Humana and the National Quality Forum Publish Population Health Paper in the New England Journal of Medicine
April 23 2020 - 09:03AM
Business Wire
Paper examines the importance of addressing
social, behavioral and physical factors in ensuring better patient
outcomes. Research underscores why the coronavirus is particularly
challenging on historically disadvantaged populations and others
facing health-related social needs.
Physician leaders from Humana Inc. (NYSE: HUM) and the National
Quality Forum (NQF) explore the impact that social, behavioral and
environmental factors – such as access to healthy foods, safe
environments and social support – can have on physical and mental
health and why these aspects need to be incorporated into payment
models. The findings were published today in the New England
Journal of Medicine (NEJM) in a paper titled “Clinical and Social
Risk Adjustment – Reconsidering Distinctions.”
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The paper, which is co-authored by William H. Shrank, M.D.,
M.S.H.S., Chief Medical Officer, Humana, and Shantanu K. Agrawal,
M.D., Mphil, President and CEO, National Quality Forum, argues for
evaluating social risk adjustment alongside clinical risk in
population-based payment models, to provide incentives for
addressing health-related social needs to improve health outcomes,
rather than lowering the standards for their care.
“Growing evidence indicates that socially disadvantaged people
have comparatively worse health outcomes suggesting that clinical
and social risk are related,” said Dr. Agrawal, “To improve the
health outcomes of all people, including the disadvantaged, we must
consider this growing body of evidence as part of a comprehensive,
21st century approach to risk adjustment.”
A focus on upstream causes of poor health have been an emphasis
of more recent value-based reimbursement models, with the goal of
preventing disease and keeping patients healthy. The analysis and
recommendations in the NEJM article build on a recent NQF and
Humana collaboration, Food Insecurity and Health: Overcoming Food
Insecurity Through Healthcare-Based Interventions. The guide
highlights that social needs such as food insecurity and social
isolation can lead to or worsen serious chronic conditions.
Crisis situations, such as COVID-19, can also create new social
needs gaps and worsen those already present. Early research on the
coronavirus pandemic indicates that the virus’s toll is
particularly hard on historically disadvantaged populations and
others facing challenges with social determinants of health.
Population health strategies must address these social needs,
due to the downstream health impacts these cause and especially
during a time of crisis, according to Dr. Shrank. “The COVID-19
crisis has underscored the inter-relatedness of social context and
physical health,” said Dr. Shrank. “Our proactive outreach to our
COVID-19-positive and highest risk members has uncovered high rates
of social isolation and considerable barriers to accessing healthy
food, which put them at higher risk for bad outcomes. Given the
associations between social risk and clinical risk, it stands to
reason that risk adjustment for payment models should incorporate
the breadth of patient characteristics that predict the need for
health care services.”
In addition to social needs, these individuals have also faced
systemic barriers to accessing health care services and engaging in
preventative health behaviors, leading to a higher prevalence of
conditions such as diabetes and hypertension. The presence of these
underlying chronic conditions has led to worse outcomes for
COVID-19 patients.
For more information about Humana’s efforts to address the
impact of social needs, especially among people living with
multiple chronic conditions, please visit
https://populationhealth.humana.com.
About Humana
Humana Inc. is committed to helping our millions of medical and
specialty members achieve their best health. Our successful history
in care delivery and health plan administration is helping us
create a new kind of integrated care with the power to improve
health and well-being and lower costs. Our efforts are leading to a
better quality of life for people with Medicare, families,
individuals, military service personnel, and communities at
large.
To accomplish that, we support physicians and other health care
professionals as they work to deliver the right care in the right
place for their patients, our members. Our range of clinical
capabilities, resources and tools – such as in-home care,
behavioral health, pharmacy services, data analytics and wellness
solutions – combine to produce a simplified experience that makes
health care easier to navigate and more effective.
More information regarding Humana is available to investors via
the Investor Relations page of the company’s web site at
www.humana.com, including copies of:
- Annual reports to stockholders
- Securities and Exchange Commission filings
- Most recent investor conference presentations
- Quarterly earnings news releases and conference calls
- Calendar of events
- Corporate Governance information
About the National Quality
Forum
The National Quality Forum (NQF) works with members of the
healthcare community to drive measurable health improvements
together. NQF is a not-for-profit, membership-based organization
that gives all healthcare stakeholders a voice in advancing quality
measures and improvement strategies that lead to better outcomes
and greater value. Learn more at www.qualityforum.org.
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Alex J. Kepnes Humana Corporate Communications 502-580-2990
akepnes@humana.com
Proof Strategies 202-478-9326 Press@qualityforum.org
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