[{"innerBlocks":[],"name":"core\/freeform","postId":1459,"blockType":{"name":"core\/freeform","keywords":[],"attributes":{"content":{"type":"string","source":"raw"},"lock":{"type":"object"}},"providesContext":[],"usesContext":[],"selectors":[],"supports":{"className":false,"customClassName":false,"reusable":false},"styles":[],"variations":[],"apiVersion":3,"title":"Classic","description":"Use the classic WordPress editor.","category":"text"},"originalContent":"Roy Beveridge, MD, chief medical officer at Humana, contends that the insurer has made great strides in leveraging data to improve care.

Louisville, Ky.-based Humana is one of the nation\u2019s largest <\/b>health insurance companies and has an extensive and growing value-based care presence, and as such, it\u2019s looking for ways to better use its data as the healthcare industry moves from fee-for-service to pay-for-performance models.

\u201cWe\u2019ve been on the vanguard of this for 15 years or so,\u201d says Beveridge, noting that 66 percent of those covered under Humana\u2019s Medicare Advantage plan are cared for by physicians in value-based care relationships with Humana, \u201cwhich is very high for the industry.\u201d

Humana has approximately 2 million individual Medicare Advantage members and about 130,000 group members who are cared for by more than 52,000 primary care physicians in more than 1,000 value-based relationships across 43 states and Puerto Rico.

In addition, Humana\u2019s total Medicare Advantage membership includes more than 3.5 million members, who are affiliated with providers in value-based and standard Medicare Advantage settings.

\u201cIt\u2019s hard to move into a value-based payment and care system if you\u2019re not trusting the parties that you\u2019re working with,\u201d Beveridge says. \u201cThe trust happens automatically once you\u2019ve got the payment mechanism aligned with the care. In the old fee-for-service (approach), you didn\u2019t have the trust.

\u201cWe have feedback electronically that\u2019s very sophisticated from a technology standpoint that helps them close all the gaps in care and ensures that they\u2019re doing all the things that need to occur from a quality standpoint\u2014that\u2019s what builds the trust,\u201d he adds. \u201cWe work with physicians and physician groups to look at how they rank around quality, and that\u2019s really important when they\u2019re looking at being accountable for a population.\u201d

According to Beveridge, interoperability is critical to value-based care and payment, as is the \u201cneed for data and understanding so that the members\u2014the patients\u2014can be better taken care\u201d of by removing unnecessary cost and incentivizing health outcomes.

\u201cThe technology is absolutely crucial in order for there to be an improvement in quality,\u201d emphasizes Beveridge, who is a champion of Humana\u2019s \u201cbold goal\u201d initiative to improve the health of the communities it serves by 20 percent by 2020. \u201cUnless you arm the physician with good data in a format that they can work with and understand, they\u2019re not going to be successful.\u201d

Humana and more than 20 other organizations have formed the Da Vinci Project to work together to accelerate the adoption of HL7\u2019s Fast Healthcare Interoperability Resources (FHIR) as the standard to support and integrate value-based care data exchange.

Also See<\/b>: Blue Cross Blue Shield Association supports member FHIR adoption<\/a>

The goal of the Da Vinci Project is to unleash critical data between payers and providers so that it can empower value-based care workflows and create a rapid multi-stakeholder process for addressing delivery use cases that can be implemented on a national scale.

\u201cHumana has a vested interest in making the experiences of members and partner physicians the best they can be,\u201d says Patrick Murta, Humana\u2019s principal solution architect, business technology leadership, in a written statement. \u201cAs an industry, we don\u2019t have a great model for the sharing of clinical data between doctors and payers. But new technologies like FHIR can allow us to integrate in new ways.\u201d

Beveridge contends that information about social determinants of health is also becoming increasingly important to care in the 21st century, particularly for vulnerable populations. \u201cIt\u2019s not just the data that you traditionally see in an electronic health record, but it\u2019s also this other data\u2014social determinants of health\u2014that greatly impact the healthcare of the patient or the member,\u201d he adds.","saveContent":"Roy Beveridge, MD, chief medical officer at Humana, contends that the insurer has made great strides in leveraging data to improve care.

Louisville, Ky.-based Humana is one of the nation\u2019s largest <\/b>health insurance companies and has an extensive and growing value-based care presence, and as such, it\u2019s looking for ways to better use its data as the healthcare industry moves from fee-for-service to pay-for-performance models.

\u201cWe\u2019ve been on the vanguard of this for 15 years or so,\u201d says Beveridge, noting that 66 percent of those covered under Humana\u2019s Medicare Advantage plan are cared for by physicians in value-based care relationships with Humana, \u201cwhich is very high for the industry.\u201d

Humana has approximately 2 million individual Medicare Advantage members and about 130,000 group members who are cared for by more than 52,000 primary care physicians in more than 1,000 value-based relationships across 43 states and Puerto Rico.

In addition, Humana\u2019s total Medicare Advantage membership includes more than 3.5 million members, who are affiliated with providers in value-based and standard Medicare Advantage settings.

\u201cIt\u2019s hard to move into a value-based payment and care system if you\u2019re not trusting the parties that you\u2019re working with,\u201d Beveridge says. \u201cThe trust happens automatically once you\u2019ve got the payment mechanism aligned with the care. In the old fee-for-service (approach), you didn\u2019t have the trust.

\u201cWe have feedback electronically that\u2019s very sophisticated from a technology standpoint that helps them close all the gaps in care and ensures that they\u2019re doing all the things that need to occur from a quality standpoint\u2014that\u2019s what builds the trust,\u201d he adds. \u201cWe work with physicians and physician groups to look at how they rank around quality, and that\u2019s really important when they\u2019re looking at being accountable for a population.\u201d

According to Beveridge, interoperability is critical to value-based care and payment, as is the \u201cneed for data and understanding so that the members\u2014the patients\u2014can be better taken care\u201d of by removing unnecessary cost and incentivizing health outcomes.

\u201cThe technology is absolutely crucial in order for there to be an improvement in quality,\u201d emphasizes Beveridge, who is a champion of Humana\u2019s \u201cbold goal\u201d initiative to improve the health of the communities it serves by 20 percent by 2020. \u201cUnless you arm the physician with good data in a format that they can work with and understand, they\u2019re not going to be successful.\u201d

Humana and more than 20 other organizations have formed the Da Vinci Project to work together to accelerate the adoption of HL7\u2019s Fast Healthcare Interoperability Resources (FHIR) as the standard to support and integrate value-based care data exchange.

Also See<\/b>: Blue Cross Blue Shield Association supports member FHIR adoption<\/a>

The goal of the Da Vinci Project is to unleash critical data between payers and providers so that it can empower value-based care workflows and create a rapid multi-stakeholder process for addressing delivery use cases that can be implemented on a national scale.

\u201cHumana has a vested interest in making the experiences of members and partner physicians the best they can be,\u201d says Patrick Murta, Humana\u2019s principal solution architect, business technology leadership, in a written statement. \u201cAs an industry, we don\u2019t have a great model for the sharing of clinical data between doctors and payers. But new technologies like FHIR can allow us to integrate in new ways.\u201d

Beveridge contends that information about social determinants of health is also becoming increasingly important to care in the 21st century, particularly for vulnerable populations. \u201cIt\u2019s not just the data that you traditionally see in an electronic health record, but it\u2019s also this other data\u2014social determinants of health\u2014that greatly impact the healthcare of the patient or the member,\u201d he adds.","order":0,"get_parent":{},"attributes":[],"attributesType":{"content":{"type":"string","source":"raw"},"lock":{"type":"object"}},"dynamicContent":""}]

Humana CMO: Data critical to success in value-based care

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