northwell Direct 
Moderator: Arianna Huffington, Thrive


Brainstorm Health 2022 - How Prevention Can Prevail: The First-Mile Approach 

Conferences

Dr. Michelle McMurry-Heath, Biotechnology Innovation Organization (BIO)
Dr. Mona Siddiqui, Humana
Nick Stefanizzi, Northwell Direct 



Brainstorm Health 2022 - How Prevention Can Prevail 


Dr. Michelle McMurry-Heath, President and CEO, Biotechnology Innovation Organization (BIO)
Dr. Mona Siddiqui, Senior Vice President, Enterprise Clinical Strategy and Quality, Humana
Nick Stefanizzi, Chief Executive Officer, Northwell Direct 



Brainstorm Health 2022 - How Prevention Can Prevail: The First-Mile Approach 


are you all feeling relaxed? Have you moved from the sympathetic to the parasympathetic nervous system? Our job is to get you back to the sympathetic nervous system by telling you about all the problems that we are trying to solve at the last mile of healthcare and why this amazing panel is working hard to try actually and move us upstream and address problems before they become chronic conditions. So um I'm really excited to be talking with you as you know, this is a very personal passion of mine. So I would like to start with you Michelle because when we think about health care, a couple of images that come to mind are a doctor's office or an emergency room, but that's really sick. Yeah. So why so little attention, so few resources relatively about 3% of the massive healthcare budget being spent on prevention on what we're calling the first mile? Well, as the daughter of a public health nurse who used to go door to door in the bay Area, I can tell you it's a shame that we don't spend more on preventive care and services and there's so much that needs to be done in that space. But I think it's important as we open that aperture back up again following Covid that we remember that technology can also be a very important part of that prevention, particularly as we're trying to get clean air, clean water and nutritious and vegetables to communities in need and mana having come to humana from HHS who were just joking that She is now dealing with a company that has a mere $65 billion dollar budget having come from An operation that had a $1.3 trillion dollar budget. And but in both, you know, the government and private private sector, we see again the same reluctance to address the problems and while there are still daily habits and before they become chronic conditions. No, I think it actually starts with even earlier in our medical education system. When I think back to my training and I and I went to Hopkins um you know, the focus is on just medicalization of everything. Um when I think about the second year of medical school, it's um I think in service of in many ways of the pharmaceutical industry, right, we are learning about medications and and and drugs were not learning really about the importance of food and right nutrition. We um we give lip service to it, but we don't really think about how important that is and Um the focus on both nutrition, but also all of the other things that we now call social determinants of health, which is really 80, of what impacts our health care over the course of our lives is not a part of the structure in which we, in which we operate within the health care system. For the, for the most part, right? It it is not um we don't have approaches for how we think about scaling those programs. Um so I I do think that we have to address both, how we go upstream and the education system and really think about to focus on the whole person on nutrition on communities and how we support communities, um but then also when we do have these efforts around addressing social determinants of health, how we set them up so that they are actually scalable that they're not living in pilot health forever, right, that we are doing one transportation pilot here and one food initiative here, but how are we really working across um a set of partners in the ecosystem to make sure that uh those those local uh those those local entities are really supporting um the patients in the communities in ways that are scalable, you know, let's take a specific example because Humana gave 116,000 ft bed um to Medicare advantage plan members, how did that work out? So you know, you see variable engagement um across some of these, Right, and I think it's uh these are really important initiatives because being aware of your own health is really a first step in and being able to manage your health and and being able to advocate for yourself. So I think we have to continue with those initiatives, I think we also have to help people in seeing how tracking these things are actually is actually impacting their health and and and enabling them to stick with it for a longer period of time um and not and for it to not be a size thing right for it to for for them to understand how is the information that is getting collected then feeding into their interaction with their provider, how is the provider using that to have a conversation with them and then having an intervention that is caring for both that kind of information, but also more of the clinical information and combining those. I don't think we have the infrastructure right now fully for those things to get supported in the, in the ways that I think we would want for it to scale. Um and what's unfortunate is that, you know, folks like us and looking around to see how many people here are wearing some device and you know, most of us are um but it's really the most vulnerable that I think um often don't get access and and aren't able to sustain their engagement with those and given the prevalence of employer provided health insurance coverage in the US, what role do you think businesses can play to accelerate the shift um, from providing sick care basically to prevention in the first mile. Yeah, I'm glad you asked about employers and I just want to say, I was in full agreement with what you said in the opening session earlier about how business leaders have become health leaders and I think there's another opportunity just like there was in covid for business leaders and employers to lead the way here. And if you think about it, why There are a 155 million people in this country who have access to health insurance by virtue of participating in an employer sponsored health. It's a tremendous number. Um and in my view, employers not only have an interest but an imperative to do something. You know, if you look at the last five years of trend line on the premiums for those health plans, they've increased 22% and employees on average are Paying 22% of the cost share of those premiums. And the C. H. R. O. And the Cfos know this conversation well every year, how much of that premium is going to get absorbed by the business and how much is going to get passed on to the employee. And I think that conversation has become much more difficult now with the inflationary pressures across the country, but I also think Covid has changed what's expected by employees of their employers. That's become particularly acute given the great resignation. And I think the employers of choice going forward are going to be those that are making the investments in health well being and the resiliency of their workforce. That that first mile type of mindset is going to position those employers to win, but that it also makes sound business and financial center over the long term to make that shift to make those bold choices and those investments. Yeah, that's the big mindset shift to realize that it's not just a nice to have benefits, but measurable in business metrics, tangible to the bottom line in both the short and the long term. Because if you think about what the drivers of those costs are, it's chronic conditions that aren't managed effectively that get out of control. Uh, it's unnecessary admissions into the hospital because care isn't being coordinated. Um, the investments in the short term in changing the paradigm of how health care is organized in my view will yield a lot of value in this. And Michelle we can go even further upstream. You know, Nick talked about managing chronic conditions holistically and that's of course very important. But what about preventing chronic conditions from occurring? I mean, we know for example, that diabetes and heart disease and hypertension are to a very large extent preventable. Who is the lifestyle changes stress reduction. So what can biotechnology do and to go out to help us go upstream. Yeah. And so essential that we do go upstream, you know, another quella of the covid pandemic is that we're facing a tsunami of chronic Non communicable diseases. Because the normal prevention efforts that we've relied on for the last 10 or 20 years have totally fallen off the radar in that time period. So we need to be able to engineer a healthier generation coming up and we need to use technology also to better predict and identify who is likely to become ill um, in a way that we haven't relied on before. So if you think about it, I'm I'm a pediatrician by training. If you think about how you grow a generation of healthy kids into adults, you need clean air, you need clean water, you need healthy fruits and that are also accessible, affordable and attractive to those populations. And you know, we have companies like Benson Hill that are bioengineering micro crops of fruits and vegetables that are designed to grow in hydroponic settings, meaning you can grow them in the deserted strip mall down the street from the bodega and have, you know, very affordable and accessible food that's actually engineered to taste better, have more protein, you know, apply everything that those growing bodies need to become successful healthy functioning adults. So this is something that we have to focus on. And it's it's a question of not just health, but it's also a question of just and we have a book coming out called Just Science which is about how we can use technology to equal the in just playing field to really help poor communities, you know, be freed from from illness and other things that hold them back from achieving dream. And most people think of humana as an insurer, but in fact more than half of your employees working direct clinician roles, what can they do, um, to become agents of a greater focus on prevention. Yeah, well I would just say, you know, in addition to the insurance like my for folks who don't realize that we um have a large presence of senior focus primary care clinics. We have a emphasis. We now own the largest home health company. Um We have a an enormous focus on building communities through R. S. D. O. H. Efforts um and also um an increasing focus on on behavioral halt. So yes, we have a large clinician workforce, but we also have um direct uh care that we're providing through all of these different channels. And also really trying to think about how do we move care from the traditional brick and mortar systems that we are used to which are really more about medicalization and and more into home and community based settings I think along with that and and and you know, to your your point to what I what I think sometimes we are faced in within the healthcare um conversation is we we've generally interacted with people in those brick and mortar systems like right when there's an emergency or something is needed or we're really trying to address an acute issue. Um I think the model for engagement also has to change and I don't think we fully understand what it is that we need to do to engage people at the right time. Um and how do we really uh behavioral change? We talked about a lot in healthcare is one of the hardest things to do. Where how do we begin to think about the right moments in which to engage an individual outside of those traditional settings? What are those communities, community efforts that we need to engage in to to get people to focus more on on prevention? How do we partner with with other entities in in ways that we haven't done before, you know, to our conversation um that really focused on health and wellness that that aren't focused on, what are we doing for that individual after they have an er visit or after they're getting discharged, which is really primarily where the healthcare ecosystem focuses in on um and uh you know, we haven't solved it by, by any, by any means I think is one of the hardest things to address, but and what we saw during the last two years I think is really people coming together and breaking silos across businesses to work together. Um and it wasn't this sort of competitive thing of um you know, this is, this is my lane and this is yours or we're competitors. So we're not going to partner. I think it was folks really leaning in to say, how do how do we engage in partnerships in a, in a much more meaningful way to accelerate the work that we're all trying to do. And my hope is that in, in, in this, in this evolution of so many of our companies really focusing on health and wellness that we do bridge these partnerships with people we may have never uh done work with, but who can help us in getting to the right people at the right time to really have that conversation around engagement and and behavior change and nick, you know, Mona talked about incentives to help change behavior, which as we know, is very hard, but they're also the financial incentives based on the fact that premiums keep going up. So why can't we use this financial incentives more effectively? So let's say even if people didn't care about anything else, they clearly care about saving money. So how can we appeal to that base instinct? Well, we talked about this a little bit earlier in the lunch, there are some structural challenges that we have in the system. Um we have a lot of middlemen that exists throughout the healthcare ecosystem and there's questions about whether or how they add value uh to the overall process. But I think again, just back to the fact that employers are responsible for a lot of the health care coverage in this country, there's an opportunity through things like benefit design in partnering with HR leadership in these organizations that can help to drive and incentivize the right behaviors. So we see innovative partners around the country doing things like leveraging wellness credits to try to drive the right behaviors and get the employees engaged in proactive, We see things like copays and deductibles that helped to steer people towards the right types of care at the right time and getting ahead of particular conditions. We also see people encouraging and incentivizing participation in uh, disease specific or chronic care type manage management program to try to help people more effectively take control of their care. So I think there are a lot of levers that we can pull and we ought to think about how to partner with the right folks, whether it's at the employer level or whether it's structurally and we and we can do things, you know, going direct to employers, direct to providers without middlemen sitting between us to try to start to address. Thank you nick. So I'm planning to end all the panels that are moderating by asking the panelists a personal question because ultimately health care is personal. We talk about premiums and middlemen, but ultimately healthcare is the sum total of our daily habits, 90% of the time. Sure, there's 10% that is outside our control, But 90% who can control. So I want to ask this extremely busy people in very stressful job, what are you guys doing to take care of yourself? What are you doing to prevent as the development of chronic conditions in your own lives and in your family's life, Michelle Well, with a 10 year old, I spent a lot of time running around this morning. But I think, you know, one of the things that I've tried to also leave my organization in is really opening this portal to meditation. I think that's something that we haven't talked about enough in terms of, and you heard it earlier in the previous panels, you know, really relieving stress and giving people a sense of more control over not just their time and their day, but their body and their health. Um, and so I think that's key and you do that every day. I do it three times a week. So you don't manage micro steps, we call them a drive that somewhere greater mana. So I'm a little bit of a health nut. Um, I will say I, I'm fairly regimented. I wake up really early and I get my workout in every day. I'm a big believer in physical and, and, and spiritual and um, and you know, nutrition, so I do focus on on all three. Um, I try to meditate, but I also try to um read a fair amount in this space. Um, sleep Ariana is the one thing that I continue to struggle with. It's um, it's the one thing that I, uh, you know, my, my, my tracker is not happy with me. Um, you know, so I, that's the one place where I struggle and I'm continuing to focus, but the physical, the workout and the, and the nutrition, if I feel like if I don't get that right. Um, really, I can't show up for anybody else if I can't show up from, I'm very happy to be your personal sleep coat. Actually, my first recommendation is sleep rather than set the alarm on to go exercise in the morning because if you don't get enough sleep, um your body is going to crave that throughout the day. We can talk more about that. Guys, you have complete permission for the sleep advocate here to forget the morning exercise and sleep in and get your exercising later. Even if it's less than great, I'm getting coached. So so I worship at the sleep altar of Ariana. I am, everybody that works with me knows that I am useless late at night. Uh and so I am very diligent about trying to get to bed at the same time every night to the extent possible getting a full night's sleep and rest and then getting up early because that's when I tend to to be at my best. Well thank you so much and and thank you all for listening and maybe you can think of what are your micro steps, the things you can do every day to improve our health. We cannot learn from each other. Thank you

Bruce Broussard says without mandates "we'll never get out of this predicament."

Humana's CEO is Mandating Vaccinations for Office Workers and Contractors

Leadership

Humana's CEO is Mandating Vaccinations for Workers

Bruce. Thank you so much for joining us to talk about Humana. I know you've been a big advocate of health and wellness for a long time even before the pandemic and you know, the importance of getting people vaccinated against the Covid virus. So do you think that this new full approval of Pfizer's vaccine will boost public confidence about the safety and effectiveness of vaccines and they will go out and get vaccinated. Is this a game changer? I think it's going to greatly help me. I do believe that it's going to motivate more people as a result of the safety of it. Um you know, for us as an organization, we just announced last week in front of the approval process that we are going to mandate the vaccine for all our employees that come to one of our facilities basically works out anybody that works outside their home uh and for contractors and we feel the having the FDA behind that turn into a full approval really provides that feeling safety. And I know for a number of our employees the question was around, is it safe? And I think that's brings the more credibility to that. So we're hoping so, and I really believe, and I do believe just businesses need to take a leadership role here and encouraging both in the community and outside the community through the employee base of having vaccination. Well as a top healthcare ceo what can you say to business leaders who are on the fence about this. As you know, it's been highly debated topic of whether you should be forcing your employees that they have to be vaccinated to come into the office, what would you say? You know, we're talking to our fellow ceos. What I'm finding is as much about the vaccination is about the labor shortage and there are certain populations that are low in vaccination and there's a significant amount of uh demand for those services for the that labor pool. And so they're weighing that. I just feel the more we can encourage the vaccination through mandates through assistance and getting the vaccination, the delta variants and all what comes with. It will basically go away without that. We're going to see this continued mutation of the virus and we'll never get out of this predicament we're in. I do believe business leaders really need to take a stance on this even though it might create some labor shortage for that. Well this is such a huge public health Issue as as you know, and I know that at Humana you have been making an effort to get people vaccinated. How successful have you been? We're good. I mean I think we're about where the public is in general in the 60% level now our seniors that we serve daily or above 80%. Um so we are seeing progress. So we're seeing a significant change and we're also seeing people now get the vaccination. So we're hoping that this will push people over the edge? But again, as you articulated the approval? I think will be a great assistance here. What more do you think that humanity can do? Is there some way to incentivize people to get vaccinated? We offer it, but we find the incentives really are not the motivator. I think this concern of safety is more part of the reason why people aren't getting vaccinated and I just feel we have to continue to reiterate that safety and appropriately, if there are medical conditions that could jeopardize somebody's health and we, we want to accommodate that. But the safety seems to be the largest issue around the vaccination versus access, which before it was access or some other inconvenience. We're not seeing that today. You know, Bruce when people hear the name Humana, they think big medical health insurance company, but you've been buying or partnering with hundreds of primary care clinics, you acquire a telehealth startup company not long ago and you've been moving into the business of home health services. So it sounds like humanity doing a lot more than just paying medical claims. Tell us where you're going with all of this. And why, you know, what's really interesting is Humana started out as a nursing home company And then evolved, this was 60 years ago. In fact, our anniversary was last week evolved to a hospital company and then to a health insurance company. Um, what we believe in is is that long term the payment is going to change from a volume based payment model to a model that is more around outcomes, quality and cost. And what you see the organization is really moving to accommodate that evolution. The more we can help people stay healthy, the better we do. So it's just do right for do good kind of activity. And so as we think about how do we keep people healthy? It's this proactive care where we can ensure people are getting their proper testing for the primary care doctor, we can bring a nurse into their home to ensure that we're providing the proper care to them on a more proactive basis where they might not have transportation or provide telehealth, behavioral telehealth in the home or I'll deliver their pharmacy into this home. So this idea to make it easy for our customers to get their health and do it in an integrated way and we feel the more we can invest, can own in those businesses and integrate them through technology, it is much easier for our customers. How did the covid pandemic influence what you're doing now and what more do you want to do in this direction? What's interesting is we had started this actually a number of years ago and Covid has accelerated it. This idea of an omni channel delivery care really came out of Covid. And so what you see us doing is trying to accelerate it as opposed to change it. And we do believe that over time a more convenient care model where it's coming to the individual as opposed to the individual going to the care is what's going to be really the winning strategy. And that's what you see the organization. So really speeding it up, scaling it is what we're really worrying to do now. You mentioned the omni channel approach because we've seen so many companies in other industries who have embraced these digital technologies much more actively, but when it comes to health care, uh, companies have been much slower to embrace it. Has Covid changed your thinking about how much more forward you want to go with the digital growth. Very much so it has really accelerated I think the use of technology and health care and there's really two sides of it. One is around the companies offering it and the second is around the customer and the provider, the doctor using it. And what we've seen with Covid has become much more comfortable of not only the company offering it, but also users using it now, very similar to our work environment today where before videoconferencing was always around, but it wasn't used that much. Now we see the same thing in health care. And so it gives us this opportunity to really scale it. You've been um ceo of Humana for 10 years and you really reshaped the company during your tenure, looking ahead five years. How do you want people to describe humana? And what it does really we want to describe Humana as a health service company that is oriented to the outcomes of individuals health as opposed to financing or providing insurance. It's really around that. We are caring for individuals health and doing that in a proactive and integrated life. On a personal note, Bruce, you wrote an op ed piece recently and you said that the covid pandemic and I'm quoting you, stretched Humana and me in ways we have never contemplated before. And you also said that there were some lifelong lessons that you learned that's actually influencing the way you read Humana. So what was the most important lesson and what kind of changes are you making as a result of that? It's really around this idea of intentionality. And what I mean by that is, you know, when you come to the office and you work in the office, you think you're creating a culture and for for us we have 500 locations. So creating a culture in one office seems to be sort of naive and what covid really brought to me is a much more outreach orientation and for me, what I've learned is I have much more effective to be able to be virtual, but to be more oriented to being able to touch people and in a way that I wasn't able to touch before, Not because I didn't have the opportunity, it just never came to me. So this intentionality of being a leader that is more outgoing and as opposed that it coming to you is a really important part of what I've seen in covid.

 Mark, the buzz word these days is disruption, creative disruption. And certainly, health care is a target for revolutionizing things. But can that change for health care come from an existing player, like Aetna? Or does it have to come from an outsider. It's harder for a large legacy organizations to do that. And it has been around for 164 years. And we're around versus all the other names who are gone because we have constantly been able to see around corners and make changes that we need to make. So that is why we've disrupted our own business model. It's hard to do. It's culturally difficult. But we believe it's worth the investment because we do have the economics and the capital to make that happen. There are a lot of entrepreneurs that are getting into health care and some of them are pretty successful. What are you learning from looking at these new startups? We buy some of them. If we like the idea and we think it fits with where we're headed, we will acquire it. So you have done a lot of things to change things up at Aetna. The big news earlier this year that you would raise the minimum wage for the companies lowest paid workers. Why did you do that? So Thomas Piketty's book, Capitalism in the 21st century, was scary to me. And I actually read it. And so I got a copy for each of my team members for Christmas that year, and said read this. This is the alternative. We're going to have forced income redistribution. Or should we, as captains of industry, actually engage in how we can become a better corporate citizen and treat our employees better? And so I said, what do we need to believe that we can do it versus having the government do it? And let's start a trend in the conversation among CEOs and corporations around the country about what is our role in doing it, how do we invest in our employees, how do we improve their engagement. 70% of American workers are disengaged. 20% of them actively disengaged, which means they're actually hurting our businesses. So how do we make that difference? And what is it that we do to make that investment, like we do on our computers and our machines and all the other things we build? What has been the impact inside and outside of your company? Well outside the company, we have a lot of interests. So we have our own microsite now where we have a lot of, you know, CEOs and corporations can go and see how do you do this, how do you think about it. Inside the company, I can't walk down the hall without getting a hug which is great. Makes me feel good. But we've just seen in that population of 1600 basis point increase in their engagement. 

CEO Mark Bertolini tells Fortune's Susie Gharib, 'We buy them.'

How Does Aetna Compete With Disruptive Startups?

 We're seeing a lot of mergers in health care-- your company, Aetna, with Humana, Cigna, and Anthem. And people are concerned that consumers will have less choices, that prices will go up, and that businesses will not be incentivized to innovate. What do you say to that? Well, there are 400 insurance companies in the United States providing services. And so when we look at our particular combination with Humana, the overlap is fairly small. Humana's in the Medicare Advantage Medicare business. We're in the commercial business. So we bring two great products together. So there are plenty of choices out there. I think people look at big companies coming together and whether or not that's going to impact the competitiveness, but quite frankly, at the local market, the blues are the dominant player in 30 states, where they have more than 30% of market share-- some of them, as high as 70% of the market share. The other issue that's a real hot button for people are drug prices. People want the breakthroughs in technology for their health, but they're opposed to pay, let's say, $1,000 for a pill. Right. What do you think about that? What's the way out? Well, I think it has to be related to what it's going to do, and so I think we need to have a much tighter connection between the drug itself and the outcome. We need to have a less expensive way of getting drugs to market and go through the approval process. And all of those require us to change the way we think about what drugs are valuable to the population. But what do we have to do to incentivize providers, payers, and consumers to reduce costs? I think it's really about-- again, back to this issue of, are we focused on the right definition of what health means? And today, we have doctors that work on a cash basis. As long as I have money in the bank, I'm good. We have hospitals that were going to revenue basis. As long as my revenue grows, I can afford more stuff. And then we have insurance companies and drug companies that work on a margin basis. So all these major actors have different economic models. It's a wonder the thing doesn't work. We need to get everybody on the business of, how do we maximize our return on investment and what we spend so that we can reinvest in the system and the health of the population? Is there an Uber for health care? Everybody looks at Uber as kind of this problem solver of any kind of business model issue. The best place to provide health care with the best provider is in the home by the family. And so that's a community-based model. But that's not possible in this day and age. Sure it is. It can happen every day. We get all sorts of stuff sent to our home today. Pretty soon, we're going to have it land by drone. If we can have a nurse go around the corner to take care of a neighbor versus having to get in a car, drive to work, get an assignment, drive to a patient, and then go home-- instead of that person having a job, they have a role in their community-- huge idea. 

Mark Bertolini explains to Fortune's Susie Gharib why consolidation is nothing to fear.

Aetna CEO: Consumers Shouldn't Worry About Healthcare Mergers

Mark Bertolini explains why consolidation is good. 

Humana

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Humana

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World's Most Admired CompaniesAs of 2/2/22

World's Most Admired Companies
As of 2/2/22