Humana is a national health insurance company with an office based in Kansas City, Missouri. Humana launched its first Bold Goal Markets in 2015, and Kansas City was added to that list in 2017. The Bold Goal is to make the population in a given market 20% healthier by 2020 and beyond. This effort includes making health easier, working with more communities, and collaborating with more partners.
Humana’s Bold Goal teams measure their success by the CDC Healthy Days Measure. This is calculated by the number of unhealthy days a person has had in the previous month, including both physically and mentally unhealthy days. But Humana does not restrict their understanding of health to clinical needs. Instead, their position is that both clinical and non-clinical needs must be met to improve health. This is because social determinants of health have a high impact on someone’s healthy and unhealthy days.
Humana’s Bold Goal is currently focused on measuring and alleviating social isolation and loneliness as well as food insecurity. But rather than starting entirely new initiatives in their Bold Goal markets, Humana is committed to partnering with organizations that already have programs in place to move the needle on these things. These partnerships have been with physicians and clinicians, government agencies, nonprofits, for-profit companies, and community leaders. This variety of sector partnerships is based in Humana’s goal to improve the health of the community as a whole, not just their members.
This systematic approach to social impact focuses on the relationships between organizations and progress toward shared objectives. This is all undergirded with the understanding that meeting both social and clinical needs are what will actually improve health, not just one or the other. Kansas City’s Bold Goal key actions are: maximizing healthy days; coordinating and connecting partners and care; optimizing relationships and networks; and providing technical assistance. The health impact of this mission is improved healthy days, health outcomes, and access to resources. The partner impact is building relationships, aligning networks, and aligning grant funding.
This work is being done through a collective impact strategy. This includes conversation convening, partner identification, data driven impact, and change theories. The importance of these partnerships is demonstrated in Humana’s approach to addressing food insecurity, a social determinant of health. They want to make sure as many people and places as possible are screening for food insecurity. Because of this, they’ve given health and hunger trainings in many partner organizations. This includes teaching what food insecurity is, how to screen for hunger vital signs, and what the follow-up should be when someone screens positive.
Humana has done these trainings with the YMCA of Greater Kansas City, and soon all locations in the Kansas City Metro area will be doing these screenings with new members. Many physician partners have added this measure to their electronic health records and are now screening patients at regular appointments. Walgreens locations in the Kansas City Metro area equipped with clinics now have this screening available. It’s crucial to have many places and professionals asking because patients may be more comfortable being honest about these questions with some professionals more so than others.
As far as food insecurity solutions go, Humana has partnered with Harvesters and Sunflower Medical Group to implement mobile food distributions. These involve six or seven pallets of food, mostly fresh produce, that volunteers unload and distribute into people’s cars. Unlike some more traditional food bank models, there is no restriction or required documentation to go through the line. No income, residency, or even names must be reported. Each month this has been active in Kansas City, participation has grown. Last month, 680 were served, with people lining up six and a half hours before distribution began. Humana is currently working with other organizations to start a mobile distribution program at the Olathe YMCA.
The North Kansas City YMCA has been a partner on an on-site food pantry sponsored by Harvesters. Humana has worked with Wyandotte County and the KU School of Architecture and Design on a mobile grocery store to address food deserts in the county, expected to be on the road in January 2020. Humana’s corporate office has developed a food insecurity tool kit in collaboration with Feeding America, which is available for use in physicians’ and clinicians’ offices.
A similarly robust network of partnerships has been developed in relation to social isolation and loneliness, another social determinant of health. Screenings use the UCLA Social Isolation and Loneliness screening tool. YMCA locations are now screening for this when they screen for food insecurity. Internal nurses, case managers, and social workers within Humana are screening members. There is another toolkit for this that is available for anyone in the community to use.
A particularly interesting partnership was with the Kansas City Art Institute. Humana approached them asking for a class to work with veterans on a social isolation and loneliness project. The class eagerly agreed, and students each interviewed one of 14 veterans and subsequently painted their portraits. It is now a traveling exhibit.
Another example of a community partnership is Humana’s More Healthy Days tour in partnership with the Black Health Coalition. This is a tour of barber shops and beauty parlors to screen for blood pressure, glucose levels, depression, food insecurity, social isolation and loneliness, and more. Those who screen positive for any of these things are followed up with a health worker and asked additionally about their medical coverage and health homes. About 50% of those screened don’t have health insurance or a health home, about 20% have undiagnosed high blood pressure, and about 18% have high blood sugar but are undiagnosed with diabetes.
Maggie Little with the North Kansas City YMCA was able to talk more directly about their partnership with Humana. As mentioned above, they now screen all new members for food insecurity and social isolation and loneliness during their coaching connection progress. These screenings have been in place for just over three months now, with most YMCA of Greater Kansas City locations participating. Of all those screened, 23% screened positive for social isolation and loneliness and 7% screened positive for food insecurity. At the North Kansas City location, 35% screened positive for social isolation and loneliness and 13% for food insecurity, both higher than the national average. The YMCA gives out resources to those with positive screenings, such as suggestions of group exercise classes or volunteering to combat social isolation. The branch also has resources in place for food insecurity, such as the food pantry, which has served over 2280 families in its first three months. There is also a kids cafe, before and after school care, early learning centers, head start, camps, and weekend meals.
Among the range of social determinants that have an impact on the Kansas City community, the Bold Goal team expects to focus next on transportation.
See slides for this presentation here.
Leslie Newton of Humana’s Office of Population Health Bold Goal Team and Maggie Little, Senior Healthy Living Director for the YMCA of Greater Kansas City, presented this information to KC Digital Drive’s Health Innovation Team on August 28, 2019.