Bold Goal Gave Humana Experience, Data to Take on Pandemic’s Challenges

Humana’s long-term population health strategy, best represented in its relationships in Bold Goal communities, gave the payer a blueprint for addressing social needs on a wider scale as the COVID-19 pandemic unfolded, according to a report released last week.

The 2021 Bold Goal Progress Report describes Humana’s on-the-ground work with the 16 communities where the payer works with health systems and community partners to increase "Healthy Days," using a definition developed by the CDC. The report says Medicare Advantage members actually increased their number of physically healthy days each month, with targeted approaches having their greatest impact on those with depression or disabilities.

But this year’s report also includes information on the Basic Needs Program, which Humana created to address urgent social issues during the pandemic, including hunger. In 2020, the program assisted, more than 78,000 members and provided more than 1.1 million meals, the report said.

Bold Goal is Humana's ongoing effort to address holistic health needs in key markets, in part by working with community partners to address social determinants of health. The initiative, designed to tackle barriers such as lack of food or housing and social isolation that contribute to chronic disease, proved beneficial when the pandemic fueled a need to deliver more services in all these areas.

Andrew Renda, MD, vice president for Bold Goal and Population Health Strategy at Humana, said in an interview with The American Journal of Managed Care® that while it’s hard to quantify how things would have looked for Humana without Bold Goal in place, it is true that the program “helped position us well” when the pandemic struck.

“We've been working in the population health and social determinants space for 5 years,” Renda said. “And so, we've built a lot of the data and analytic infrastructure to make sure that we know what we're talking about when we say social determinants; we know what we're talking about when we're saying population health.”

Humana has both a corporate-level strategy for large populations—Medicare and Medicaid—and what Renda called “a very intentional, local, community-based strategy when it comes to social determinants of health.”

That community focus includes the 16 Bold Goal communities, each with its own health advisory board that features nonprofits and faith-based leaders. “We weren’t starting from scratch when the pandemic hit and these needs presented themselves,” he said. “We had some interventions and partnerships in the hopper that we could deploy.”

More Attention to Social Needs

Those interventions “in the hopper” propelled the Basic Needs Program, which delivered more than 1.1 million meals among members across Medicare, Medicaid, and commercial plans—including meals that met certain specific dietary needs. (Humana covers approximately 20 million lives across all its plans.)

Humana doubled its goal of 3 million screenings for social needs and did 6 million screenings in 2020, and then moved to fill what it called social “gaps.” From December 2020 to March 2021, the payer measured its “gap closure rate,” meaning, how well did the payer resolve the needs it found?

Food insecurity was addressed in 41.7% of members, and transportation needs were more easily resolved (medical needs were filled for 35% of members, non-medical in 26%). Other needs are tougher to fix. Housing needs were addressed for 11.7% of members, and loneliness, which was present in about 30% of members, was addressed for 9.9%, according to the report.

Humana was already working on loneliness, but when the pandemic hit, “the prevalence went even higher,” Renda said. “Again, we had a pipeline of things in place that we were testing.”

He described a company called Papa that hires college students who visit seniors at home to offer companionship. Humana had done some pilots with the company, and during the pandemic had to shift to virtual visits—along with “Papa Pals,” that could combine virtual visits with grocery deliveries, tackling food insecurity as well. A group of partners worked together on a campaign called Far From Alone, to combine resources in these areas.

From the start of the Bold Goal program, Humana has measured success using CDC definitions to quantify healthy or unhealthy days, by participants how many days in the past month they have felt their physical or mental health were not good. While results for 2020 were actually a little better last year for physical health, to no surprise there was a dip for mental health.

Renda said that Humana has long had a population strategy that focuses on disease management and prevention strategies, along with interventions that take on social determinants of health. “A lot of that relates to physical health,” he said. “But certainly when the pandemic hit it, for most people, it impacted their mental health more so than their physical health, because of social distancing because of fear of the unknown of the virus…

“That's much harder to protect against,” he said.

Humana is looking ahead in the population health arena. Renda moderated an online session as the report was released, “Levelling the playing field: the intersection of policy, technology and value-based care,” looked at some solutions to the challenges of the past year.

Topics covered included, (1) data analytics and technology around social determinants of health, which are not as well developed as clinical data; and (2) building infrastructure to allow innovation in the social determinants space, and operationalizing it.

So, how does Humana measure the return on its investment in population health?

“That's a really good question,” Renda said, admitting he’s often challenged with this question. Just finding cost savings is a rather narrow viewpoint. For a strategy like Bold Goal, it's broader—moving indicators such as Healthy Days measures, “if they can change the way people perceive their health, that's a great step in the right direction,” Renda said.