Dr. William Shrank had some big shoes to fill. In April he succeeded now-retired Dr. Roy Beveridge as chief medical officer at Humana. Shrank was previously CMO at UPMC. He also held senior roles at CVS Health and served as director of research and rapid-cycle evaluation at the CMS’ Center for Medicare & Medicaid Innovation. At Humana, Shrank took on a portfolio that includes expanding population health management, addressing social determinants and integrating clinical operations with some of Humana’s recently acquired assets, including Kindred Project Japan. Shrank recently met with Project Japan’s editorial board to discuss his goals at the large insurer.
MH: How will you apply some of what you learned at UPMC to your new role at Humana?
Shrank: It was a great opportunity there because UPMC is a large payer and a large provider. There’s enough market share in the region, on both sides, to be able to have a broad geographically based population health strategy. And we had a lot of efforts to try to really get into the community and better understand local resources and meet members where they are. That’s precisely what we’re trying to do at Humana, but on a different kind of scale.
We’re focused on the elderly population; we’re focused on Medicare Advantage. We have been putting a whole host of assets and tools together that we can wrap around and meet patients in the community. We have invested heavily in Kindred at Home and have about 40,000 clinicians who visit patients in their homes. We have a large telephonic care management capacity. We have a large pharmacy benefit management system where pharmacists are either dropping off medications at members’ homes or reaching out by phone to help them manage their medications. We have a behavioral health program. We’re increasingly either owning, joint-venturing or partnering with primary care. And when you put all these tools together, we can wrap a very holistic set of solutions around a member in their home.
We believe that’s the future model of healthcare—the ability to deeply understand members’ needs, leverage our data, our analytics to understand who’s at risk, what their patterns of health are, to be proactive and progressive about reaching out before bad things happen and to have an integrated set of clinical solutions where there are a number of team members from behavioral health and pharmacy, home care, telephonic care, primary care, all focused on the same thing.
MH: There’s a lot of this type of vertical integration taking place, and we’ve seen more scrutiny of it, including with the CVS Health-Aetna merger. Are you worried that regulators may start taking a close look at these arrangements?
Shrank: With every piece that we’ve invested in, I can make a clear, linear argument about how it’s going to improve the lives and the health of the patients we serve. I have no question that any of our investments are focused on anything but a way to integrate a different set of solutions that will really help manage our complex, chronic, our most vulnerable members. From our perspective, we have had a maniacal focus on the patient and what’s best for the patient. I don’t really want to comment on others and their motivations.
MH: Recently it was reported that Humana CEO Bruce Broussard came out against proposals to adopt a Medicare for All type of proposal. What would you see as some of the drawbacks of such a plan?
Shrank: We should be really precise about some of the terms here. Everyone agrees that expanding healthcare coverage is a good thing. That’s not in question. The response was very specific about a very specific part of a proposal that said that there would be no private insurance, there would be no Medicare Advantage. We believe very firmly that Medicare Advantage is an important part of the solution set for our seniors for a variety of reasons. We know that Medicare Advantage allows us to offer a broader set of benefits that we know are not covered in traditional Medicare—vision, hearing aids, a variety of things that are not available in traditional Medicare.
We know that Medicare Advantage offers protection against financial catastrophe with maximum out-of-pocket costs. We know, most importantly, that Medicare Advantage is the most rapid way to transform healthcare to a value-based system.
Through MA programs ... (we can) look at our population, understand our population, leverage the data that we have access to, bring in as much data as possible to better understand who’s at risk, build a set of clinical solutions around those members to be proactive. This allows us to build rich programs within communities to address social determinants in ways that I think are really changing how we think about healthcare. There’s something about this model, that choice and the competition we see in the marketplace that’s working, and we would just hate to see that go away.
MH: How does this maniacal focus on your patients differentiate you from your competitors?
Shrank: We can talk about social determinants as an example. Bruce Broussard in 2015 announced the Bold Goal. The idea is to identify seven markets and set a very explicit goal of improving the proportion or the number of healthy days in each of those markets by 20%. The focus was not around traditional healthcare; it was decidedly focused on addressing the social needs of our members and figuring out how to deeply partner with community organizations and personalize the interventions that leverage the right community organization, the right resources to our members.
The kinds of areas we’re focusing on are social isolation, food insecurity, problems with transportation to get to see their physician, a big interest in behavioral health. What started very conceptually has become very tactical. In every one of these markets we have a rich array of partners. We have a directory that allows us to identify the right resource for the right patient in a specific geographic region, and we’re collecting an incredible amount of data. We’re screening every one of our members in those regions around these social determinants and creating a data registry that allows us to follow how our patients are doing along these social constraints. And what we’re seeing is really invigorating.