Doctors may diagnose ailments, but for most of us, an insurance company steers our health care decisions.
We hear a medical opinion, and think, '"Is it covered? Can we afford it?"
These days, insurers are asking similar, bottom-line questions. The Affordable Care Act is changing the way they make money.
Bruce Broussard is the president and chief executive officer of Humana, which insures more than 1.8 million Floridians with plans like Medicare Advantage and employer-based policies. Seniors, military members and families all depend on the Louisville-based Fortune 500 company for coverage.
He said that Humana is betting that keeping their members well over time will help the company stay healthy - financially.
“There's really an opportunity for the industry to step out and to move from being viewed as insurance underwriting - You know, when you're in good health, we help you. When you're in bad health, we don't help you - to a point where we help everybody. But we're helping people with their health as opposed to just getting them treatment,” he said.
This week, Broussard visited Humana's St. Petersburg office and sat down with Health News Florida reporter Mary Shedden.
MS: Should people in Medicare Advantage expect to see the premiums and the benefits change?
BB: I know this year, if you look at 2014, we worked really hard to keep the premiums stable for individuals. And we hear constantly from our members that programs like Silver Sneakers is a very important part of their program. And so we strive hard to continue to allow them to have programs like that.
MS: You're collecting data as part of that. And that's helping you make better calculations about risk. Why is it appropriate for an insurance company to be collecting that health data that some folks probably think that maybe the doctor should be the only one seeing that?
BB: One of the unique aspects of the Affordable Care Act that came out on the individual area was that it was guaranteed issuance. And what that means is we can't reject anybody. We can't adjust their premiums for their conditions. So we take everybody. And what that allows is that it's no longer about underwriting or anything related to their conditions. It's about how can we help them?
And so when you see us collecting data, it is really about gaining more insight into their health so that we can help them identify the programs they need. So if we know that somebody is smoking, and we do have a wonderful smoking cessation program, we can help them getting access to that program. If we know they have some chronic condition like diabetes, we can help them with the diabetes program.
So actually receiving the information is not from a pricing point of view. It is actually trying to help them with their programs.
MS: In terms of that, can you talk about what you offered on the exchanges and how it compares to existing Humana plans?
It's a very complicated program. It's complicated about who to call, what to call. Do you call the government? Do you call the insurance companies? So there's a lot of confusion there. And it's new to a lot of people. This is the first time that they have had insurance. So now you've got deductibles, you've got co-insurance. You've got premiums. You've got subsidies. And what we have found is that we have to spend a lot of time with people, both our representatives in the field and on the phone.
In fact, we've probably spent hours for one or two individuals a day because they are really questioning, 'What do I have?' 'What do I buy?' They're reading about it in the newspaper, and the confusion has been high. And one of our responsibilities is to lower that confusion and to make it easier for them to engage in being healthier.
MS: How much of your overall philosophy at Humana "Get 'em while they're young, keep 'em while they're older"?
BB: We do think that a long-standing relationship with members is an important part of our business plan. We believe that because if we can help them as they are younger and stay healthier, then when they are older, they will be more affordable.
So engaging with them over that period of time is a good aspect of that. Medicare members are with us for a number of years. Sometimes, when they first join us, we lose money. But we look at it over the longer period of time, that if we are helping them in the earlier years and getting them in the proper programs and making proper decisions, that it will actually pay off in the long run.
--Health News Florida is part of WUSF Public Media. Contact Reporter Mary Shedden can at (813) 974-8636, on Twitter @MaryShedden, or email at shedden@wusf.org. For more health news, visit HealthNewsFlorida.org.
