Episode #139: Customized healthcare that actually cares for seniors – with William Shrank MD, Senior Advisor & former Chief Medical Officer at Humana

Friends,

Whether you’re 25 years old or 75 years old, when you walk into primary care providers’ offices in most places across the country, the care you’ll receive is pretty much the same. The people in the office are the same; the services are the same; the protocols are the same; the time slots you get are the same. Does that make sense to you? To state the obvious – a 65-year old, 75-year old and 85-year old have much different needs, concerns and issues to deal with than patients in a younger demographic. And yet, the healthcare seniors receive is largely undifferentiated.

In this episode, we’ll hear about a segmented, customized, personalized and holistic approach to senior care that is being delivered by a highly innovative pay-vider. Humana has, for years, been a national leader in senior care, home-based care, and the social determinants of health. In this episode, we’ll explore these topics with the incredibly accomplished Dr. William Shrank.

Now, I do want to add that there are other organizations who have been segmenting and customizing care for seniors. My three favorite examples are ChenMed, CareMore and Iora Health. ChenMed is, in my opinion, the paragon for VIP care of seniors.  A few other examples include Archwell, Oak Street, Patina, Landmark, Lena Health, and Landmark which is now part of Optum. Large hospital/healthcare systems across the country are also beginning to develop similar models of care that are focused on seniors.

Dr. William Shrank serves as a Senior Advisor at Humana, after recently stepping down as Chief Medical Officer. His current responsibilities include implementing Humana’s integrated care delivery strategy. He leads Humana’s Care Delivery Organization, clinical operations, and the Bold Goal population health strategy. Dr. Shrank held the position of Chief Medical and Corporate Affairs Officer from July 2019 to July 2021, during which time he also oversaw government affairs. Dr. Shrank joined Humana as Chief Medical Officer in April 2019, having previously been employed by the University of Pittsburgh Medical Center (UPMC) where he served as Chief Medical Officer of their Insurance Services Division from 2016 to 2019. Prior to UPMC, Dr. Shrank served as Senior Vice President, Chief Scientific Officer, and Chief Medical Officer of Provider Innovation at CVS Health. Before joining CVS Health, Dr. Shrank served as Director of the Research and Rapid-Cycle Evaluation Group for the Center for Medicare and Medicaid Innovation, part of the Centers for Medicaid and Medicare Services (CMS).

Dr. Shrank began his career as a practicing physician with Brigham and Women’s Hospital in Boston and as an Assistant Professor at Harvard Medical School. He has authored over 250 peer-reviewed publications.

Dr. Shrank received his M.D. from Cornell University Medical College. He completed his residency in Internal Medicine at Georgetown University and his fellowship in Health Policy Research at UCLA. He also earned a Master of Science degree in health services from UCLA and a bachelor’s degree from Brown University.

In this interview, we’ll hear about:

1. The impressive investments that Humana has made into senior care, home-based care & the social determinants of health.
2. Humana’s national deployment of senior care clinics as well as the larger integrated Centerwell brand that includes home-based care & pharmacy.
3. The incredibly thoughtful divisions they’ve created focusing on digital health, social equity, and clinical solutions. 
4. How Dr. Shrank views the relationship between healthcare systems and payers.
5. The significant emphasis that Humana places on being a “rapid learning organization” and their focus on data-driven decisions & evidence-based deployment.

I admire so many things about Dr. Shrank. He is a physician, health services researcher, healthcare administrator and visionary leader. He’s also incredibly humble and as much a learner as he is a doer. His background and the years he spent at CMS and CVS have provided him with incredible experience in how to deploy and evaluate large-scale, value-based programs. 

Along these lines, the emphasis that Humana has placed on scientifically evaluating their initiatives and making data-informed decisions is exemplary. In this episode, Dr. Shrank articulates some of the challenges in systematically and scientifically evaluating whether or not initiatives create patient engagement and deliver on outcomes; as well as their scale-ability. 

One also has to respect Humana’s forward-thinking focus on social equity and the social determinants of health, which is largely credited to their CEO, Bruce Broussard, who initiated “The Bold Goal” project in 2015. Along these lines, Dr. Shrank discusses the CDC’s self-reported “healthy days” metric that Humana has been pursuing; as well as their perspective, which is to make social determinants of health an integral part of every day care delivery. 

We go into some depth on why Humana has created a segmented and customized care model focused on seniors, and what differentiates this value-based model from the generic primary care medical home. Dr. Shrank is very firm in his belief that in order to deliver seamless, personalized care and optimal outcomes for the senior segment of our population, we need to create a very different primary care model. He also makes the point that data and analytics is the key to understanding patients’ needs, and that these understandings will contribute more to personalized care than genomics. 

In the final moments of the interview, I asked Dr. Shrank what message he had for healthcare system C-suites.  His response was one word, “partner”.  He makes the point that healthcare is too complex for any one system or stakeholder to get it right; and in the best interest of our patients and our communities, we need to become better partners with one another.  When I asked him what message he had for the leaders at HHS & CMS, his response was to put outcomes over ideology; which is no small task given the current polarized political climate. 

Dr. Shrank didn’t use this term, but it was apparent to me that throughout our dialogue he was painting a picture of a ‘whole health’ model of care. His point of view is laser focused on what matters most to patients, especially those that are part of more vulnerable populations. One saving grace of our healthcare system is that we have humanitarian leaders like Dr. Shrank and his colleagues at Humana who not only talk the talk but also walk the walk – leaders who are committed to a value-based system of care that places personalized health outcomes as their KPI.

Until next time, be well.

Zeev Neuwirth, MD