Wellness isn’t just a health care buzzword. In fact, it’s what’s driving business strategies across the senior care continuum.
Providers of all shapes and sizes are looking to achieve wellspan, and executives at organizations like Humana Inc. (NYSE: HUM) and Lifespark are doing so by leveraging data, care coordination and more.
For Humana, a major component of achieving wellness is enabling people to stay in home and community-based settings.
“[Wellness] is a holistic definition and a set of services that enable people to stay home and avoid unnecessary utilization of the health care system,” Mona Siddiqui, senior vice president of clinical operations for Humana’s home solutions business, said at Aging Media Network’s Continuum conference last month.
Humana’s unique business model allows the organization to facilitate this.
Based in Louisville, Kentucky, Humana is one of the largest insurance companies in the U.S. The company has roughly 5.8 million Medicare Advantage (MA) members. Its health care services arm, CenterWell, includes pharmacy, home health care and primary care. CenterWell Home Health has more than 350 locations.
“That connection of information across the benefits and the care services side has been so powerful and transformative for these patients to be able to have that holistic experience across the two sides,” Siddiqui said.
At Humana and Lifespark, executives are seeing ROI as a result of their wellness-focused strategies.
On its end, Lifespark has made a commitment to taking on full global risk. This means that the company takes on the full medical loss ratio, degradation, surplus or deficit.
“I think it’s the right thing to do for business, and more importantly, it’s the right thing to do for humanity,” Joel Theisen, founder and CEO of Lifespark, said at the Continuum conference. “It’s the right thing to do for what we’re trying to accomplish.”
Lifespark is a Minnesota-based company that offers home care, home health, hospice, primary care options and senior living. It’s one of the few home-based care companies that has ventured out into the worlds of senior housing and skilled nursing facilities, a testament to its mission of providing a full continuum of care in the name of wellness.
Despite Lifespark’s success with taking on full risk, this isn’t a move that every organization is equipped to pull off.
Providers that want to take on full risk need to have a strong data infrastructure in place and keen understanding of their patient population, Siddiqui noted.
When considering different programs, two key factors are top of mind at Humana. The company is looking to implement programs that will achieve the best outcomes for beneficiaries and programs that will also yield ROI.
“You’re looking for [a significant] ROI for both the time and level of investment that you’re putting into these programs,” Siddiqui said.
Interoperability is also important to driving the cross-continuum integration that companies are trying to embrace as part of their wellness focus.
At a multiple pronged-organization like Humana, the challenge is to bring together these segments in order to offer holistic services to its beneficiaries. In order to do this, breaking down silos will be necessary.
“Talking about providing holistic services is easy, but actually creating that integration is much tougher inside these organizations,” Siddiqui said. “Sharing how we’re all doing that is really key for moving the entire industry forward.”
Theisen stressed that executives need to center the patient perspective when trying to improve interoperability at their organizations.
“Think about it from the client’s use case, because most people don’t do that,” he said. “We miss the actual person we’re trying to serve many times in our models, because we get enamored with our own business case.”
Companies also have to be ready to adapt to change, according to Siddiqui.
“When I did this at HHS, and the tech integration across the different agencies, the biggest challenge was culture,” she said. “Technology was probably the last thing I worried about. It was really getting everyone aligned, and comfortable. If you’ve done the same thing, the same way for 20 years, changing the way you do it takes an enormous amount of inertia.”
Overall, Theisen believes that companies are well-positioned to step up and embrace change.
“Our boomers are demanding a different type of optionality,” he said. “They’re not going to be okay with the current product offerings, in the way they’re getting offered. I think it’s really upon all of us as leaders to take the bull by the horns and wrestle this opportunity to create that longitudinal wellspan.”
