Humana's Bold Goal Program Takes Aim at Chronic Disease in Time of COVID-19

Humana’s Bold Goal program helped its Medicare Advantage members experience 816,000 more healthy days in 2019, and the insurer reported progress in every target market for the first time since it began the ambitious population health effort 5 years ago.

Having the program in place heading into 2020, as the country has grappled with the worldwide coronavirus disease 2019 (COVID-19) pandemic, has given Humana insight into the racial disparities the public health crisis has exposed—and the infrastructure to help members going forward, the company said.

Bold Goal is Humana’s effort to address holistic health needs in key markets, in part by working with community partners to address social determinants of health. The program seeks to tackle barriers such as lack of food or housing and social isolation that contribute to chronic disease, including hypertension, depression, and congestive heart failure (CHF).

To assess progress, Humana uses Healthy Days, a CDC measure that not only asks if people are free of illness and injury but also about mental health and quality of life over the past 30 days. As Humana has learned over time, Healthy Days is a challenging measure, because events such as hurricanes across Florida or flooding in Baton Rouge, Louisiana, can disrupt people’s lives and health, making the need for public health infrastructure and partnerships essential when working with at-risk populations.

COVID-19 has only put a brighter light on this challenge, Humana President and CEO Bruce Broussard said in statement. While African Americans make up 13% of the US population, they have accounted for 34% of the cases and 21% of the deaths as of mid-May, in part because they are more likely to have comorbid conditions that make people more vulnerable to COVID-19.

“During the last 5 years working in the Bold Goal communities, we have seen firsthand the impact of clinical and social needs on our members,” Broussard said. “COVID-19 has further widened ongoing health disparities, disproportionately affecting Black and Latino communities. Humana is deeply committed to working with our community and government partners to ensure we support members in improving their mental and physical health. Working together, we can break down barriers to drive lasting change.”

Bold Goal offered an early view of the potential of addressing social determinants within the context of Medicare Advantage, even before CMS changed regulations to allow plans to cover nontraditional services to address these areas. It’s a look into the future for Humana, which has a huge footprint in Medicare, with 8.4 million members in all 50 states, of whom 4 million are Medicare Advantage members.

The Bold Goal program started in San Antonio, Texas; Humana then added Tampa and Broward County, Florida; Baton Rouge and New Orleans, Louisiana; Knoxville, Tennessee; and its home of Louisville, Kentucky. Eventually, the program expanded to 16 markets.

Over the years, Humana’s effort has seen uneven progress across the markets where Bold Goals operates, as community partnerships took hold. This year, however, Bold Goals reported progress in every Medicare Advantage market served by the program.

While the decline in the average number of reported unhealthy days seems modest—from 13.44 to 13.42—this translates into 816,000 more healthy days than participants would have seen without the program. Among other 2019 highlights in the report:

• Humana reported substantial progress in some of its original 7 markets: Medicare Advantage members in Tampa had 3.7% fewer unhealthy days, and those in New Orleans—a city that has long seen high rates of chronic health conditions—had 2.2% fewer unhealthy days compared with 2015.
• Working with community partners, Humana screened 2.6 million members for social determinants of health in 2019—more than twice its goal—and learned that members had an average of 3.5 health-related social needs.
• Much of the progress is coming in helping members with serious chronic conditions. Patients with coronary artery disease, chronic obstructive pulmonary disease, CHF, hypertension, and depression all reported fewer unhealthy days; declines among those with hypertension and CHF were above 3%.

Of note, low-income Medicare Advantage members saw a nearly 4% improvement in the number of healthy days. In Humana’s statement, Humana Chief Medical Officer William Shrank, MD, MSHS, who heads the Office of Health Affairs and Advocacy, said serving these members requires “empowering providers with the means to access social risk data in electronic health records.”

“While the movement toward interoperability is gaining momentum, physicians need a detailed understanding of their patients, and that comes when they have data that identifies unhealthy behaviors,” said Shrank, who is also a member of the editorial board for The American Journal of Managed Care^®. “Humana’s holistic approach to addressing whole-person health, combined with our strong provider partnerships, enabled us to reduce the number of unhealthy days for Medicare Advantage members living with chronic conditions, and this is an essential part of human care.”

Over the years, Humana has emphasized the importance of community partnerships in addressing social determinants of health. Caraline Coats, vice president, Bold Goal and Population Health Strategy, said these partnerships are “fundamental” to creating the infrastructure that will meet members’ social needs, especially in the wake of the pandemic.

“We were able to successfully adapt and craft quick solutions to address the clinical and social needs of our most vulnerable members,” Coats said. “We are at a time when our work has not mattered more. What we do, who we serve and how we can make a difference are all top of mind every day.”