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Cutting Age: Humana's innovation agenda

Cutting Age is new series of profiles on Aging2.0 about innovators in the aging space. 


[caption id="attachment_3555" align="alignleft" width="192"] Paul Kusserow, SVP, Humana
Source: Insider Louisville[/caption]

Paul Kusserow, SVP at Humana gave an interesting keynote talk during lunch at the recent AgeTech CA annual conference (mentioned on our blog here). He walked the audience briskly through a well put-together deck, that contained a number of frameworks that were both simple and rather bold, for a Big Corporation. Here at Aging2.0 we love frameworks, and there were a lot here to play with. Katy and I took the snapshots (below), but if we get the original slides, we'll post them here. 

This post highlights a number of issues were I thought this approach was innovative and a welcome contribution to the discussion, and identifies a number of follow up questions about Humana’s role in the ecosystem that his talk opened up.

A fresh perspective, focusing on deals

Paul Kusserow is clearly not from the health insurance industry, nor is he a lifer in the aging services industry. His background is as a deal maker – a health care investor in venture capital / private equity and as such he’s clearly been brought in to get deals done.  Since he joined in 2009, Humana has markedly ramped up its M&A, picking up assets such as Addison, Concentra (both focused on work-place injuries), Arcadian and MD Care (Medicare HMOs), Senior Bridge (chronic care provider) and Anvita (health data company). He talked about how their entire company focus has shifted towards the senior population, more so than their competitors (echoing the shift in ‘government sponsored’ lives rising from 33% in 2010 to 44% in 2017). The bottom-line, Humana are looking aggressively for deals and could be an exit strategy for certain (larger) startups in the space, if they can demonstrate the ability to scale beyond pilots and meaningfully improve Humana's margins, which seems to be a key point with Medicare reimbursements continually under attack.

Using a ‘dyad’ approach – seniors and their caregivers

[caption id="attachment_3556" align="alignright" width="240"] Humana's dyad approach - addressing the needs of both seniors and their caregivers[/caption]

People working with older adults are always trying to come up with new and better words and phrases, since most of the words associated with the space have negative connotations. Humana’s use of ‘aging with grace’ to describe seniors aging in their homes is a nice play on the well-worn ‘aging in place’ phrase (though may be too cute to catch on widely). 

The other segment that he included in the dyad was ‘Aging-in Caregivers’. He pointed out the importance of family caregivers to Humana and that two-thirds of care givers are over 50, resulting in a host of complications about the caregivers themselves aging and being subject to physical and emotional stresses. Stressing that this group is traditionally overlooked and neglected, is a smart move, as very few corporates are making any major plays to support this important and underserved group. 

My question here was why the Aging With Grace cohort only goes between 65-80. Do they not expect over 80yr olds to stay home? 

Taking a holistic approach to ‘aging with grace’

[caption id="attachment_3557" align="alignleft" width="300"] Humana's proposed platform for 'Aging with Grace'[/caption]

Paul presented a framework highlighting seven research areas that represent innovation potential for Aging With Grace. It seems that much of this can also be applied to people who are looking to live independently, but happen to already have moved out of their homes to communal living – it broadens the discussions away from just what color grab-rail to install. Here are the seven topic areas:


  • Holistic Independence Plans: Holistic tools to assess and control the drivers and risks of personal independence.

  • Social Safety Network: High tech and high touch systems for prediction, prevention and recovery.

  • Individualized Care Management and Coordination: Proactive, preventative and attentive delivery of care at the right time and place.

  • The Livelong Movement: Promoting and reframing the value of supporting independent aging in our communities.

  • New Business Models: Simplified access and payment to independent aging support for seniors.

  • Caregiver & Family Support: Empowering caregivers to develop sustainable caregiving situations.

  • Fostering Caregiver Support Groups: Supporting caregivers through enhanced community groups.


This is a broad collection of concepts - some high level and abstract, others much more tactical, and naturally a large amount of overlap among them. They key takeaway for me here is that Humana recognizes that keeping people in their homes is a group activity, together with the family caregiver, and there's an ecosystem of pieces that need to be in place around them. Many of these concepts will be foreign to most seniors living at home - lots of opportunity ahead. 

A ‘Big Idea’: Developing a Home Based Services Platform for Seniors

[caption id="attachment_3558" align="alignright" width="234"] Humana's big idea - senior focused care delivery platform[/caption]

Discussions in the margins of Aging2.0 meetings have often focused on how best to build THE platform that provides a way to connect the rapid fire innovation happening in startups and corporations around the world to make a meaningful difference to the lives of seniors, who are often non-users of technologies or late adopters. A trusted distribution channel to millions of seniors is well up there in terms of things that would finally get attention from the major investors.

So, what would such a platform look like, who would build it and how? Humana gave a tantalizing glimpse of that with a slide that was modestly called: Potential Solution: Create a Home Based Services Platform for Seniors.

This platform has six components, centered around the senior, loosely modeled on Maslow’s hierarchy of needs:


  • Quality Health Care:

    • Tailored networks

    • Acute / post-acute care management



  • Home and Personal Services:

    • Senior bridge (in-home care)

    • Humana Cares (remote care management)

    • Technology for the Home



  • Community and Social

    • Guidance Centers

    • Faith-based organizations

    • Community resource directory



  • Financial

    • Products

    • Rewards

    • Real estate (where to live)



  • Expert Advisor

    • Groupon for Seniors

    • Home Delivery Services

    • Senior Information



  • Purpose

    • Volunteerism

    • Associations




Paul went through the slide fairly quickly so didn’t expand in too much detail about what each of these areas meant. Either way, this is a fairly broad agenda, even for an ambitious company like Humana, that started life as a nursing home operator in the 1960s, and then became the world’s biggest hospital operator. Unlike the previous slide that had both the caregiver and the senior in the center, this one focused on the senior itself, so it’s not clear whether this platform is also designed to address the needs of the family caregiver.

Now, some questions…

Overall this ambitious approach is exciting, and represents a bold agenda for positioning Humana as an innovator improving the lives of seniors. The devil of course, is in the details, and it’s clear that there are still a number of issues still to be tackled about in order to implement this vision. Some of the questions that jumped out at me:

1. Acquisitions are one thing. But integrating them, and ensuring a culture of innovation and customer-centric services is quite another. How to ensure things will all work smoothly?  

The challenge with corporate strategists (I spent half a decade as one) is that the plans look good on paper, but reality often intervenes, and either stalls projects or sends them careering down a different path. And when you go the M&A route, as Humana is open to, how to ensure an integrated experience and culture across the organization? Creating and maintaining a culture for employees and customers won’t come from acquisitions, but from internal leadership. Would be interesting to hear more about what efforts they have in place there.

2. How could smaller companies plug in to this new home-based platform?

I asked Paul this in the Q&A session, and it’s clear that this is still a work in progress. There are two issues here. The first, is how to attract young coders to work on solving problems for this traditionally unsexy market. There are ways to do this, and most of our Aging2.0 presentations have our opinions on the topic.

The second, more significant issue, is how to build a ‘living platform’ that allows small companies to plug in and grow with it. The default approach for Humana, as Kentucky’s largest company, and one that serves 11m people, will likely be ‘which large player can we plug in to target the largest number of people quickly’, rather than, ‘how do we spot the best talent and allow them the opportunities to grow and build the best customer experiences using our platform?' To get there, Humana will need to open its kimono, and share with growing companies what exactly it needs from them, and focus as much on partnerships as acquisitions (so as not to kill the innovative culture). 

3. Do you think the doctor or the patient should be in the middle of healthcare?

Paul showed how models of care are changing from the traditional fee for service (FFS) model to a new coordinated care model.

In the first version, multiple players such as hospitals, doctors, diagnostic facilities and the family were scattered around, disconnected. In vision of the coordinated care model, we saw that all these players were neatly lined up in a circle around the hub. I had to do a double take when I saw the doctor in the middle, since I’d assumed that would be the patient. No, the patient was another spoke, feeding to the doctor.

Here is a major mismatch based on the language used to describe the new trends (holistic care, continuum, proactive…). If the doctor is in the middle, how will new preventative, patient-centric approaches that lower health care costs by skipping the doctor and medications entirely get a chance? Doctors generally have the best interests of their patients in mind, but to assume that it’s a perfect match (even when fee for service has been replaced by a model with more aligned incentives) is fantasy. We hear so much about the health benefits of good diet, meditation / yoga and exercise, yet what chances will holistic approaches have in a doctor-centric world?

4. What are some of the biggest ‘known unknowns’ you are working with?

Much of this thinking relies on certain assumptions: Obamacare being implemented, privacy concerns being manageable, qualified workers being in short supply, immigration laws not really changing, seniors and the baby boomers adopting new technology etc. It would be interesting to understand the biggest assumptions that Humana is making that will shape the context of decisions over the coming months. As an industry leader and one with an ambitious innovation agenda, it would be a helpful contribution to smaller companies to know what they think will happen in the coming years.

So, an interesting, fast-paced overview of an ambitious innovation agenda by one of major players in the aging space. It will be interesting to watch their progress. Expect some major acquisitions, but hopefully also a coherent culture and an integrated, vibrant platform, adopted by companies big and small, that effectively delivers a joined-up service that puts the older adult, and their caregiver, at the center of it all.

 

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