The initiative includes targeted efforts in 7 cities to reduce the number of "unhealthy days," a metric devised by CDC to gauge physical and mental well-being.
Published Online: March 23, 2017
The term “population health” is still relatively new in the United States, but it generally refers to measuring the health outcomes of an entire group under the care of health system, accounting for all the factors that feed into their well-being—those inside the doctor’s office or hospital, as well as those beyond.
The health insurer Humana approached population health in a new way in 2015 when it launched the Bold Goal initiative
, which seeks to make the population it serves 20% healthier by 2020. This week, Humana announced it’s making progress, as defined with the CDC survey tool “Healthy Days
,” which measures the number of unhealthy days a person has in a 30-day period, based on both mental and physical health.
Overall, Humana found a 2% improvement among members for healthy days, with 6 of 7 “Bold Goal” communities seeing improvements of 3%. Bold Goal communities are metropolitan areas where Humana has coordinated with local supermarkets, transportation providers, and other community providers to meet deal with those things outside the health system that affect outcomes—like not having the right food, being lonely, or needing behavioral healthcare.
Humana’s Chief Medical Officer Roy Beveridge, MD, said the approach is a far cry from his medical school days when “treating” a patient newly diagnosed with diabetes meant prescribing insulin—and nothing else. “When you think about what we understand about diabetes now, we need to treat the patient and the entire family,” Beveridge said.
Educating the patient means making sure he or she understands that losing 10% of body weight could mean that insulin is no longer necessary, he said. Educating the family means telling whoever controls the meals and the shopping that “meatballs every Sunday,” as Beveridge put it, isn’t good for a person trying to meet that 10% goal.
Addressing Social Determinants of Health
According to Beveridge, things like food insecurity and social and behavioral needs are crucial to healthcare costs, and these problems hit harder on those at the lower end of the socioeconomic scale. Addressing them isn’t “soft,” he said—it’s good for the bottom line.
“When you measure these things, when you look at patients with diabetes, any behavioral health issue leads to a 4 times greater per-patient per-month cost,” Beveridge said.
In fact, he said, the social determinant of health that is most strongly connected to cost is isolation. “It could be an early sign of dementia. It could be a sign the person has 5 diseases and cannot leave the house.”