Interoperability offers transparency and better health outcomes

I was no stranger to health care while growing up, as my father was an obstetrician in Louisiana and Mississippi. He told me he sometimes felt handicapped in appropriately treating his patients because he didn’t know their family history or if they were having difficulty maintaining the right nutrition. Families struggling to put food on the table would sometimes supplement their meals in ways that could be very harmful – especially for pregnant women – but as a specialist, my father often wasn’t aware of his patients’ complete health picture.

This is the example I think about often in my current role at Humana. What my father wanted then is something we are working hard to achieve today – better information sharing among all of us in health care, or “interoperability.”

We must reduce friction between payer and provider to create a health care system that makes access to care simple, convenient and seamless for our customers.

Humana is an industry leader in advocating for and working toward greater interoperability among beneficiaries, plans and providers, meaning information is shared and easily accessible by all. We have come a long way in the last decade with technology and data exchange, but we still have a lot of work to do. As a payer and provider, through our CenterWell health care services, we know building trust with providers is the only way we can truly become interoperable and improve the experience for our members.

For members, better and faster communication means increased access to quality care, reduced wait times for receiving care, and better health outcomes.

For physicians, interoperability makes determining the best course of treatment for their patients easier and faster. By offering a full picture of a patient’s health – with records from each provider a patient has visited in one central place – interoperability increases physician awareness.

It also increases transparency and reduces health care costs for patients. A 2019 study by Humana and the University of Pittsburgh School of Medicine found that waste accounts for a quarter of all health care spending, amounting to between $760 billion to $935 billion a year.

?Integrated Health – The Humana and CenterWell Example

At Humana, we have made great strides in interoperability in recent years with our own CenterWell health care services ( CenterWell Senior Primary Care , CenterWell Home Health , and CenterWell Pharmacy), led by my colleague, Sanjay Shetty, MD .

Integrated health brings our health plan offerings and health care services together to offer integrated senior care, providing people with quality, affordable care and the resources they need to improve health outcomes.

I think we can all agree that filling out multiple forms with your contact information and past and current health issues every time you visit a new provider can be frustrating. It can even be inaccurate if you forget to include something. ?

With integrated health, CenterWell patients who are enrolled in a Humana plan only need to provide basic information at each visit. We will already have past health assessments on file, allowing the physician to go right to work interacting with the patient.

The shared information doesn’t stop with health assessments. Our goal is to ensure the provider has access to patients’ health plan details and can help them navigate their benefits. For example, if the CenterWell Primary Care team can see that a Humana member has a plan that includes a transportation benefit, they can help them understand how to use it to access care in the future.

Ultimately, we want our members to have a differentiated experience that offers health care when and how they need it without the stress of managing it alone.

We want to give them access to senior-specific care and support. An integrated care team, led by primary care as the “quarterback,” can help patients adhere to medications, coordinate with specialists, connect health at home to the clinic, and support patients’ post-acute medical events.

We’re early in our integrated health initiative, but preliminary data shows our Humana members have better health outcomes and reduced hospitalizations when they use more than one of these CenterWell services.

While Humana works with an extensive network of providers, and CenterWell provides care for seniors with a variety of health plans, the way we are integrating care serves as a model for the industry for how payer and provider can partner together to offer seamless connectivity between plan and care.

To dive deeper into the value of our integrated health model, you can read Dr. Shetty’s recent article, Transforming Healthcare with Integrated, Differentiated Experiences.