Q&A

Humana leader shares perspective on enhancing outcomes with insights

By Carley Thornell | August 26, 2021

""

Glenn Raley has worked at Humana, one of the country’s largest health insurers, for more than two decades. The first half of his career was in IT leadership, but today as the Director of Provider Interoperability, he focuses on how connections can enhance relationships and outcomes. He chatted with athenahealth Vice President of Product Management Michael Palantoni to share his thoughts on innovation, collaboration, and strengthening the healthcare ecosystem.

What are the most important factors to enhance collaboration between payers and providers?

One important function is trust. The payer and provider relationship hasn't always been one that's had a healthy relationship, because of decades-old practices that were based upon trying to make sure costs were controlled. What Humana is focused on — and where the interoperability opportunity really lies — is building that trust. Because we do have so much data, and we all want the same outcomes for our members.

What that data and that trust enables providers to do is deliver on the metrics. By being able to show that we are improving quality scores, that we are increasing experience scores, that we are really focused on getting members’ out-of-pocket costs lowered through some of these capabilities of an athenahealth partnership, it is enabling that trust to be built. That foundationally drives even deeper opportunities for integration and collaboration. As we move from that fee-for-service space into the value-based world, that only increases the opportunity for the collaborations to become really important.
 

What is the value of increasing connections across all players in the healthcare ecosystem?

Value really comes in multiple fashions, right? There’s the value in increased risk-sharing. There is value in being able to redeploy the staff of health systems to focus on patient care and outcomes, instead of record retrievals and fax machines. There's an overall value to the provider, because the information is integrated into their workflow — now they now have more time for patient care. And the patients should have a better experience, because now they're getting to talk to their doctor and not him shuffling through the papers and reports and logging into multiple portals while they're there.

So there's the value of time. There's experience value. And ultimately, those efficiencies should eliminate some of the costs that are part of what is just too much bloat in the healthcare system.

What are some examples of how you’ve seen collaboration lead to better clinical and financial outcomes?

Our larger health system partners are able to shift the focus of clinical staff to patient care. We've seen where they've been able to take their analysts and their IT staff and redeploy them into creating better information for the providers to act on, and not necessarily have to deal with what the payer was looking for.

But that is only one facet of from a cost perspective. We're seeing some of those same providers increasing their value-based reimbursements significantly. For some providers who have been providing us clinical data because of their value-based arrangements, through these collaborations with the EHRs and what we're working on with you at athenahealth, they've seen their HEDIS scores improve by 300 percent in terms of the number of gaps closed and those gaps are getting closed in days instead of months. The old cycle was so focused on “everything happens through the claim” and now we’re able to exchange the EHR data and do so bidirectionally, and get more real-time with that data to close care gaps faster.

How has the pandemic changed business models – and the culture of “business as usual”?

If the global pandemic has taught us anything, not having people running around in medical offices, and allowing the exchange of this data bidirectionally without the need for multiple interactions has really been a huge boon in terms of existing processes. Because [bidirectional exchange] not only has clinical and financial benefits, it's protecting patient data better because that data is handled by fewer people. So, you've got a more compliant model for data-sharing and HIPAA-related transactions.

Hear more by listening to the webinar, “Why giving clinicians actionable insights at the point of care is essential.”