November 02, 2020 – As the healthcare environment faces major changes, payers may face challenges in maintaining their focus on whole person care across all strategies.
Given the influence of the pandemic, payers may need to pay close attention to the role that whole person care plays in their population health and telehealth strategies.
“Whole person health includes equal emphasis on our clinical and our social behavioral or environmental or physical healthcare needs,” Caraline Coats, vice president of Bold Goal and population health strategies at Humana, explained on a recent episode of Healthcare Strategies. “At a high level to me, it’s really about wrapping ourselves around an individual’s life in their community and everything that affects their health so that people can truly live their best life.”
The coronavirus pandemic emphasized the need for strong population health strategies in order to track the pandemic’s spread, support infected members, and implement policies around students returning to school.
Whole person care must lie at the heart of those strategies. In order to address a population’s health, payers must understand the individual needs of that population, Coats noted.
“You can’t tackle population health without addressing individual and local needs and looking at individuals as representation of a larger population or community,” Coats said. “And so whether you define that population by zip code, by race, by condition, you can kind of slice and dice that a lot of different ways.”
When it comes to the recent eruption of popular interest and demand for telehealth, whole person care has required a home healthcare-driven strategy. Telehealth is an opportunity for whole person care to get more personal as payers get a glimpse into the member’s non-clinical environment.
“From an investment perspective around telehealth, payers can play a critical role by making sure reimbursement includes not just that CPT code visit check off the box, but an opportunity to look inside the member’s home from a telehealth perspective,” Coats shared.
“We have a ton of standardized questions, whether it’s around food insecurity or loneliness or healthy days that could be implemented in that telehealth visit, if anything, to open those gateway questions with that member, to understand, and to get a sense of how they’re reacting to those questions literally in their home environment.”
While the payer industry has developed robust strategies around whole person care, there is a lot of room for advancement in how payers implement those strategies. This involves evolving whole person care implementation from pilots into sustainable programs.
“I envision seeing the positive outcomes of these pilots translate into things like a social risk index that affects our payment and translates into creative and innovative benefit solutions,” Coats projected. “And we start to kind of flip our healthcare system on its head a little bit and reallocate the dollar. We’re spending more on that 60, 70, or 80 percent that affects our quality outcomes of life and balancing out the investment from a reimbursement and a benefit perspective of both clinical and social. When we do that, then we’ll strike more of a balance, truly achieving whole person health.”