At Humana, IT augments the human touch

Humana has evolved from a health benefits company to a consumer-focused healthcare organization, with the mission of helping people achieve lifelong well-being.

As we move toward a more experience-based, individualized economy, consumers expect a simpler, more personalized co-created experience–the ability to get what they want, when they want it. These trends have elevated technology’s prominence in our company, because technology not only enables better care delivery but also helps us develop an integrated care delivery model.

Integrated care delivery brings together our three primary activities: care delivery, the consumer experience, and clinical and consumer insights. This model helps us increase customer engagement and improve outcomes while lowering the total cost of care.

Four technologies are at the core of this model: mobile, social, cloud and analytics. Mobile is about connectivity, whether you’re a member or a caregiver. Social is about how your care is delivered–whether it’s a family social network, a care delivery social network or a combination. The cloud is critical because it’s how these capabilities are delivered. And all that activity fuels analytics. Analytics helps us become contextually aware of what is happening to members. It’s not just analytics in a back office but algorithms that can, for example, identify the next best action and present that to the member at the moment of greatest potential influence so the best care decision can be made.

Several major initiatives are bringing our mission to life. For example, an integrated clinical experience will enable a single view of the member across all interactions so that clinicians are aware–appropriately and securely–of what is going on with the patient. And in analytics, we are working to deliver 360-degree views of consumers, clinicians and our own associates across the business. Analytics also involves using algorithms to derive insights from those 360-degree views, and then connecting the insights to transactional systems. This will increase opportunities for engagement, which often leads to behavior change and better health outcomes.

We’re already seeing results. We’ve integrated our electronic prescribing capabilities with our clinical reference engine, which alerts physicians to drug interaction information that can be discussed with the patient in real time. We’re also able to proactively inform members when they are about to access an out-of-network provider and help them find an in-network provider. This is one of those examples of delivering a “wow” experience–engaging with members in a way they need it most and when they least expect it.

And with Humana at Home, we’ve networked members’ scales to communicate weight gains or losses so that in-home care coordinators can be alerted to check in. These kinds of clinical interventions have resulted in overall lower claims costs because they flag early warnings of conditions like congestive heart failure. This is an example of meeting members where their health is, and it shows how technology can augment the human touch.

Brian LeClaire is SVP and CIO at Humana, a leading health and well-being company. He is a member of the CIO Executive Council.