Shifting away from sick care: The additional role of insurers in the new healthcare environment

With the shift from fee-for-service to pay-for-performance and the many other changes in the healthcare industry due to healthcare reform, insurers are becoming more concerned with cutting costs and improving the health outcomes of patient populations.

The changes in the industry have caused many health insurance companies to reconsider the role they play in their members' lives and develop new strategies for becoming more involved in their members' health. Some insurers, such as Louisville, Ky.-based Humana, have made a shift from dealing with illness to focusing on health.

Roy Beveridge, MD, senior vice president and CMO at Humana, says his company spent a significant amount of time thinking about how a health and well-being company could help its members become more engaged in their own health, which required looking at the big picture from the consumer's standpoint.Dr.Beveridge

Humana realized offering health education to members and providing incentives for being active are helpful tools for patient engagement. For example, the HumanaVitality wellness and rewards program incentivizes members to make healthy choices and rewards them for doing so. "These types of processes allow people to become more excited about their own health," says Dr. Beveridge. "The key is maximizing each individual's health improvement."

Humana is also involved in more than 900 accountable care relationships, which place the primary care physician at the center of patient care. Humana is incentivizing primary care physicians to be actively responsible for the health of their patients by providing more compensation to physicians when they meet quality scores. To meet quality measures, physicians have to do more than just treat patients for the condition they come in with. "We want our physicians to be preventing illness, which will improve the overall health of a population," says Dr. Beveridge.

The change in the culture at Humana evidences the overarching change in the healthcare industry. For instance, 10 years ago patients would go to a physician with a foot ulcer because their diabetes was poorly controlled. However, with accountable care, the focus is on ensuring the patient never develops that foot ulcer. "When physicians are held accountable, they begin understand that by engaging patients one truly gets a win, win, win," says Dr. Beveridge, as "it's better for the patient, it's better for the physician and it's better for society because the global costs are less."

Most physicians agree with the type of approach Humana has taken, with a recent study sponsored by CareCloud in partnership with QuantiaMD finding 40 percent of physicians believe patient engagement programs such as population health efforts hold the greatest promise for practice performance in 2014.   

In addition, when physicians are more engaged with their patients' care, patient satisfaction improves. "We've found that the patient acceptance and enthusiasm for having a provider engaged in their care and trying to improve their health is what consumers want," says Dr. Beveridge, and "physicians are excited they are preventing illness from occurring."

More articles on patient engagement:

Study: Idea of what patient engagement means is still vague
6 Necessary Guidelines to Create and Manage a Successful ACO
Study: Email, Telephone Outreach Can Increase PCP Visits Among Patients With Chronic Conditions

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