Marrying trust with tech to prevent ulcers and amputation: message from #Humana CEO @BruceDBroussard

A superb article from Bruce Broussard, Humana’s President and CEO on the use of big data– with a big heart– to prevent ulcers and amputation. Enjoy.

by Bruce Broussard

Everyone has an opinion about how technology will disrupt and reshape his or her field of endeavor.

For me, it’s been fascinating to experience the growing impact of technology in health care, which has begun to embrace things like data analytics and Artificial Intelligence. Health plans like mine are using data analytics to identify those at risk of diseases or dangerous falls, and we’re identifying diabetics who are more prone to negative developments.

Yet technology will only take us so far. It’s one thing to identify a person’s medical problem. It’s quite another to help them do something about it.

Of Minds and Machines

Recently, I read – and highly recommend – the book Machine, Platform, Crowd by Andrew McAfee and Erik Brynjolfsson, who also wrote The Second Machine Age. What really hit close to home was the authors’ examination of Artificial Intelligence and its use in medical diagnoses.

I disagree with their premise that the “computer should take the lead” when it comes to medical diagnosis. But the authors did acknowledge that AI does not measure up in one critical area – empathy:

“Most patients, however, don’t want to get their diagnosis from a machine. They want to get it from a compassionate person who can help them understand and accept often difficult news. And after a diagnosis is made, medical professionals who can form interpersonal connections and tap into social drives are highly valuable because they stand a better chance of getting patients to comply with the prescribed course of treatment.”

In other words, you can’t harness the power of data analytics unless you have a way to intervene.

My Own Experience

While I was reading Machine, Platform, Crowd, I thought about how my company serves our Medicare Advantage health plan members (aka customers), many of whom are 65 or older.

Each week, my management team and I participate in a discussion we call “The Voice of the Customer,” where we listen to actual calls with our members and discuss the care they received.  For one particular call, we sat down with employees from Humana At Home, who visit unhealthy, at-risk Humana Medicare Advantage members who may be susceptible to a diabetes-related foot ulcer (DFU).

Such ulcers are a significant issue for Humana and our members. Last year, approximately 38,000 Humana Medicare Advantage members were diagnosed with DFUs (October of 2015 to September 2016). During that same time period, more than 3,100 had an amputation, which costs, on average, $21,684. And treating a DFU costs, on average, $6,501. In total, Humana spends approximately $400 million a year on members who have been impacted by diabetic foot ulcers.

The Humana At Home team had engaged with a Medicare Advantage member we’ll call “Jimmy,” who was identified as at risk for developing a DFU and was also battling obesity and other chronic diseases. We had identified Jimmy via a predictive data analytics model that identifies members who have the highest likelihood of developing a DFU. Managed by our Clinical Analytics team, our model was also designed to identify members who were at risk of developing diabetes-related complications so we could engage them and slow their disease progression.

Being able to detect a DFU in a timely way is essential for avoiding an amputation, since a large number of diabetes-related amputations are preceded by a DFU. This obviously impacts an individual’s long-term health and well-being. After an amputation, research has shown that over a five-year period, the mortality rate is 77 percent.

Jimmy’s Story

The care team that identified Jimmy knew it wasn’t going to be easy to help him because initially he didn’t trust us. We knew it would take time, but the longer it took the less successful we might be.

So the care team – from Humana At Home, Innovation and Clinical Best Practices – started the old fashioned way, with a phone call to learn about Jimmy and his life. Jimmy declined in-home services and several of our initial attempts to contact him, but he eventually accepted telephonic care management.

The first conversation, albeit brief, led to a second conversation and blossomed after we helped him with a claim. We were building trust, which led to Jimmy sharing more details of his life. As the team learned more, they were able to develop a holistic understanding of Jimmy’s challenges.

Jimmy also had 25 prescriptions, and because of his financial situation he was taking them based on which ones he could afford. He also told his Field Care Manager that he “didn’t know I needed to see the podiatrist,” and his HbA1c (long-term blood sugar levels) hadn’t been measured in years because he didn’t know to ask for the test. Jimmy also had issues with the co-pay and deductible.

When Jimmy opened the door to the care team, they were able to intercede. The team helped him secure transportation to see the doctor (this had also been an issue) and arranged for him to see a podiatrist and a nutritionist, both of whom he now connects with daily. The team also helped identify financial support for his care costs. Jimmy was also able to save $2,000 annually by moving his 25 medications to Humana Pharmacy.

Most importantly, over time and with coordinated care, Jimmy was able to improve his health. He began checking his feet regularly, saw a podiatrist, educated himself about diet and lifestyle, and lost weight. His HbA1c level went down from a 10.1 percent to a 6.6 percent, which was a significant accomplishment, and he began to see his care manager four times a month to reduce his chances of having to go to the ER. While his care is moving in the right direction, Jimmy was disappointed with one of his physicians and is working with this care manager to find one he is more comfortable with.

Jimmy’s lifestyle is not easy, and he’s not out of the woods yet. He is going to deal with health issues the rest of his life, but he won’t be alone. He’ll have a team in his corner to help him.

Lessons Learned

I’m proud of how our data analytics team worked with our clinical care team to identify Jimmy and build the trusting relationship that helped him change his health. It’s what we do best, and I know we’ll do it even better next time.

Jimmy’s experience shows the power of data analytics. But getting people like Jimmy to change will require an engaged team of care managers, physicians, nurses and others.

As Machine, Platform, Crowd has argued, Artificial Intelligence and other technologies will have a profound impact on health care. Yet technology alone cannot make you eat less. Or walk when you just want to sit. Or force you to call the doctor. Or, if you’re Jimmy, prevent you from developing a diabetic foot ulcer.

Today, there are tens of millions of people over 65 who are living with chronic conditions, which are very difficult to improve. It’s essential that we use the combined power of data analytics and care teams to help people like Jimmy understand how lifestyle can impact health and how taking certain steps can improve health. Let’s move beyond treatment for random events and put the focus on individual health engagement. By taking a more proactive approach, we’ll keep Jimmy and others out of the hospitals.

David G. Armstrong

Dedicated to amputation prevention, wound healing, diabetic foot, biotechnology and the intersection between medical devices and consumer electronics.

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