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Providers looking to reduce costs need to address the social determinants, Humana says

A Medicare Advantage member who is food insecure can have up to 26.6 unhealthy days a month, correlating to $15.64 per month in higher medical costs.

Providers striving to generate better health outcomes and reduce costs should increasingly help patients address social and economic concerns--such as isolation and food insecurity--along with their physical conditions.

That's one of the key takeaways of Humana's new 2019 Bold Goal Progress Report, which examines the company's own progress in improving results among some of its Medicare Advantage members.

The recently released report, now in its fourth year, tracks various health-related developments among Humana's MA populations in several southern communities that are part of the company's Bold Goal initiative. The population health strategy is aimed at improving the health of the communities the insurer serves by 20 percent by 2020, partly through the use of social determinants screenings.

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Bold Goal uses the Centers for Disease Control and Prevention's health-related quality of life measurement known as healthy days -- which actually measures self-reported mentally and physically unhealthy days over a 30-day period -- to track progress.

The 2019 report's findings show that Medicare Advantage members living in Humana's original seven Bold Goal communities have seen a 2.7 percent reduction in their unhealthy days since 2015. That compares to a 0.6 percent increase in unhealthy days reported by the company's MA members in non-Bold Goal communities.

Humana Medicare Advantage members in San Antonio, the company's first Bold Goal community, have experienced a 9.8 percent reduction in unhealthy days since 2015.


Social, environmental and economic factors influence about 70 percent of what makes people healthy, the report said. The company found that a Medicare Advantage member who is food insecure can have up to 26.6 unhealthy days a month, while someone who suffers from loneliness can have 24.4 unhealthy days a month.

That's a big deal because, each unhealthy day is correlated to 10 hospital admissions per thousand -- or the potential of $15.64 per member per month in higher medical costs, according to Humana's research.

The upshot is that addressing the social determinants of health could potentially drastically improve outcomes and costs.


Bold Goal has fallen short of its 20 percent improvement target so far. One reason: New Humana MA members reported high mentally unhealthy days, which offset gains in several of the Bold Goal communities.

But the overall trend toward better outcomes is encouraging, especially given the growing importance of addressing social determinants of health, such as loneliness and food insecurity, in an increasingly value-based care world.

For example, the report notes that social isolation costs Medicare $6.7 billion a year, and is on the rise; reports of loneliness in adults over 45 have doubled from 20 to 40 percent since 1980; lonely senior citizens are almost 64 percent more likely to develop clinical dementia; food-insecure seniors are 65 percent more likely to be diabetic and 66 percent more likely to have had a heart attack.


"Given current demographic trends, we expect to see continued demand for a support structure that addresses social needs, along with clinical ones," said Bruce D. Broussard, Humana's president and CEO.

Mark Klimek is an independent writer and editor with 20 years' experience covering financial issues, healthcare and more.