Reimbursement News

Value-Based Reimbursement: Humana CEO’s Payer Perspective

By Jacqueline DiChiara

- In a Tuesday morning keynote speech at the Healthcare Information and Management Systems Society’s (HIMSS’) annual HIMSS15 conference and exhibition conducted this week in Chicago, Bruce D. Broussard, CEO and President of Humana, addressed several key points about the future direction of value-based reimbursements for the healthcare industry at large.

Value-Based Reimbursement HIMSS15

The numbers don’t lie according to Broussard, who says the industry needs to begin heavily focusing on financial outcomes to improve quality care.

“Of the $3 trillion spent in healthcare today, one trillion is wasted a year,” confirms Broussard. “$200 billion on administrative costs.  $250 billion on over-treatment.  $150 billion in administrative red tape.  Some significant dollars are being wasted because we’re focused on the supply and not the demand.”

Broussard confirms one primary dilemma requiring addressing is that the healthcare system has been erroneously focused on episodic care as opposed to chronic care. Broussard maintains 80 percent of healthcare costs relate to chronic conditions. Managing these conditions, he says, requires perceiving the holistic person beyond a mere routinely implemented checklist of symptoms.

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  • “Today it takes two weeks for a patient to get in to see a primary care doctor. If you’re diagnosed with an illness, that’s a long two weeks,” Broussard says. “[The system] was built for one-and-done, bill, and move on to the next patient.”

    Broussard asks the poignant question, “How do we make the conversion to value-based reimbursement, and how do we encourage consumer choice?”

    He confirms such solutions are indeed complex.

    More than half of Humana’s member have a relationship with providers who were reimbursed in relation to cost and quality, Broussard explains. Additionally, he notes a 25 percent improvement in Healthcare Effectiveness Data and Information Set (HEDIS) scores, which measure performance regarding care and service.

    “Value-based reimbursement along with integration is so powerful,” says Broussard. “We see today when information is flowing freely through the system, it creates better efficiency, better decision making, and a significantly better consumer experience.”  

    To further implement these objectives, Broussard says billing and collections must be made simpler.  

    “The way you look at your fixed assets is going to have to change,” Broussard states. “But if you don’t, and if I don’t, the industry is going to still be producing unhappy customers.”

    Broussard confirms the healthcare industry has to boldly take action to effectively transform these need changes into a tangible reality.

    “We have to change our perspective to ask, ‘Where is the customer?’” states Broussard.  “What’s happened over the years is that the consumer is at the middle of the problem.  The provider is at the middle of the problem.  They’re the ones that are enabling the system to work and connecting the system together.”

    Broussard emphasizes the healthcare industry must actively adjust its focus to improve the overall quality of health for customers, members, and patients.