CMO Dr. William Shrank on Humana's physician strategy, 'Medicare for All' and home care as the Netflix of healthcare

Humana wants to do for healthcare what Netflix did for home entertainment.

Humana's CMO William Shrank, MD, said the insurer's strategy for its 16 million members, most of whom are Medicare Advantage enrollees, is to meet patients where they are — at home.

"If you look at the movie industry, you see there was a time when people used to go to the retail outlet to buy or rent their DVDs, and now there's a better service that's more convenient. It's more personalized in the home," Dr. Shrank told Becker's Hospital Review during an in-person interview June 4. "That's our goal. Our goal is to be that more progressive solution that is patient-focused, convenient, integrated and meets patients where they are. It's more of a Netflix kind of thing."

For Humana, this means better leveraging data, technology and analytics to be proactive, and reaching out to patients before medical issues arise to provide appropriate services in their bedrooms, kitchens and living rooms.

It's a different tactic than competitors like CVS Health/Aetna and UnitedHealth Group have used, but Dr. Shrank said that to Humana, home-based care is the future of healthcare. The insurer's investments are evidence: Humana and two private equity firms bought Louisville, Ky.-based post-acute care provider Kindred Healthcare in a $4.1 billion deal, with the trio also buying hospice operator Curo Health Services for $1.4 billion.

Here, Dr. Shrank further discusses Humana's at-home strategy and answers questions on the payer's primary care moves, its partnerships with hospitals and the possibility of "Medicare for All."

Editor's note: Responses have been lightly edited for clarity and length.

Question: CVS/Aetna just announced plans to open 1,500 "HealthHubs." UnitedHealth's Optum is acquiring physicians. Amid these moves from competitors, what's your physician strategy?

Dr. William Shrank: The large payers — at least the three of us focused heavily on Medicare Advantage — are blurring the lines between payer and provider. We're thinking more holistically about how we manage a population rather than figuring out how to pay claims. We are all taking a little bit of a different tactic. Ours is focused on the home, on meeting patients where they are. United is going to buy more and more primary care docs, and CVS is doing more in the retail space. We think the future of healthcare is going to be in the home.

Q: Humana's CEO Bruce Broussard recently spoke out against Medicare for All. Heading into the 2020 election, what are your thoughts on the proposal?

WS: The comments that have been made have been about eliminating private insurance within Medicare Advantage. We are all in favor of expanding insurance. The issue is not around insurance coverage. The issue is around making sure there is a room for Medicare Advantage.

The number of people selecting into Medicare Advantage is growing rapidly. [Medicare Advantage] is important because we have more flexibility around what benefits we offer, and there's a whole host of benefits that are available for our members in Medicare Advantage that are not available in traditional fee-for-service. There are financial protections in Medicare Advantage that patients don't get in traditional Medicare. And, most importantly, we think Medicare Advantage plans are in a far better position to endorse a more holistic set of solutions for our membership.

As we think about the move toward value-based care, do we want the federal government shifting the risk to providers directly, and the providers have to build all these assets, or do we want Medicare Advantage plans to create those relationships with providers and be able to fill in all the holes that providers may or may not be able to fill themselves?

Q: Many insurers — Anthem comes to mind — are building out their Medicare Advantage lines. How do you think growth in Medicare Advantage will affect hospitals?

WS: I think in the long run, it's good for hospitals. As providers move toward value-based care and incentives are better aligned, there's more and more opportunity for a hospital and a health plan to partner around some of the hardest parts of a hospitalization: the transitions. Whether it's a transition to a post-acute care center or home, those transitions are a time of great vulnerability. Deep partnerships around both clinical interventions, whether it's care managers or nurses, or data that helps you to make sure you are consistent with medications with therapeutic approaches across different settings, is paramount to reduce readmissions and improve the care of our members and hospitals' patients. We do think that partnership is going to provide value to those caring for patients in the hospital, as well as the health plan.  

Q: How far along are you on your Bold Goal initiative to improve health by 20 percent in several communities by 2020, and how does this play into your overall strategy?

WS: In our most mature market, San Antonio, we saw an approximately 10 percent improvement in healthy days, and across the board, nearly a 3 percent improvement in healthy days.

We're increasingly convinced that if we're going to take good care of seniors, we're going to have to think hard and be deeply engaged with the community around how to address social context. We are deeply committed to that as a central theme to the work we do.

The one change now is we're going from testing some of these ideas as more proof of concept to now thinking harder about more rigorous analytics to understand what are the most effective interventions, and how do we look to scale these efforts?

Now with all of these efforts in place, there's a bigger focus on integrating them and turning them into more of a team-based holistic solution. We're not just acquiring all these different assets; that doesn't fix how we care for members. The goal is to bring these all into one synchronized, coordinated approach to ensure different members of the team are acting in concert rather than bumping into each other.

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