Speaker 0: This is where health insurance leadership comes together. Becker's fourth annual spring payer issues roundtable brings together over 400 payer and health plan executives and more than 100 speakers to Chicago April. This year's event includes keynote conversations with the industry's top leaders and former president George w Bush. For the full agenda and event details, visit beckershospitalreview.com and click on the events tab in the upper right. We're looking forward to hosting you here in Chicago.

Speaker 1: Hello, everyone. This is Elizabeth Caslow with the Becker's Payer Issues podcast. I'm thrilled today to be joined by Alex Ding, enterprise deputy chief medical officer at Humana. Doctor Ding, thank you so much for joining us today.

Speaker 2: Thank you so much for having me. I'm really excited to join you today.

Speaker 1: Great. So before we dive into Humana's value based care report, which is gonna be our central focus, I would love to hear a bit more about yourself and your career background.

Speaker 2: Sure. Would be delighted to. So as you mentioned, I'm Alex Ding. I'm the deputy chief medical officer at Humana, and I've been with Humana for the past five plus years based out of Louisville, Kentucky. I'm a practicing physician.

I am a diagnostic and interventional radiologist by training still practice, in Louisville, Kentucky. Prior to joining Humana, my background has been primarily in clinical practice and so I've practiced in academic settings in addition to private practice. And I've also worked in healthcare innovation as well, working on, how we bring technology enablement into health care, particularly through the use of innovations like, augmented intelligence.

Speaker 1: Great to hear. So thank you again for joining us. So, yeah, we're gonna talk about that report. So thinking about the report's context, so I would love to hear how exactly Humana defines value based care because sometimes that term gets thrown up in the air, and we're not always on the same page. So I would love to hear in the context of the report, how does Humana define value based care?

Speaker 2: Yeah. I I I think you're right. There are different interpretations, different takes, different definitions for how one might think about value based care. At its core, Humana defines value based care as realigning health care around outcomes, quality and experience, not just volume. And so in our report, we simplify that idea and define it as value equals quality and experience all over or divided by cost.

And I think that framing matters because it shifts the conversation away from how much care we deliver and really moving toward the conversation of how well are people actually doing, how healthy are we able to keep, patients? And I think it moves away from this idea of how much activity we're generating in the health care system and really moves toward what sort of outcomes we're achieving in our health care system. I would say, practically, value based care enables proactive whole person care, using data through care teams and longitudinal relationships that prevent problems, keep people healthy rather than just reacting to them when it's further down the line. And I think for clinicians, that also means less feeling like you are on a treadmill or on that hamster wheel of seeing as many patients as possible and really getting more time to focus on meaningful patient care. And I think for the system at large, it's really about how we get to something that is both clinically better but also financially sustainable at the same time.

Speaker 1: Thanks for grounding us in that context. So I wanna give you the opportunity to talk about what you think is the most valuable what you think are the most valuable findings, from this report, and where did they confirm or even challenge what Humana is seeing in practice?

Speaker 2: Yeah. I I think there's a number of items that are interesting in the report in terms of the things that we are, as as I mentioned, defining value based care as, which includes, improvements we see in quality but also improvements in experience. Then that is both true for, patients and members, but also for the clinicians that are practicing within the system as well. All at the same time, the sorts of reductions you can see in cost and utilization. And we've got some of the numbers that are in the report that I'd encourage, people to to jump into.

But I would say what stood out most was really how clearly the data validated what clinicians, I think, intuitively already know, that continuity of primary care matters matters a lot. And in these value based care arrangements, we saw meaningfully fewer, unnecessary hospital admissions and emergency department visits that is paired with more scheduled primary care visits, more continuity of care, more intensity of engagement with primary care, and I think that combination is incredibly powerful. I think it's what allows for earlier care intervention, allows for better management of chronic disease, and as a result leads to fewer downstream health crises. Not to mention, I think the importance of spending more time with your usual source of care, with your doctor, with your care team, and that as a result developing stronger therapeutic relationships between the patient, their physician, and the whole of the clinical care team. I think one of the things that, also stood out in terms of kind of the the other side, the the challenge of it is that there's still a decent amount of uneven performance in terms of where we see, value based care firing on all all cylinders and where there's still some opportunities.

And I think that the model works, but it only works when you've got the infrastructure and you've got the data liquidity. You've got the care teams that are consistently in place. And I think that being able to bridge that gap is one of those areas that we will continue to focus on.

Speaker 1: So just to bring our listeners up to speed, and I'm reading this straight from the report, Medicare Advantage members and value based care arrangements had 24.3% fewer inpatient hospital admissions than those in original Medicare in 2024. And, Humana Medicare Advantage members receiving value based care had 13.4% fewer emergency department visits and 7.6% fewer hospital admissions. So that's those are some of those numbers, that doctor Ding was touching on there. But, yeah, let's talk about those challenges. So what are those harder those more more difficult operational barriers that Humana still sees when translating that belief of value based care into consistent performance across markets?

Speaker 2: Yeah. I would say the biggest barrier is that we are still predominantly operating inside a health care system that is built for fee for service. And so clinicians are being asked to deliver proactive coordinated care while still working in these workflows that were designed to be reactive, that were designed to be episodic. And I would say one of the biggest challenges is practices trying to operate really with one foot in fee for service, one foot in value based care. I often call this having one foot in each canoe.

And I think that is an incredibly hard place to be because you're essentially trying to deliver proactive population based care on a fee for service chassis that was not never designed, to to do well in that. And I think that internal tension really shows up in workflows, in staffing models, and clinical priorities, and it can unfortunately blunt the impact of what value based care can accomplish even when the intent is there. And I would say, you know, layer on top of that the broader health care system issues. So fragmented data, inconsistent infrastructure, variability across markets. And so while I think the belief in value based care is strong, I would say the work now is really in taking it to that operational level and helping practices fully cross that bridge by reducing administrative burden and friction by improving data flow and liquidity and really aligning incentives so that they don't feel like they're paddling in two directions at the same time.

Speaker 1: So how do you distinguish between nominal participation and value based care and, like, an actual commitment to transformation?

Speaker 2: Yeah. I think I think the distinction is really less about kind of the what the contract looks like and really looking much further downstream into what the care delivery model, looks like. And I would say nominal participation means that a practice may have a value based care arrangement. They have they may have a value based care contract, but the care itself at the clinical level still looks and feels like be for service. So there's limited coordination, there's reactive visits, there's minimal, if any, use of data.

And I think that true transformation really shows up when you look at how the care is being organized day to day, how it's being delivered, how it's being experienced by not only the patient but also by the clinician who's working in that system as well. And so in those systems, you see team based models, you see continuous patient engagement, You see data being used prospectively, not just for reporting, but also for clinical decision making as well. And I think it's really a a huge leap in mind shift mindset shift from really thinking about or asking the question of how many patients that I see today to how well are my patients doing today and how well are they doing over time. And I think that's when you start to see the financial transformation leading to clinical transformation, which is really what we consider true transformation in the system.

Speaker 1: Yeah. And from your perspective as a physician leader, what does a mature value based care arrangement really look like, and how does alignment look between payers and providers in those situations?

Speaker 2: I would say in a in a mature value based model, alignment looks like a a true partnership between the payer and the provider, rather than a more transactional sort of relationship or I would say even worse yet an adversarial one. And I think that effective alignment looks like a genuine partnership that is built on transparent, timely, actionable data that clinicians can use at the point of care to make informed clinical decisions, in real time. And I think incentives are structured in these models to reward participation, care coordination, patient well-being rather than just volume and the number of patients that you're seeing in a day. I think clinicians also have support from integrated care teams so that they don't feel like they're responsible for every single, aspect of patient care that they're shouldering on their burdens, which, we know that clinicians are incredibly burdened and, many are burnt out. And I think that this alignment reduces that administrative burden, and we have seen that it allows for more time with their patients, which enables that sort of relationship based care that not only builds care between that doctor patient relationship, but broader trust with the health care system writ large.

And I think that that as a result proactively keeps people healthy and improves outcomes, and it's something that improves not only the patient experience but the clinician experience as well. And so I think when that alignment is in place, that trust overall improves, and I would say trust is what allows value based care to continue to scale over time.

Speaker 1: And based on the report's findings, what changes is Humana thinking about when it comes to its value based care strategy over the next year or two?

Speaker 2: I would say, overall, the large the findings largely confirm our overall direction. I do think that they help, sharpen our priorities. However, I would say over the next twelve to twenty four months, we're focused on continuing to deepen that primary care continuity and intensity that I mentioned earlier on. That's also part of the report because I do think that is where the biggest clinical and experience gains occur. At the same time, I would say that I'd like to take a lot of our learnings from scaling and maturing value based care models in primary care into specialty care as well.

I think over the next twelve to twenty four months, we're also continuing to invest more in better or effective interoperability that allows for more real time data exchange and analytics so that clinicians can act earlier, not later, and reducing administrative burdens and strengthening that team based care model that continues to be a critical enabler of what it means to function effectively in a value based care operating model. And then I would say, finally, we're continuing to push adoption in those areas where we see gaps in value based care adoption that high quality value based care isn't just limited or dependent on geography as an example. And so broadening the practice of value based care and deepening penetration across the health care ecosystem, continues to remain a long term strategy for us.

Speaker 1: Well, thank you for adding some color on this report. It's been great to chat with you, doctor Ding. But before we wrap up, I wanna ask, is there anything else that you think, insurers should think be thinking about when they, are honing their value based care approach?

Speaker 2: Yeah. What I'd like to say in in closing is just that value based care can't continue to be this theoretical discussion of what a future state may or need to look like in the health care system because I think the data is clear, and it I think it's also something that clinicians and patients can feel and experience as something fundamentally different. And that's part of the reason we continue to publish evidence to that effect year after year. This is our twelfth annual report and continuously year after year, we continue to share some of this data because we think it is so important. But at the same time, I recognize that the real work is really about helping practices to fully move into these models, these models that reward prevention, continuity of care, and outcomes, without asking them to really fight against this fee for service system at the same time.

And so I think that if we are able to truly get this right, if we continue to push, it's not just about improving metrics, but I think it continues to help us build a health care system that is fundamentally more sustainable, and it's better for the people, the patients, the members that we serve all at the same time. And so I would encourage all of your listeners today to check out the report. It is available at humana.com/vbc. It gives you a little bit more detail into the discussion we had today and would really think that you'd all find it enlightening. So please check it out.

Thank you.

Speaker 1: Well, thanks again, doctor Dang. It was great, having you on to chat.

Speaker 2: Thank you again so much for having us.

Speaker 1: Great. Well, to our listeners, just a quick note. If you'd like to listen to more podcasts from Beckers Health Care, you can visit beckershospitalreview.com. Thank you.