Latest / Becker’s Payer Issues Podcast / Pankhuri Sharma, Strategy and Operations Leader at Humana

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Pankhuri Sharma, Strategy and Operations Leader at Humana · Becker’s Payer Issues Podcast

• 0:00
  Hello, everyone. Welcome to Becker's Healthcare Payer Podcast.
• 0:02
  I'm Scott King joined by a very special
• 0:04
  guest, Pankari Sharma, strategy and operations leader with
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  Humana. Pankari, it's great to talk to you
• 0:10
  again. How are you?
• 0:11
  I'm doing well, Scott. Thank you. How are
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  you doing? I'm good. You know, we're just
• 0:15
  talking just a couple weeks here to our
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  big spring payer event, but it's it's great
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  to talk to you again. And and as
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  always, get, your insights. And and before we
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  do that for maybe someone or some of
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  the audience that hasn't heard from you, I
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  was just wondering if you could just kinda
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  briefly introduce yourself and describe, your work at
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  Humana and, you know, aligning with your focus
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  on on population health management.
• 0:36
  Sure.
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  My name is Pankari Sharma, and as you
• 0:39
  said, I'm a strategy and operations leader at
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  Humana.
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  I'm a part of Humana's clinical strategy org,
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  where our primary mandate is to improve our
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  members'
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  health outcomes
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  and member experience
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  while optimizing,
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  the total cost of care.
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  In my role, I lead initiatives
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  at the intersection of strategy,
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  analytics, and operations,
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  and have a strong focus on population health
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  management.
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  At a high level, my work is about
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  helping make sure our members receive the right
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  intervention
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  at the right time,
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  whether that's closing care gaps or improving
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  chronic disease management.
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  Thanks so much for that background info. You
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  know, you just you just mentioned
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  those those gaps. So and, you know, where
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  do you see the biggest gaps today between
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  population health strategy and then real world outcomes?
• 1:35
  Yeah.
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  I'd start by saying that our industry has
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  made meaningful progress in a number of areas.
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  Today, our health plans are much better at
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  identifying members who may need support,
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  and we also have built a wide range
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  of programs and capabilities
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  that simply do not exist at scale, say,
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  ten or fifteen years ago.
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  Having said that, I'd say I'd say the
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  biggest gap we still see is around behavior
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  change.
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  Ultimately, population health works
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  only if members are able and willing to
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  take actions that improve their health, whether that's
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  taking medications consistently,
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  seeing their PCP,
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  or making lifestyle changes.
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  And the nuance there is that those behaviors
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  happen in the context of people's everyday lives.
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  So a member may be dealing with transportation
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  barriers or work constraints or
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  caregiving
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  responsibilities.
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  So even when the system identifies the right
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  intervention,
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  turning that into
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  real world action is much harder.
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  And
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  that's the biggest challenge. I would say that's
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  where the intentional engagement becomes really important.
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  How we are outreaching the message, the channel,
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  the trust relationship,
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  all of that starts mattering.
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  And,
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  in this area, I would say with newer
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  tools such as AI enabled communication and personalization,
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  we could
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  close this gap even further,
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  if we use these levers thoughtfully.
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  Just to follow that up,
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  how much does data play a role in
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  closing that gap? Because it sounds like, you
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  know, the way Humana and you like to
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  to close it is by kinda knowing a
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  member's daily routine and and what their life
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  is like. So how much can data data
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  help that?
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  Data plays a huge role, I would say,
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  not only in understanding
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  who needs our help, but also
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  when they need our help. At the end
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  of the day, like I mentioned earlier, population
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  health is all about
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  getting to the right member at the right
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  time with the right intervention,
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  and all of those insights come from the
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  data.
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  Absolutely.
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  And the next topic I wanna ask you
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  about, Pankuri, is what operational challenges still make
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  it difficult for health plans to translate population
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  health strategy into measurable impact?
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  Yeah.
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  A couple of things,
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  come to mind here. And the first one,
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  that we just touched upon is data, like
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  getting the right data at the right time.
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  In many cases, even today, the signals we
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  rely on come with some delay.
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  So for example, claims data, it often arrives
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  with a lag. And then even the predictive
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  models
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  that are using that information give out data
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  takeaways.
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  And this matters,
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  like I said, because population health is very
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  sensitive to timing. If the need for identification
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  for the intervention is identified
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  weeks or months after an event,
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  the opportunity to influence behavior or care decisions
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  gets smaller. So I would say that is
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  the key operational challenge. And then the other
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  one is coordination
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  across different players.
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  Population health programs
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  typically involve,
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  a variety of players like health plans and
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  providers,
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  care management teams, and often vendors.
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  And even sometimes even within one organization,
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  different teams may hold different pieces of the
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  data or the operational
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  responsibility.
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  And then if those pieces are not well
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  coordinated,
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  outreach can be delayed or misaligned or even
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  missed altogether.
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  So those are the key operational challenges that
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  come to mind.
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  Thanks so much. And I also wanted to
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  ask, what changes will be most important for
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  health plans to improve outcomes
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  through population health management and value based care?
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  Yeah.
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  One way I think about this is
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  where does population
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  health take place? So the way,
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  I segment it, it's it happens in two
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  places. First is the clinical setting, and then
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  the second one is members' everyday life.
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  In the clinical setting,
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  deeper operational alignment
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  with providers will continue to be important.
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  As we know, members tend to trust their
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  providers the most, and many population health interventions
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  ultimately depend on what happens during or after
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  those clinical encounters.
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  So the most effective programs
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  are the ones or would be the ones
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  that are designed with the providers or care
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  teams and
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  fit naturally into their workflows
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  rather than sitting outside the care delivery process.
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  And
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  I I flag here that value based care
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  models have helped move the industry in that
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  direction, but we would need to continue
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  on the operational alignment with our providers because
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  it is just as important as the financial
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  alignment.
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  And then the second place where population health
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  happens is, members'
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  everyday life, their day to day lives. This
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  is where they decide whether to adhere to
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  the medication
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  and decisions regarding diet and physical activity
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  and preventative care happen,
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  you know, when they're just leading their lives.
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  And the effective lever here
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  would be to engage members thoughtfully.
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  Like I mentioned earlier, we are doing this.
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  We can always,
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  make this happen better,
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  and technology could play a role here if
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  it is applied in a way that supports
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  how members actually make these decisions in their
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  daily lives.
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  Yeah. There's there's obviously a lot of moving
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  parts with health plans and and health care,
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  especially in regards to, you know, the recent
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  government regulations. But
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  what do you think health plans should prioritize
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  over the next few years to make population
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  health programs
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  more effective?
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  Yeah. Like you said, there are so many
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  moving parts. There can be different priorities
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  based on,
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  where an organization is at and what they're
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  trying to achieve.
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  But a few things that come to mind
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  based on what we have discussed,
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  first,
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  we should continue to improve on how we
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  translate
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  insights into timely intervention.
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  It's important so that we can act at
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  the moment when it actually influences
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  outcomes and not later.
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  Secondly, I'd say
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  strengthening coordination across the ecosystem.
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  So efforts across these different players like plans,
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  providers,
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  and other partners, they are aligned and not
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  fragmented.
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  And
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  the third one,
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  that comes to mind is we should
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  continue to evolve how we engage members themselves.
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  There's been a meaningful progress here, but we
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  need to keep thinking how we give members
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  tools and pathways
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  and ultimately more agency in their own health
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  journey.
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  Members need to be in the driver's seat
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  here, and we all should be very effective
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  enablers,
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  for them to get to their most optimized
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  health.
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  And I feel that is where population health
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  ultimately succeeds.
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  I think it's a great way to put
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  it that members should feel like they're in
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  a driver's seat. I think that'll lead to
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  a lot of happy members that that mindset.
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  And the last thing I wanna ask you,
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  Pankuri, is, you know, what what do you
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  think it takes to be an effective leader
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  in the, in the health plan space right
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  now?
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  Gosh. There's so many things, but I would
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  say,
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  being a collaborative
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  partner with different,
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  stakeholders that are in the field. And like
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  I said, it involves,
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  providers and it involves members and vendors. There
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  is so much innovation that is happening,
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  but all of that is happening in the
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  background of the legacy systems.
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  So how do we integrate things so that
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  they are seamless, they actually help the, achieving
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  the health outcomes
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  that we all want to achieve? I would
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  say that makes for an effective leader in
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  the health care space right now.
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  Margaret, thanks so much for joining the podcast
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  and for a great conversation
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  as always, and really looking forward to having
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  you speak at the Spring Fire Issues roundtable.
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  Yeah. I'm looking forward to it, and thanks
• 10:06
  for chatting with me, Scott. It was great.