The Power of Rethinking Your Routine

What does it take to make a difference?

In the world of health care, health problems become more frequent and complex as a person ages. You need empathy, compassion and dedication to build a trusting relationship with the patient. 

Yet this relationship is not enough. Solving these complex problems requires creativity, innovation and ingenuity. These traits are characteristics of how challenging yourself to think differently can make a difference. At Humana, this is a core value we call “Rethink Routine,” which is defined as “innovation emerges from a culture that cultivates curiosity. We spark creativity by challenging ourselves to think differently.” 

And nowhere is this value more evident than in “Nancy,” a care manager from Humana’s Chronic Care Program who directly supports the health care needs of our nation’s seniors. 

A Difficult Situation

At Humana, Nancy and thousands of others are focused on making it easy for our Medicare Advantage members to achieve their best health. 

The Centers for Medicare & Medicaid (CMS) state that “Nearly one in five Medicare patients discharged from a hospital—approximately 2.6 million seniors—are readmitted within 30 days, at a cost of over $26 billion every year.” And with 10,000 people every day becoming eligible for Medicare when they turn 65, helping our members stay healthy is critical to our nation’s health care industry and the future of our country. 

The member stories that intrigue me are the ones where we had to improvise our approach and think outside the box to make a difference. They don’t just address the clinical, but look at non-clinical barriers to health, such as a lack of transportation or fixing a home not designed to support an aging senior. 

The spirit of rethinking routine was at the center of solving of what Nancy did for “Jane,” a 75-year-old new Humana Medicare Advantage member in poor health who has lived in her family home for many years and was in a dire situation. 

Jane’s husband, who was her main caregiver, died of a heart attack about a year ago. Jane lives on a limited income and she doesn't have any children. She used to be active in her church, but has not gone much since her husband died.

Her health challenges were very serious. Jane had a stroke several years ago and uses a walker and a wheelchair. She had lost weight; wasn’t eating well; didn’t always take her meds regularly; felt sad; and was struggling to find joy in life. And in Jane’s case, it wasn’t about keeping her in her home. It was about making sure she had the resources to seek the care she needed. 

Going Beyond Health

Right after Jane joined Humana, Nancy was sent to meet with Jane, who also had not seen her primary care physician in over six months. 

Nancy also found that Jane had not been taking her meds as prescribed and that Jane was embarrassed to tell the doctor that she couldn't afford the copayment (Jane was paying people to bring her food and do chores). Nancy arranged for Jane to get her meds delivered to her door without a copayment and the two also agreed that Nancy would come to Jane's home to see her once a week and devise a plan to help Jane regain some control over her life. 

So often in health care we tend to just see the clinical barriers to a person’s health, not taking the time to look at the non-health barriers that the person may face. These aren’t solved with a new prescription or another visit to the physician, but are solved outside the traditional clinical setting. Nancy was not only astute enough to identify these problems, but also knew that the solutions were not of a traditional nature.

Nancy learned that Jane had not been able to get out of the house because previously her husband had carried her down the five steps at the front door. She could get around inside but couldn't handle the steps outside and didn't have anyone else she could ask to carry her. Jane needed a ramp but couldn't afford one. Transportation services would only pick up at the curbside.

 Go Outside the Box 

When I heard Jane’s story, I thought about how the solutions to Jane’s challenges weren’t just monetary, pharmaceutical or clinically-driven in scope. Nancy’s holistic and creative approach, which was also reflective of collaborating with the community in which Jane lived, helped her address four non-health-related barriers: 

• Engage the Community – Used community resource directory to find a program through the local Home Depot that enabled her to get materials to build a ramp.

• Faith-based Support – Connected with a local faith-based organization that provided volunteers that helped to build and install the ramp. 

• Coaching – Helped Jane understand how important it was for her to be open with her doctor about any issues or concerns she had so her doctor could best treat her.

• Retirement Options – Jane’s deceased husband was a veteran and Nancy found that Jane met requirements for a VA program that would help provide funds for a home health aide to come weekly to help Jane with shopping, meals and household chores.

Nancy was also able to help Jane reach out to her church and to reconnect with some of the church members. They have organized church volunteers to bring Jane to Sunday services and Jane is participating in her church community again. 

Nancy also arranged for the transportation service to pick up Jane curbside since she could now get outside, which then enabled Jane to see her primary care physician and other doctors regularly. 

A New Hope

Although Jane still misses her husband, she feels she has purpose and is part of a community. She feels she has some control over her own health. Jane’s doctor notes her health has improved and, thanks to fixing the transportation issue, she sees him regularly and keeps him up to date on any concerns or issues.

Jane said, “I didn't think anyone cared about me, but I found out there are a lot of people who have shown me they cared and that has given me a new outlook on life.” 

If you were to tell Nancy that her holistic approach to Jane was reflective of rethinking her routine, and displayed out of the box thinking, she would probably shrug and say this is simply what we do every day to help our members stay healthy. Nancy and her Humana Chronic Care Program colleagues are making a difference not just in Jane’s life, but in the fact that Humana members participating in the program are 42 percent less likely to be readmitted to the hospital within 30 days than non-members. 

Nancy’s holistic and community-driven approach is the perfect example of the innovation that can be achieved when one rethinks routine. She recognized that the challenges Jane faced went well beyond her traditional health and took the initiative to solve it. This spirit led her to reach out and build a community-based team of individuals that – working together at the behest of Nancy – could help Jane address the barriers that were keeping Jane isolated.

For the health care community, Nancy’s story is also a reminder of discretionary effort, which is defined as the “difference in the level of effort one is capable of bringing to an activity or a task, and the effort required only to get by or make do.” By building corporate cultures that support collaboration, innovation and challenging the status quo, we can empower Nancy and others to help Mary and other people know they are not alone.

Orison Swett Marden once said that “there is no medicine like hope, no incentive so great and no tonic so powerful as expectation of something better tomorrow.” Thanks to Nancy’s help, the power of hope is alive with Jane.