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MedicareMedicare members in 4 cities across the South and Southwest reported improvements in CDC’s Healthy Days measure, according to a 2018 progress report on Bold Goal, an ongoing Humana population health effort to improve connections among physicians, patients, and communities.

The cities—New Orleans and Baton Rouge, Louisiana; Knoxville, Tennessee; and San Antonio, Texas—represent 4 of the 7 original Bold Goal communities, which also include Humana’s home of Louisville, Kentucky, and Tampa Bay and Broward County, Florida. But even areas without an overall decline in Unhealthy Days saw improvements among some of the sickest members of the population, including those living with depression, diabetes, and chronic obstructive pulmonary disorder.

Roy Beveridge, chief medical officer for Humana, told The American Journal of Managed Care® in an interview there are important takeaways from the findings: (1) engagement works, (2) measurement matters, and (3) the CDC metric is useful, based on Humana’s experience.

“The common thread here is the willingness of many others to engage,” Beveridge said.

The CDC Healthy Days metric is a short questionnaire that asks people how many healthy or unhealthy days they have experienced in their physical or mental wellbeing over the past month, and whether this has affected their activity.

“The more data we get over time, the more we are validating everything the CDC has been saying for 10 years, until it baffles me that not everyone is using this as a standard tool of measuring progress within communities,” Beveridge said.

And Humana now knows precisely how healthy days affect the bottom line. With this update, the health plan reports it has calculated that 1 unhealthy day costs $15.64 per person in monthly medical costs.

Besides tracking the Healthy Days metric, Humana has focused interventions around social determinants of health: food insecurity, loneliness, and social isolation. Efforts occur inside and outside the clinic, and require direct work with officials through town hall meetings and partnerships with local agencies.

According to the report, improvements in healthy days from 2015 to 2017 include:

  • Baton Rouge saw a 4.1% improvement in healthy days
  • New Orleans saw a 3.9% improvement in healthy days
  • San Antonio Medicare improved their heathy days 3.5% overall; those with diabetes improved their healthy days by 5.1%.
  • Knoxville Medicare members improved their healthy days 5.4%, and those with diabetes improved their healthy days by 9.7%.

Events in 2017 showed that even when the number of healthy days declines, the metric is useful in helping Humana forecast its needs and spending, Beveridge said. The South Florida data in the aftermath of Hurricanes Irma on September 10, 2017, and Maria on September 19, 2017, directly accounted for an additional 0.75 unhealthy days in those regions in November.

Seeing that dip allowed Humana to target resources to the affected areas, he said. “Now, we’re right back on track, having dramatically improved in those areas from where we were in November and December,” Beveridge said.

Each community has its own story of engagement and cooperation to tell, reflecting the need for local leaders to develop relationships that work best in their areas. Beveridge said in the San Antonio area, for example, there has been some success with the use of telemedicine for behavioral health, but it’s too soon to say if what’s working in Texas would work elsewhere.

Across all the Bold Goal regions, engagement with physician groups to promote diabetes and hypertension management is a priority. Knoxville’s largest physician group has been particularly active in connecting hospitals and affiliated social workers to promote medication adherence, Beveridge said.

Humana launched Bold Goal saying it wanted to make the communities it served 20% healthier by 2020. Since the start of the effort, 5 more cities have been added to the original group.

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