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Transformation

Partnerships are enabling Humana, Highmark to transform during COVID-19 and beyond

Gabriel Perna | August 12, 2020

Key Takeaway: Partnerships between various health care stakeholders play a vital role in:
*Standing up virtual health

*Engaging patients

*Shifting to new models of care

*Improving care within communities

COVID-19 has provethat the health care industry has the ability to transition into new models of care to treat vulnerable patient populationspowered by a surge in usage of virtual health technology. But the pandemic has also showed that this transformation has to be a team effort. 

“I’ve never seen more industry collaboration than I have over the last five months,” said Alan Wheatley, Segment President, Retail, Humana on a recent Health Evolution Executive Briefing webcast. “We all agreed that we were going to try to be part of the solution, not part of the problem through the pandemic. We’ve tried to work collectively as an industry to advance the provider’s ability to see patients and the patient’s ability to connect with providers.” 

Wheatley participated with TripleTree Head of Investment Banking Justin Roth and David Holmberg, President & CEO, Highmark Health and Chairman of the Blue Cross Blue Shield Association Board of Directors for the virtual gathering, Payer CEO Insights: New Directions for Virtual Health and Payer-Provider Relationships. 

“Back in February, when we all started to realize the gravity of what was happening, it became clear that a war effort was necessary based on what we were seeing in China, Italy and then New York. What we found was that people were willing to work together and partner with some folks who hadn’t done that before. It was critical to the survival of our patients and the communities that we know and live in,” said Holmberg.  

The experts detailed how partnerships between payers, providers, health IT vendors, government officials and outside stakeholders didn’t just help during the pandemic, but are important for:  

  • Standing up and running a successful virtual health program 
  • Engaging patients and keeping them active in their health care, regardless of where they live 
  • Shifting to new models of care, where reimbursement is based on improved outcomes rather than fee for service 
  • Improving care within communities 

Standing up a successful virtual health program 

Both Humana and Highmark health plans, as well as the Allegheny Health System, which is a part of Highmark Health, saw substantial increases in virtual health usage since the pandemic began. Holmberg said the health plan has processed 1.2 million virtual claims since the pandemic began and the Allegheny Health System has gone from 25 virtual appointments per day to 4,000. Wheatley said Humana had 50,000 telehealth visits across its 46-state footprint for all of 2019. Between March and the end of July, they’ve had more than two million. 

In terms of partnerships, Wheatley gives a lot of credit to EHR vendors for moving quickly to make the virtual experience easier for providers. He said the EHR vendors understood their concerns and worked with them. Holmberg saw the same thing on his side. “Whether it was Epic or any of the other systems, there was a rapid reassignment of priorities that really helped facilitate this and get care to people who otherwise would have not had the access,” he noted. 

Moreover, the health plan executives credit providers for their willingness to use virtual health and educate themselves. Not only were docs able to connect with patients, Holmberg said, but with their fellow doctors as well. “We’re partnering with [St. Louis-based telehealth company] Mercy Virtual and we’re doing virtual ICUs. The advantage to that is you have a community hospital that doesn’t have the ability to recruit an ICU team but through virtual medicine, we can support them and give them that team,” he said. 

In terms of government partners, Wheatley credits CMS for quickly changing payment models to make it financially conducive and reasonable for providers to leverage technology. He said it’s very important for those temporary changes around telehealth usage to become permanent, once the public health emergency order ends. “It’s very important that providers get paid for the services they render and those incentives to continue to leverage that capability need to be there,” he said.  

Engaging patients  

It wasn’t enough for Highmark and Humana to just help providers stand up a virtual health operation. If their members, especially those who are vulnerable and suffer from multiple chronic illnesses, weren’t utilizing the technology then it would have become a moot point. As such, the health plans had to rely on partnerships and strategies to engage their patient populations and do it in a seamless way, as Roth noted. 

The biggest strategic ally in this regard were the providers themselves. Wheatley worked with doctors, nurses, and other care management professionals to reach out to members. The health plan, he noted, made one million calls to its customers. “We facilitated many direct connections between providers in the community and our members through telehealth, he said. Roth added that “providers are really on the front lines of building, maintaining, and enhancing relationships with the members” that the health plans serve. 

Holmberg said that virtual health tech allowed them to have better contact with its members in Arizona, Florida and places that are outside its main region in Western Pennsylvania. “While we don’t have as much direct contact with them as we do and in the states we operate in, we have extended these virtual relationships and we’re partnering with innovative tech companies and innovative care solutions in order to maybe change the game a bit,” he said. 

We found that relationships like that and our willingness to be disruptive had been met with the willingness to be disruptive by others

David Holmberg, Highmark Health

One example was the health plan’s deployment of Contessa, which offers a hospital room at home platform. “We found that relationships like that and our willingness to be disruptive had been met with the willingness to be disruptive by others,” Holmberg added. “In this world that we’re in, it requires unconventional partnerships.”  

Shifting to new models of care 

Looking past the pandemic, it’s easy to envision a scenario where this newfound shift into virtualized health leads to the emergence of new models of care. In fact, Wheatley saw a major difference in how providers in value-based arrangements and those in fee-for-service models reacted to the pandemic, in terms of utilization of virtual health. 

“From a value-based standpoint, those providers get paid on outcomes. They leveraged telehealth very quickly to stay connected with their patients, manage their health, close gaps in care and ensure they understand members’ needs. From a fee-for-service standpoint, it was candidly more about survival of the practice,” Wheatley said.  

As such, many fee-for-service providers are seriously considering a move to value-based care. They’ve seen that value-based providers haven’t had the same cash flow challenges, Wheatley said. Holmberg has seen the same willingness and interest from Highmark’s providers. 

“We’re finding that clinicians are satisfied, patients are satisfied and it’s all wrapping around social determinants of health,” he added. “Most clinicians are willing to take a stab at this approach because it’s a part of their DNA and if you can show them how to make the economics work and make that transition, they’re interested.”  

Both say that shifting to an outcomes-driven model of care requires analytics and remote health monitoring solutions as well as the aforementioned telehealth platform. All these technologies must interoperate with the EHR and claims data, to provide actionable information for clinicians at the point of care. As such, CEOs must be able to work with their tech vendors to make this happen. It also requires collaboration between payers and providers. 

“It’s really important to partner with others in order to do these things because when we think about what we’re doing, we want to keep people healthy, we want to keep them out of the hospital, and if we can take care of them at home, we want to do that. But all of these new care models that are addressing chronic disease require significant amounts of data and we need actionable data that has insights,” Holmberg said.  

Another strategic partner that’s critical to enabling this shift to value-based care is the federal government, said Wheatley. He said it will be important for the government to develop value-based care models similar to what private insurers like Highmark and Humana have done to help providers more easily navigate the shift. In that regard, Humana is working with the CMS Innovation Center to develop various programs. Holmberg agreed and said the barriers to clinicians and insurers adopting value-based medicine need to be addressed.  

Improving care within communities   

The pandemic has showed that strategic relationships in health care can come from unlikely places. Holmberg noted his organization worked with a company called MSA Safety, which makes fire safety equipment, and they collectively developed a respirator that can be repeatedly reused.  

During COVID, Highmark is taking what they’ve learned, whether it’s regarding safety equipment or virtual care, and sharing it across its network. “Our goal is to find somebody in each region who can be the beachhead for that region and be the innovator. And then from there, we can actually make real change happen, both nationally and on a regional basis,” Holmberg said.  

The downstream impact of this focus on improving community health, both Holmberg and Wheatley said, is that there’s a greater chance to address health disparities and care for vulnerable populations. Holmberg added that the technology and new models of care need to be used to level the playing field and reach into underserved communities and patient populations. But this can’t be done alone.  

We have to keep the progress going as an industry because I think we’re all set up for success. And underserved communities are going to be a lot better off as a result,” Wheatley said. 

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About the Author

Gabriel Perna, Senior Manager, Digital Content

Gabriel Perna is the Senior Manager of Digital Content at Health Evolution. He brings 10+ years of experience in covering the intersection of health care and business. Previously, he was at Chief Executive, Physicians Practice and Healthcare Informatics. You can reach him via email or on Twitter at @GabrielSPerna