Putting Members and Their Health First

By Bruce Broussard, President and CEO of Humana

Recently, the Centers for Medicare and Medicaid Services (CMS) issued updated ratings for health insurance plans across the country. The annual “Star Ratings” assess the quality of care and services a consumer enrolled in a given plan can expect to receive — on a 1 to 5 scale. Although a number of criteria go into Humana’s overall rating for the 2018 plan year, we don’t believe the recent scores offer a full and accurate reflection of our work. For instance, a closer look at one key Star criterion — our HEDIS scores, which are now higher than they have ever been (when using a member-weighted average of all plans*) — shows that we’re making notable progress for our members’ health.

The Healthcare Effectiveness Data and Information Set (HEDIS) is a tool used by more than 90 percent of America’s health plans to measure plan performance on a number of dimensions of care and service, including some of the most important ways plans help people manage common health conditions. Independently developed by technical experts in quality measurement, HEDIS has been used since the 1980s and is considered by many as the gold standard for plan performance.

HEDIS scores measure a wide range of conditions and health issues such as diabetes care, breast cancer screenings, and controlling high blood pressure. So, HEDIS scores reflect, among other things, whether a health plan’s members effectively follow their outlined treatment regimens.

Based on the updated data from CMS for Plan Year 2018, Humana’s overall Star rating is 3.62. Of significance, however, is that Humana achieved its highest-ever HEDIS result when using a member-weighted average of all plans, earning 4.16 Stars. This is up from 3.9 Stars for 2017 and 3.86 Stars for 2016. Additionally, we received a perfect 5 Stars on Care for Older Adults-Medication Review and Care for Older Adults-Pain Screening (on all plans that were required to report the measures), as well as 5 Stars on Controlling Blood Pressure (for most plans).

While our goal is to deliver the best care possible for our members, rather than focusing on rankings and ratings, these scores are important. They help us gauge our progress and provide us an opportunity to reflect on our values — and how the care we provide measurably improves the lives of our members.

It’s always exciting to me as Humana’s CEO when I see an area of improvement in delivering quality care to our health plan members; this is also personal for our Humana associates. To all of us at Humana, we care about what the numbers represent.

I cannot state more clearly how committed we are to providing quality care to every Humana member, every day. The way we view it, quality care is about a better consumer experience, and better health outcomes at lower costs, because those are the things that matter most to our members. It’s about whether we can help our members live their best lives.

One way we’ve tried to accomplish this goal is through our efforts to lead the healthcare industry’s shift toward what is known as “value-based care.”

These aren’t just buzzwords. Thinking about our business this way means that we’re always putting our members and their health first. Rather than reimbursing doctors based on the number of tests and procedures ordered, for instance, we’re increasingly compensating doctors based on how healthy their patients actually are. This means we all have the same goal — better health outcomes.

Our Medicare Advantage members in value-based care settings had 7 percent fewer inpatient hospital admissions and 6 percent fewer emergency room visits in 2015, compared with members treated in traditional fee-for-service settings. And less time in the hospital translates into more days at home and a better quality of life. For instance, over the past four years, people who are currently enrolled in Humana At Home services spent more than 1 million more days at home than they would have experienced had they not received Humana At Home services.

Additionally, Humana experienced 20 percent lower costs in total in 2015 for members who were affiliated with health care providers in a value-based reimbursement model setting (versus an estimation of original fee-for-service Medicare costs using CMS Limited Data Set Files). Also in 2015, Humana Medicare Advantage Prescription Drug plan members could have saved almost $5,400** on average on their prescription costs compared to having no insurance coverage.

These latest results tell us we’re moving in the right direction. But, as always, there’s a lot more work to do. As we continue with the 2017 Medicare Advantage and Prescription Drug Plan Annual Election Period (which lasts through Dec. 7), and the Healthcare Exchange Open Enrollment Period (which continues through January 31, 2017), we always have an eye on how to provide the best quality care for our members, both today and going forward.

As a CEO, I see lots of numbers on lots of spreadsheets each week. Those numbers are important, but what matters most is the people they represent.

When we see a member’s health improve after years managing a chronic condition; or when we’re able to help another member live at home with his or her family, rather than in a medical facility; or when we receive an email from a member who is so thrilled with how much money her new plans have saved her; that’s when we truly know we’re doing our jobs.

* All plans owned or affiliated with Humana Inc. were included in the calculation.

** 2015 Humana Member Savings Report. This report shows the average savings on prescription drugs. It compares Humana’s Medicare Advantage Prescription Drug Plan members’ out-of-pocket costs and premiums for prescription drugs covered by their plan to retail prices for drugs purchased by individuals without insurance.