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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. Thank you so much for having me.
I'm really excited to join you today.
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.
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.
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?
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.
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?
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.
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?
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.
So how do you distinguish between nominal participation
and value based care and, like, an actual
commitment to transformation?
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.
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?
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.
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?
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.
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?
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.
Well, thanks again, doctor Dang. It was great,
having you on to chat. Thank you again
so much for having us. 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.