Latest / Becker’s Healthcare Podcast / Advancing Value-Based Care at Humana with Alex Ding, MD

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Advancing Value-Based Care at Humana with Alex Ding, MD · Becker’s Healthcare Podcast

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This is where health insurance leadership comes together.
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Becker's fourth annual spring payer issues roundtable brings
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here in Chicago.
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Hello, everyone. This is Elizabeth Caslow with the
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Becker's Payer Issues podcast. I'm thrilled today to
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be joined by Alex Ding,
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enterprise deputy chief medical officer at Humana. Doctor
0:45
Ding, thank you so much for joining us
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today. Thank you so much for having me.
0:48
I'm really excited to join you today.
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Great. So before we dive into Humana's value
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based care report, which is gonna be our
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central focus,
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I would love to hear a bit more
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about yourself and your career background.
1:00
Sure. Would be delighted to. So as you
1:03
mentioned, I'm Alex Ding. I'm the deputy chief
1:04
medical officer at Humana, and I've been with
1:07
Humana for the past five plus years
1:10
based out of Louisville, Kentucky.
1:12
I'm a practicing physician.
1:14
I am a diagnostic and interventional radiologist
1:18
by training still practice,
1:20
in Louisville, Kentucky.
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Prior
1:23
to joining Humana,
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my background has been primarily in clinical practice
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and so I've practiced in academic settings
1:30
in addition to private practice. And I've also
1:33
worked in healthcare innovation as well,
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working on, how we bring technology enablement into
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health care, particularly through the use of innovations
1:41
like, augmented intelligence.
1:44
Great to hear. So thank you again for
1:46
joining us.
1:47
So, yeah, we're gonna talk about that report.
1:49
So thinking about the report's context, so I
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would love to hear how exactly Humana
1:54
defines value based care because sometimes that term
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gets thrown up in the air,
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and we're not always on the same page.
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So I would love to hear in the
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context of the report, how does Humana define
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value based care?
2:04
Yeah. I I I think you're right. There
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are different
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interpretations, different takes, different definitions for how one
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might think about value based care.
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At its core, Humana defines value based care
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as realigning health care around outcomes,
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quality and experience, not just volume. And so
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in our report,
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we simplify that idea and
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define it as value equals quality and experience
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all over or divided by cost. And I
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think that framing matters
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because it shifts the conversation away from how
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much care
2:39
we deliver and really
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moving toward the conversation of how well are
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people actually doing, how healthy are we able
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to keep,
2:48
patients? And I think it moves away from
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this idea of how much activity we're generating
2:53
in the health care system and really moves
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toward what sort of outcomes we're achieving in
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our health care system.
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I would say, practically,
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value based care enables
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proactive
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whole person care,
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using data through care teams and longitudinal
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relationships that prevent
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problems,
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keep people healthy
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rather than just reacting to them when it's
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further down the line. And I think for
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clinicians,
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that also means
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less
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feeling like you are on a treadmill or
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on that hamster wheel of seeing as many
3:26
patients as possible and really getting more time
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to focus on meaningful patient care.
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And I think for the system at large,
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it's really about how we get to something
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that is both clinically better but also financially
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sustainable at the same time.
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Thanks for grounding us in that context. So
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I wanna give you the opportunity
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to talk about what you think is the
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most valuable what you think are the most
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valuable findings,
3:49
from this report, and where did they confirm
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or even challenge what Humana is seeing in
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practice?
3:56
Yeah. I I think there's a number of
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items that are interesting in the report in
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terms of the things that we are, as
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as I mentioned, defining value based care as,
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which includes,
4:07
improvements we see in quality but also improvements
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in experience. Then that is both true for,
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patients and members, but also for the clinicians
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that are practicing within the system as well.
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All at the same time, the sorts of
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reductions you can see in cost and utilization.
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And we've got some of the numbers that
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are in the report that I'd encourage,
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people to to jump into. But I would
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say what stood out most
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was really how clearly the data validated
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what clinicians, I think, intuitively already know, that
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continuity of primary care matters
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matters a lot.
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And in these value based care arrangements, we
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saw meaningfully
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fewer,
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unnecessary hospital admissions and emergency department visits
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that is paired with more scheduled primary care
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visits, more continuity of care, more intensity
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of engagement with primary care, and I think
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that combination is incredibly powerful.
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I think it's what allows for earlier
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care intervention,
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allows for better management of chronic disease, and
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as a result leads to fewer downstream health
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crises. Not to mention, I think the importance
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of spending
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more time with
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your usual source of care, with your doctor,
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with your care team,
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and that as a result developing stronger therapeutic
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relationships between the patient, their physician, and the
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whole of the clinical care team. I think
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one of the things that, also stood out
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in terms of kind of the the other
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side, the the challenge of it is that
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there's still a decent amount of uneven performance
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in terms of where we see,
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value based care firing on all all cylinders
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and where there's still some opportunities. And I
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think that the model works,
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but it only works when you've got the
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infrastructure and you've got the data liquidity. You've
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got the care teams that are consistently in
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place. And I think that being able to
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bridge that gap is one of those areas
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that we will continue to focus on.
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So just to bring our listeners up to
6:05
speed, and I'm reading this straight from the
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report, Medicare Advantage members and value based care
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arrangements had 24.3%
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fewer inpatient hospital admissions than those in original
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Medicare in 2024.
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And, Humana Medicare Advantage members receiving value based
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care had 13.4%
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fewer emergency department visits and 7.6%
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fewer hospital admissions. So that's those are some
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of those numbers,
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that doctor Ding was touching on there.
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But, yeah, let's talk about those challenges. So
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what are those harder those more more difficult
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operational barriers that Humana still sees
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when translating that belief of value based care
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into consistent performance across markets?
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Yeah. I would say the biggest barrier is
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that we are still predominantly
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operating inside a health care system that is
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built for fee for service.
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And so clinicians are being asked to deliver
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proactive coordinated care while still working in these
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workflows
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that were designed to be reactive, that were
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designed to be episodic.
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And I would say one of the biggest
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challenges is
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practices trying to operate really with one foot
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in fee for service,
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one foot in value based care. I often
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call this having one foot in each canoe.
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And I think that is an incredibly
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hard place to be because you're
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essentially trying to deliver proactive
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population based care on a fee for service
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chassis that was not never designed,
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to to do well in that. And I
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think that internal tension
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really shows up in workflows,
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in staffing models, and clinical priorities,
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and it can unfortunately blunt the impact of
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what value based care can accomplish even when
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the intent
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is there. And I would say, you know,
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layer on top of that
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the broader health care system issues. So fragmented
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data, inconsistent infrastructure,
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variability
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across markets.
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And
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so
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while I think the belief in value based
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care is strong,
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I would say the work now is really
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in taking it to that operational level and
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helping practices fully cross that bridge
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by reducing administrative burden and friction by improving
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data flow and liquidity
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and really aligning incentives so that they don't
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feel like they're paddling in two directions at
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the same time.
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So how do you distinguish between nominal participation
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and value based care and, like, an actual
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commitment to transformation?
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Yeah. I think I think the distinction
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is
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really less about
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kind of the what the contract looks like
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and really looking much further downstream into what
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the care delivery model,
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looks like. And I would say nominal
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participation means that a practice may
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have a value based care arrangement. They have
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they may have a value based care contract,
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but the care itself
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at the clinical level still looks and feels
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like be for service. So there's limited coordination,
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there's reactive visits, there's minimal, if any, use
9:09
of data. And I think that true transformation
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really shows up
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when you look at how the care is
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being organized day to day, how it's being
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delivered, how it's being experienced
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by not only the patient but also by
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the clinician who's working in that system as
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well. And so in those systems, you see
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team based models,
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you see continuous patient engagement,
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You see data being used prospectively,
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not just for reporting, but also for clinical
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decision making as well. And I think it's
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really a a huge leap in mind shift
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mindset shift from
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really thinking about or asking the question of
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how many patients that I see today
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to how well are my patients doing today
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and how well are they doing over time.
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And I think that's when you start to
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see the financial
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transformation leading to clinical transformation, which is really
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what we consider true transformation
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in the system.
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Yeah. And from your perspective as a physician
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leader,
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what does a mature value based care arrangement
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really look like,
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and how does alignment look between payers and
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providers in those situations?
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I would say in a in a mature
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value based model, alignment
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looks like a a true partnership
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between the payer and the provider,
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rather than a more transactional
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sort of relationship or I would say even
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worse yet an adversarial one.
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And I think that effective alignment
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looks like a genuine partnership that is built
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on transparent,
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timely, actionable data
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that clinicians can use at the point of
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care to make informed clinical decisions,
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in real time. And I think
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incentives
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are structured
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in these models to reward
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participation,
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care coordination, patient well-being rather than just volume
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and the number of patients that you're seeing
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in a day.
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I think clinicians
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also have support from integrated care teams so
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that they don't feel like they're responsible for
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every single,
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aspect of patient care that they're shouldering on
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their burdens, which,
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we know that clinicians are incredibly burdened and,
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many are burnt out. And I think that
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this alignment
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reduces that administrative burden, and we have seen
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that it allows for more time with their
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patients,
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which enables that sort of relationship based care
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that not only builds care between that doctor
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patient relationship,
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but broader trust with the health care system
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writ large. And I think that that as
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a result proactively keeps people healthy and improves
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outcomes,
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and it's something that improves not only the
11:47
patient experience but the clinician experience as well.
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And so I think when that alignment is
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in place,
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that trust overall improves, and I would say
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trust is what allows value based care to
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continue to scale over time.
12:02
And based on the report's findings, what changes
12:05
is Humana thinking about when it comes to
12:07
its value based care strategy over the next
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year or two?
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I would say, overall, the large the findings
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largely confirm our overall direction. I do think
12:16
that they help, sharpen our priorities. However, I
12:19
would say over the next twelve
12:21
to twenty four months, we're focused on continuing
12:24
to deepen
12:25
that primary care continuity and intensity that I
12:28
mentioned earlier on. That's also part of the
12:30
report because I do think that is where
12:32
the biggest clinical and experience gains occur.
12:36
At the same time, I would say that
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I'd like to take a lot of our
12:40
learnings from scaling and maturing value based care
12:43
models in primary care
12:46
into
12:47
specialty care as well. I think over the
12:49
next twelve to twenty four months, we're also
12:51
continuing to invest more in better or effective
12:54
interoperability
12:56
that allows for more real time data exchange
12:58
and analytics so that clinicians
13:01
can act earlier, not later,
13:03
and reducing administrative burdens and strengthening that team
13:07
based care model that
13:09
continues to be a critical enabler of what
13:12
it means to function
13:14
effectively in a value based care operating model.
13:16
And then I would say, finally,
13:18
we're continuing to push adoption
13:21
in
13:22
those areas where we see gaps in value
13:25
based care adoption that
13:28
high quality value based care isn't just limited
13:31
or dependent on geography as an example. And
13:33
so broadening the practice of value based care
13:36
and deepening penetration
13:38
across the health care ecosystem,
13:40
continues to remain a long term strategy for
13:43
us.
13:44
Well, thank you for adding some color on
13:46
this report. It's been great to chat with
13:48
you, doctor Ding. But before we wrap up,
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I wanna ask, is there anything else that
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you think,
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insurers should think be thinking about when they,
13:55
are honing their value based care approach?
13:58
Yeah. What I'd like to say in in
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closing is just that
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value based care
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can't continue to be this theoretical discussion of
14:08
what a future state may or need to
14:10
look like in the health care system because
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I think the data is clear,
14:15
and it I think it's also something that
14:17
clinicians and patients can feel and experience
14:20
as something fundamentally different. And that's part of
14:23
the reason we continue to publish evidence to
14:26
that effect year after year. This is our
14:28
twelfth
14:29
annual report and continuously year after year, we
14:31
continue to share some of this data because
14:33
we think it is so important.
14:35
But at the same time, I recognize that
14:36
the real work is really about helping practices
14:39
to fully move into these models, these models
14:42
that reward prevention, continuity of care, and outcomes,
14:46
without
14:47
asking them to really fight against this fee
14:49
for service system at the same time. And
14:51
so I think that if we are able
14:53
to truly get this right, if we continue
14:55
to push, it's not just about improving metrics,
14:58
but I think it continues to help us
15:00
build a health care system that is fundamentally
15:03
more sustainable,
15:05
and it's better for the people, the patients,
15:08
the members that we serve all at the
15:09
same time. And
15:11
so I would encourage all of your listeners
15:13
today to check out the report. It is
15:15
available at humana.com/vbc.
15:18
It gives you a little bit more detail
15:19
into the discussion we had today and would
15:21
really think that you'd all find it enlightening.
15:24
So please check it out. Thank you.
15:26
Well, thanks again, doctor Dang. It was great,
15:28
having you on to chat. Thank you again
15:30
so much for having us. Great. Well, to
15:32
our listeners, just a quick note. If you'd
15:35
like to listen to more podcasts from Beckers
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Health Care, you can visit beckershospitalreview.com.
15:40
Thank you.