Healthcare Digital Transformation | Heather Cox, Humana’s Chief Digital Health & Analytics Officer

In this episode of TD Cowen’s FutureHealth Podcast Series, Heather Cox, Chief Digital Health & Analytics Officer of Humana speaks with Charles Rhyee, Cowen Health Care Technology Analyst. They discuss the parallels between the digitization of financial services and healthcare and how lessons learned in financial services can improve healthcare technology and increase patient convenience.

They also speak about how Humana is leveraging technology to improve patient experiences and care for diverse populations through a focus on data security, combining enterprise data lakes with machine learning to uncover insights, and simplifying digital health platforms to improve the healthcare experience. Press play to listen to their conversation.

Heather Cox, Chief Digital Health & Analytics Officer, Humana

Heather Cox joined Humana in August 2018 with the responsibility of building Humana’s digital care delivery operations and leading its enterprise analytics efforts. Heather brings 25 years of experience to the role, most recently serving as Chief Technology and Digital Officer at USAA, where she led the teams responsible for designing and building personalized and digitally-enabled end-to-end experiences for USAA members. Prior to USAA, Heather was the CEO of Citi FinTech at Citigroup, helping the company adapt to a future dominated by mobile technology, and she headed Card Operations, reshaping the customer and digital experience for Capital One.

Transcript

Automated:

Welcome to Cowen Insights, a space that brings leading thinkers together to share insights and ideas shaping the world around us. Join us as we converse with the top minds who are influencing our global sectors.

Charles Rhyee:

Hello, my name is Charles Rhyee, Cowen’s Healthcare technology analyst. And welcome to Cowen’s Future Health Podcast. Today’s podcast is part of a new monthly series that continues Cowen’s efforts to bring together thought leaders, innovators, and investors to discuss how the convergence of healthcare, technology, and consumerism is changing the way we look at health, healthcare, and the healthcare system. And today I’m honored to have with me Heather Cox, Humana’s chief digital health and analytics officer.

Charles Rhyee:

Heather joined Humana in August 2018 with the responsibility of building Humana’s digital care delivery operations and leading its enterprise analytics efforts. Heather brings 25 years of experience to the role most recently, serving as chief technology and digital officer at USAA, where she led the teams responsible for designing and building personalized and digitally-enabled end-to-end experiences for USAA members. Prior to USAA, Heather was the CEO of Citi FinTech at Citigroup, helping the company adapt to a future dominated by mobile technology. And she headed card operations, reshaping the customer and digital experience for Capital One.

Charles Rhyee:

Heather, thanks for being here with us today.

Heather Cox:

Thank you, Charles. I appreciate the invitation. I’m excited to be here.

Charles Rhyee:

I want to start out here. It’s been over two years now at Humana. Maybe start out, what surprised you the most so far in your time?

Heather Cox:

I appreciate that question and it’s not one I get often. And quite frankly, what I’ve appreciated most about jumping into healthcare and joining a company like Humana is just how the folks internal to Humana and people across the industry have welcomed me in. Everyone is looking for opportunities to drive change for easier frictionless experiences, trying to find ways to create better health outcomes. That’s with digital health. And underneath that and driving it is advanced analytics is all about. And so I just have been so amazed at the warm welcome and the show of support that I’ve had. It’s been fantastic.

Charles Rhyee:

And you come really here to healthcare with a lot of experience, creating digital consumer experiences. What have other industries like the financial sector done right would you say in terms of integrating digital interactions into the overall experience?

Heather Cox:

When I think about my experience in financial services, Bruce Broussard CEO kept insisting, “I know your skills will translate into healthcare, even though you don’t know healthcare.” And what was fantastic is that’s in fact the case. And there’s a lot of reasons why, including one that I think is really important. What we learned in financial services was over the course of time the importance of more interactions, more channels by which to engage, giving consumers the choice for how they engaged. And while you didn’t see uptick right away. So let’s talk about dot-com, the emergence of it and the late ’90s and early 2000s or mobile devices, you saw steady adoption, but then you actually got to the point where you saw hockey sticks. And a lot of that had to do with all of the choice.

Heather Cox:

Now, what I love about what we saw in financial services. So let’s kind of go back in time a little bit. You used to have the branch. That was the only way that you could engage and get your money deposited or withdrawn. And you had to go in and physically talk to a teller. Then you could drive up to a window, which is a little more convenient. And then suddenly they put that concept of the teller on the street side in the form of an ATM. Well, then you have the emergence of the web, and then you have IVRs, automated assistance in the IVRs, side-by-side chat, and then you had mobile. And all of these were distinct channels. And if you weren’t careful and you didn’t manage the experience across those channels, people could get lost. But once you learned how to string that journey across those different channels, suddenly you had very sticky consumers.

Heather Cox:

And so I think the opportunity we have in healthcare, what we’ve seen during COVID in particular, is people, both the end consumer and the providers and care teams that take care of those patients, are willing to change their behavior and leverage digital technologies in new and different ways. And how exciting would it be to watch us go from that one annual visit to consistent follow-ups by telehealth and or remote monitoring data that you’re sending back to your physician so that you don’t even have to talk or see them, but you can constantly get a view of what your health is, what you’re driving, and the medications you need to be taking? It’s super exciting.

Heather Cox:

I get very passionate about this, Charles. So cut me off if you need to. I get really excited.

Charles Rhyee:

No, not at all. It’s very exciting times here. And I guess maybe one slight push back though, I think historically a lot of people have said, “Well, healthcare is difficult.” Or people look at and say, “Healthcare has lagged behind other technology or other sectors in adopting technology.” In your experience with looking at it now over the last couple of years, are there things in healthcare that make it more challenging? Is there a reason why healthcare maybe has lagged behind So far?

Heather Cox:

Not all industries have hit the digital revolution or evolution, whatever you want to say, at the same time. Financial services hit it at a different time than content and media consumption versus others. And I don’t think that’s a problem. It’s not a matter of it lagging behind. I think what’s distinct in healthcare is I would push that there’s plenty of technology and you find it everywhere. It’s just built for single verticals and it creates more silos and there’s not the right interoperability of data floating across those technologies.

Heather Cox:

And so while we have some challenges and that can create competitive moats in essence, I think once we start to create that notion of interoperability. Again, let’s use the financial services example. ATMs are interoperable anywhere across the world. You’ve got credit card capabilities anywhere across the world running on similar rails, you have electronic money movement. That didn’t all exist 15 years ago, 10 years ago, maybe not even five years ago, but it does now. And suddenly, you can travel the world and have your information on your mobile phone and go to any ATM in the world and get your money. That’s a fundamentally different place than showing up and buying American Express checks back in the day to go travel. So that data interoperability is our opportunity, no different than any other industry, but one that we’re going to have to face and build the infrastructure for.

Charles Rhyee:

Yeah. And as we think about that, obviously Humana looks to be part of the forefront here. You are part of the executive management team. I think that’s exciting given that it’s not as common I think in healthcare for the chief technology officer to be viewed so importantly. What led you take this role and what was it that Humana was looking for here?

Heather Cox:

I would tell you that Bruce Broussard himself was a big part of the equation. Sitting down with him and hearing his path, kind of how he had gotten to where he’d gotten and the transformation he had been driving toward and what he was looking for in the future, not just for Humana, but for the industry at large, super compelling. And I was talking to a CEO who was talking in terms of advanced analytics, machine learning algorithms, APIs, microservices, and interoperability. He just has really thrown himself into the middle to learn about what it’s going to take, what they’ve done in other industries to really transform the overall experience and drive better outcomes, and how that could translate to healthcare. And he’s driving a really compelling path forward. I then met my colleagues and many people around the company.

Heather Cox:

And listen, I was a big risk to hire me from outside of healthcare on top of it. So we had lots of interviews, I spent lots of time with folks. And what I found was just incredibly brilliant people for what they do and a passion for driving innovation in the marketplace. And not unable to, just unsure exactly how to start traversing through this digital revolution. And so I had some of that experience and they were willing to partner with me. So I depended on their subject matter expertise. They work with me to make sure that what we’re talking about can actually apply and really drive the transformation or the insights that they need. And so it’s a great partnership.

Heather Cox:

It’s the people, Charles, that made me decide to do this and most of it. And the fact, I don’t want to forget, we serve a very vulnerable population, actually two. Obviously, our Medicare advantage business supporting seniors in this country, but also we’ve got Medicaid. I can’t forget the large number of military lives we serve as well. So these are people who need our support and help and deserve the best of the best that we can bring.

Charles Rhyee:

Yeah, absolutely. Now you’re in the role, you’ve been here a couple of years, maybe help the audience here. Maybe you can outline for us what are the key parts of Humana’s technology strategy? How do you guys envision leveraging technology as part of what you do?

Heather Cox:

Sure. It’s a big body of work and I’m going to try to summarize, and then you can poke wherever you’d like to go a little bit deeper. And so everything that we’re focused on is built on an infrastructure and a requirement that we’re going to move to the public cloud. And so ensuring that we’ve built the right infrastructure, we have the right security and privacy and data protection has been a really core part of what we’ve spent the last year and a half, almost two years now, once we got the strategy lined up driving toward. And we are now starting. So things like loading data into that cloud environment and creating an enterprise data lake, a single data lake. Not a bunch of ponds, but a single data lake where we can take the high-value data assets and really focus on creating new experiences for our members. Driving the advanced analytics that will create the insights that will allow us to build the next set of experiences.

Heather Cox:

And so you look at it then across what we’ve also been building in parallel, a population health platform. So that our providers both in our own clinics and in all of the provider systems that are part of our value-based care programs can have the right core information about their Humana patients. And in the case of our own clinics, it’s payer agnostic. And so having all of their health data and social determinants of health now data in a single place where they can actually see and leverage it and utilize it and their care and closing gaps in care, really powerful tool. Population health is one.

Heather Cox:

The second is we’ve been really focused on a machine learning platform and ensuring that we really find a place where we centralize the features that can be utilized to build advanced algorithms, not only so that you have reusable features that become a part of how we build and create speed to market, but we can also be consistent in how we’re training those models. But then we can also be consistent in how we monitor, slash govern, slash give oversight to those models. And ensuring things like bias don’t creep into our models. And so that centralized infrastructure, so that we have a place where data scientists can come to really drive innovation and move with speed, but also do it in a way that allows us to have explainable AI.

Heather Cox:

Number three, platform, is really about how do we democratize data across the organization. And so we can get that data into the data lake, but then how do we apply advanced analytics tools that everyday analysts can use. So beyond the data science population, how do we democratize access to data, create ability to create new insights, drive things like trend vendors, but also just to run your business on a day-to-day basis and drive more automation. So that analytics platform as a service is number three.

Heather Cox:

Number four, we start to move into what we’re calling the digital health platform. And we can get into that. We’ve pulled that forward given all that we’ve seen through COVID and really wanting to double down on our investments there. We’ve got beautiful digital properties. So it’s less about the interactions and more how we start to connect discrete digital experiences in the ecosystem, whether our own generated or third party, and really make it more simple for our members to utilize digital services and our providers to serve them.

Heather Cox:

And then finally, we have the whole core element of interoperability. So you’ve got the cloud, you’ve got the four platforms, and you’ve got data interoperability, and how do we go beyond compliance with regulation to really find opportunities to create new products and services leveraging this data. So that’s the bulk of the strategy. Digital health, that is.

Charles Rhyee:

That’s a lot you’re doing it at once here. Jumping back a little bit. The machine learning platform, is this something where you are just making the data available for others to develop machine learning algorithms for the business, or is this where you are trying to develop in-house those algorithms and apply it to your business?

Heather Cox:

Great question. The answer is both and then some more. So the idea here is to have a place where you have reusable components. So call them features. And let me give you an example of a feature. How many times has a member seen their primary care physician in the last 12 months or last six months? That’s two different features, the ones that people ask a lot. And so not having to go recreate the wheel and find the source of data and then build the features to actually create that algorithm to examine it, we’ve got it now sitting there as a standard feature. It pulls in the data and gives you the updated information literally at the click of a button. We have internal features like that, that we’ve created. We also have gone across literally the world and looked for open-source technologies that we’d want to bring in that would actually add value in how you would build machine learning models.

Heather Cox:

And so it’s a really powerful place for, again, it’s more geared to the data science community today, but takes models from design, build, train, deploy from six to eight months down to at times two to three weeks. But on the high end, it’s been four to five. So that’s a significant lift in time to get through training and ready for deploy. But we also then, once you’ve created features, you’ve combined features, added features, those go into the feature store. So it becomes a real platform. You as a consumer, as a data scientist, going in and getting the information that’s been produced for you there or the features produced for you there, but then when you create new features, you also publish it back. And so it’s a really exciting bit of innovation for a healthcare company like ours.

Charles Rhyee:

Maybe touching back to the digital health platform. You mentioned that this is sort of pulled forward because of COVID. Maybe talk about the services that you want to provide for your members, as well as providers, and particularly maybe those features that you wish were available at the start of COVID that weren’t. Maybe start there and how that could have been useful, I guess.

Heather Cox:

Well, I think we had several things in flight, but I’ll use one example. So artificial intelligence-driven triage. I think it’s relatively new, but it’s not brand new. And there are companies out there that are leveraging these kinds of capabilities. We had been testing, but we hadn’t really moved things into production. And by the way, we were able to get our first bot into production within about 14 days of kind of the real big shutdown in mid-March. So by late March, we had a basic bot up and running and helping to steer members who were looking for information. If you remember back in those early days, we just didn’t know what we didn’t know. And there was just so much fear. And so just getting information to people was really important and pushing them to the right places was really important.

Heather Cox:

And so I think AI-driven triage is one that I think has a huge, bright future in healthcare. And not to replace humans, but to really help us get intelligent on where to direct you down the side of care. And so as we progressed through COVID, we were able to leverage it to say, “Hey, you’re totally fine. Nothing indicates that you have any illness, or let’s push you over to a telehealth visit to make sure and confirm, or less find you a testing site because you need to go get tested, or let’s send you a test to your home.” So that one kind of path of onboarding members and allowing them to go to the right side of care for them in their particular instance, just the power of that is really incredible. And so I’m excited about what that holds.

Heather Cox:

Now, if we let that data just sit within that bot or within that trail, and we don’t actually tap into that data and extract it to understand and learn from what our members, what their experience was, what data they input, and populate it back to a longitudinal human record as we call it internally, then I think we create a whole new silo in healthcare. It becomes, “Oh, that’s the AI silo over there or the triage silo.” And then if none of that data dumps back to their PCP or comes back into their health record, how are we ever going to create value for a next set of interactions for that member? So the digital health platform concept is how do we start taking amazing new capabilities like AI triage or digital in-home care through applications, care management applications. Or remote monitoring data that you are using to measure your blood pressure or capture your weight is two examples. Or steps that you’ve been taking, trying to make sure that you’re getting your exercise in.

Heather Cox:

If we can get that data back in and again, leverage it in your individual record so that we can create the next best set of actions for you, insights for you and your primary care physician, that will be the beauty of digital. But if we don’t connect those things, then all we do is take the complex physical world of healthcare and replicated it in the digital space. So we’re trying to prevent that silo-driven approach from happening here.

Charles Rhyee:

Yeah. And you just mentioned here the longitudinal health record, and obviously Bruce has talked about it in the past. Maybe delve into that a little bit more here and then talk about where you are in terms of building this out and getting it out there.

Heather Cox:

Yeah. So our first deployment, I will call it MVP, was via our population health platforms that we launched in two different versions. One launched in Q4 2019, one launched in Q1 2020. Those are kind of the first round of, okay, if we can create that single longitudinal record and feed these population health platforms. And as we’re getting more information from their visits back in, how do we update it and create new insights to send back to the primary care physician on things like gaps in care as an example. Really powerful, but we’re not stopping there. And part of the reason why is because the MVP was also built in more of a hybrid environment. So not a public cloud with all the same kind of compute power and innovation that we can apply to it.

Heather Cox:

So our next version, version two, launched in Q3 of 2020. And we’re powering some specific intervention models leveraging it. And we will combine those two, by the way, here shortly. But the next version allows us to drive powerful intervention models. And then as we continue to build on it, we can then feed other parts of the enterprise. So if we’re using it for our care management capabilities today, which we are, we’ve just launched, when can we use it for stars? When can we use it to power the next set of visits in X, Y, Z? So we’re super excited, but what’s incredible about this is not just the health record because that’s almost too simple. We have to really go for something further. What’s going to be really powerful is when we can really understand the environment.

Heather Cox:

And so I’ve used this example in the past, but it’s a simple one that we can all understand. Let’s say you live in a certain zip code in Illinois and it’s October, and we know that’s when the flu season is going to spike in your area. How can we make sure that we’re pushing you, giving you options on, “Hey, you can visit the CVS a mile down the road, and they have open appointments on these days. Pick one and we’ll have your record there ready to go with your shot ready to go. And then we’ll feed it back into your record and send it to your primary care physician.”

Heather Cox:

That sounds so simple. And it’s really hard because you’re taking external weather data, you’re taking flu prediction data, you’re using zip code level kind of predictions, you’re combining types of care with actual interventions themselves, you’re feeding back to records. But that’s the potential for what we can do with the various types of data that we aggregate and collect to make sure that we serve you as the individual and your family.

Charles Rhyee:

And I can see from your end, with the data that you collect, how you can bring those insights. How much cooperation though do you need from the likes of CVS or the likes of whoever the EMR vendor that the provider is using to be able to… I mean, can you talk to that?

Heather Cox:

I won’t call it a gating factor. I’ll tell you, there are mountains we still need to climb. I think what we’re all going to find is interoperability itself and exchange of data is going to actually improve how we all can deliver care and improve healthcare delivery in the US. So I think we’re starting to start to see the momentum move in the direction of how do we start hooking up together? How do we start making sure that we’re getting the right data to the right place? The differentiation is going to come and the experience itself and the analytics that you can create from your information and your data. We shouldn’t use the passing of data as the opportunity to create value. We should see that as the opportunity to create new types of value.

Heather Cox:

And so you think about the data exchange that happens with Amazon and all kinds of retailers. That’s important value that gets created for the end consumer and for all parties in the ecosystem, or you won’t participate in the ecosystem. So I’m hopeful we’ll get there. And by the way, we’re not looking to replace things like EHR. That has a distinct place as a really important part of how we deliver services in this country and really help provider systems do great work. And automation, we’re looking to work alongside of and making sure we’re helping to fill in the holes. And I think that’s how we all have to approach this. How do we help fill in the gaps along the way? And then it’s up to us as companies to differentiate on our own core experience.

Charles Rhyee:

And you mentioned before that in the last 15 years or so, we’ve seen in financial services that interoperability becomes so ubiquitous. You can travel the world and just use your local debit card pretty much anywhere. Obviously in March, final rules for interoperability were released. I guess there’s some delay. It’s been pushed out I guess some of the requirements because of COVID, but in theory, by mid-year, all the constituents should be complying with it. The rules, as you see it as if you look through it, is this enough or is this just still just a start? As a written, is this enough to kind of get you to that world where maybe financial services is? How far along do you think this gets us?

Heather Cox:

This gets us started, Charles. And you just said something very important, kind of where financial services are. Here’s one distinct difference and why financial services pursued this versus what I’m seeing in healthcare. Financial services, smart folks kind of leaned in, a couple of CEOs in particular and said, “Well, we got to create this interoperability.” They don’t call it that, but this data exchange in these marketplaces, “Or it’s going to be done to us.” So we might as well go in.

Heather Cox:

And the example at the time was the screen scraping that was happening with certain companies out in Silicon Valley where they’re coming in and screen scraping. That it’s the most dangerous way to manage your data you can possibly think of. So let’s create secure ways by which you can consent to easily transfer your data. And we don’t have to control all tools, but let’s make sure at least your data is safe and secure, number one.And create the interoperability so that the banks can actually be a part of creating this marketplace versus having to participate on the backend because it’s being done to them. And no regulations required it, in the US at least.

Heather Cox:

What we’re seeing in healthcare is that it’s the regulatory bodies having to come in and say, “It’s time to drive innovation.” And I think that’s where we can’t miss on this going forward. We, as an industry, need to lean in and talk about fire APIs all day long and secure and safe transit and movement of data. And allowing people to consent and own their own data, import it with them and not create fearfulness on, “People don’t know what to do with their data and there’ll be dangerous with their data.” We’ve got to trust that we can create the right protections and allow the portability and create a whole new set of marketplaces in healthcare for ourselves. And I think having regulators push us to do this is probably not the best position for us to be in. So how do we get in the driver’s seat, I think is our opportunity.

Charles Rhyee:

And are you seeing now that the regulators have made that initial push, maybe that response from industry to kind of get together and say, “Hey, let’s get going as well.”

Heather Cox:

It’s getting there. And I think there’s some really key voices that I really appreciate out there, really pounding the pavement. And what we’re seeing is a combination of one, the regulations; two, acceleration of COVID. We had 10 years of digital adoption happened in three months. That hockey stick, when you look at the graph, and it didn’t miss healthcare this time. So it’s here. And you have new entrants and participants who have a lot of ingenuity on the technology end of it. Not necessarily healthcare expertise all the time, but ingenuity around data and visual capabilities, combined with the regulation saying, “You got to do this.” It’s going to happen to us unless we start leaning in. And I’m really proud of a company like ours, Humana, where we’re on the forefront talking about what can we do to push this? What can we do to drive this? How do we find more partners?

Heather Cox:

We’ve got an incredible partnership with Epic, as an example. We’ve got that the core data liberation we’re doing internally so that we can comply with these CMS requirements. But as I said earlier, we’re not just stopping there because we’re going to use that data. Now that it’s liberated, we can go feed new experiences and give you your data and multiple portability elements. And also really just help you have new insights that we just haven’t been able to do in the past because we hadn’t prioritized it and it wasn’t a requirement. Well now, we’re seeing, “Hey, this is a whole new set of products and services that are going to create value in the marketplace.” It’s super exciting actually. I think it’s a tidal wave, Charles, that’s coming.

Charles Rhyee:

Yeah. No, I hear you. You talked about the ability now with the tools that you have, with the longitudinal health record, to be able to proactively reach out to your members, help them get directed to appropriate care. At the same time though, Humana’s membership is largely seniors and it’s a more challenging population that one. Maybe talk about some of the issues that serving a senior population particular from a technology standpoint might be.

Heather Cox:

Yeah. That’s a great question and a great push. Before I get specifically there, I do want to offer just some of the other elements that we saw during COVID was just bringing our concept of human care to life. Meaning when we started to do outreach proactively to members at the start of COVID just to check in on them to make sure because people stopped going to their physicians. Making sure that they’re doing okay in particular. And we could stratify by kind of red zones of COVID, as well as chronic conditions, as well as too much time has passed since they’ve seen their physician. But we managed over the course of that to learn a lot. And a few things that we learned, people were really frightened, absolutely. And such that they were afraid to even go to the grocery store to go get food for themselves. Or they were afraid to go if they even had a part-time job to go work, so they didn’t have money to even buy food for themselves.

Heather Cox:

And so things like sending our members masks. Using data and analytics, and making sure that we’re targeting the right interventions and conversations, we were able to send masks, we were able to set up appointments with behavioral health specialists. Because what we were also finding what that isolation and loneliness became a real problem through the crisis. In addition, we were able to with the data assets we had been creating and the automation we were able to put on top of it create programs where we managed to send out in a three-month period over a million meals to our members. And so these are things that I think are really important in why data and analytics and those digital touches really did help.

Heather Cox:

Now to your point, what has also happened is we have absolutely seen the digital divide that is affecting our seniors in this country. A vast majority of our seniors, 65 and over, do not have access to broadband basic wifi capabilities, even if they have a device. The challenge is, do you had access to the data plans themselves? And two, do you have a device? And that’s what we’re starting to see is we’ve got to start to close that digital divide. It’s obvious that it’s a challenge in education and taking care of making sure kids can get schooling, but it’s an even more exacerbated problem in seniors. And we’ve got a great report coming out in partnership with an organization called OATS in early January of 2021. Just some research that has been conducted over the back part of this year to really help put numbers around what we’re seeing here and how dangerous this is because you can say people can’t afford it. Well, we’ve got to find a way to help people get access to and afford things like digital devices because it is their access to care.

Heather Cox:

When they have no transportation, when you’re in a situation like COVID, we are missing out on taking care of simple health challenges in America. And so this is one that’s going to become really top of mind and I’m super proud of a contribution, I should say an investment we made and an organization I mentioned, OATS, Older American Technology Services. In partnership with them, we’ve asked them to help build a consortium across industry players to come and really focus on how do we close this digital divide for seniors in this country. And then within three years, put 1 million more seniors online. And so we’re going to be really focused here because it’s the right thing to do, but it’s also an important access to care, and it’s also an important touchpoint for basic things like just solving for social isolation. And so we see a huge opportunity and need to move now.

Heather Cox:

On the flip side of that, Charles, here’s some interesting. I just got these. We were watching these stats through the annual enrollment period that just ended last week. This year, our visits to humana.com to get information on the plans was up over 30%. Super exciting. At the same time, access by mobile device was at 52% versus just 33% a year ago. So you’re starting to see, as people are starting to age in, that gap is going to close over time. But we close it fast enough waiting for people who are a little more savvy at age 60 and 65 right now. And so we’ve got a lot of work to do in the next five to seven years to make sure that everybody has access to devices and care and other human beings as appropriate.

Charles Rhyee:

That sounds very important here. And when you now think about it and as the seniors who are able to take advantage of their mobile devices and digital tools and can access care that way, what are other considerations that you need to take into account when you’re creating a digital experience for a senior population that might not be necessary with a younger commercial population?

Heather Cox:

A couple of things. And I don’t think the digital divide is so much what people can do or what they want to do. It’s more once you give them access and teach them. I mean, my mom just turned 70. And boy, she can move around some of those. She can move through social media faster than I can. It’s pretty impressive. And she’s a pretty darn good shopper too. But I think it’s more about if you don’t have a device, how do we help you get a device? And what CMS opened up the room for during COVID was, “Yes, this is an access to care consideration. Go ahead and send devices.” And so we’ve been testing and learning, trying to find ways if we can get you a device, can you use it? If you can’t use it, why can’t you use it? What’s difficult about it? How do we play one-click access to get you in, in a secure way for those visits? How do we create push from providers to you so that we can actually create a telehealth visit that comes to you versus you even having to go in?

Heather Cox:

And so trying to make it simple and elegant is super important. In addition, Charles, back to the whole… We could come and we can send you an iPad with 15 apps on it. If you have 15 different logins, none of us are going to figure that out and none of us are going to want that kind of experience. So again, having that one-click access that brings you in and takes you to the correct digital experience that you need that day is what’s going to be most important. Why that notion of a digital health platform that just doesn’t quite exist yet, the infrastructure needs to be there to allow for that easy flow of data and that push of experiences, that next best action. So ease, simplicity. Same thing you want, same thing I want, we needed to have for our seniors. Yeah.

Charles Rhyee:

Yeah. A Lot of what we’re talking about here earlier about the services that you’re looking for, this longitudinal care, it kind of reminds me in healthcare where we often talk about continuity of care or filling in gaps in care. But a lot of what you’re talking about seems like a world of more connected care. And I feel like there’s a little bit of distinction because it’s more multifacet at the same time. Maybe you can delve into that a little bit.

Heather Cox:

Yeah. That’s an interesting insight. Again, we are not with the digital tools in any shape or form looking to replace the human interactions because the human part of this healthcare chain is so critical. Hands-on is always going to be an important part of this journey. But if we could actually create new data points that allow you to have information that you would never see in that 27-minute visits once or twice a year as a physician, what value can that create? But there’s a lot of trust that’s got to be built into the system too. People have got to be willing to give you their information for an exchange of value of some sort, whether you can see and feel better health outcomes or you get reduced costs when you have certain types of visits.

Heather Cox:

So we’ve got a lot to do to work through the mechanics, Charles. But this notion of always-on and because it creates better health outcomes, not just because that can’t be technology for technology’s sake. It’s got to create value again for providers, for care teams, for end consumers. And a lot of this is going to be test and learn. We’re not going to solve anything with one big mega app. That’s just not the path to the future. And it’s more about how do we find the right services for the right individuals. And what’s beautiful about digital is we can tailor it and we don’t have to build it all.

Heather Cox:

A company like Humana, we can certainly have our own proprietary set of services. That there are so many beautiful and elegant services being created in the health-tech space that we can bring and integrate in if we have the right platform approach. So that, again, the providers can choose the best-of-breed technologies they want to use to serve their Humana panel. A Humana member can choose to be physical or digital, digital back to physical, and actually have an elegant set of movements between these different worlds. That it doesn’t feel like it’s disparate or disconnected. So I like your notion of connected care versus continuity of care because the connected care could actually create the data points to provide continuity of care. It’s one part of your concentric circle on this.

Charles Rhyee:

And you mentioned there putting this all together. What do you think the future will look like three years, five years out? As all these mature and reach way you’re envisioning, how do you see this all playing out, perhaps?

Heather Cox:

So I’ll say an important component is going to be AI, AI, AI. And a lot of people would say artificial intelligence, so I’m going to say it’s more augmented intelligence. So that you have the beauty of the technology and the power of the algorithms and vast access to large troves of data and the compute power to actually process through it. Great. But you’re going to have the humans that are going to need to actually pay attention because the interventions are a long way from becoming totally automated in healthcare. So I don’t think we’re getting to sci-fi mode here anytime soon, but we’re going to start to really be able to tap into new levels of compute capability that are going to allow us to consume data far faster and far more effectively.

Heather Cox:

And so let me give you a statistic. You’ve probably heard it, but it’s worth jumping on. Nearly 80% of healthcare data is unstructured. And what I think healthcare has focused on for a long time, because it’s what you can get access to easily, is the structured data. That means the vast majority of information that exists that could help you with your health isn’t consumed yet or at scale or consistently. So moving to a place and space where you, again, have this compute power and access to data, and you can drill into it using advanced analytics tools like natural language processing, as an example, it’s going to fundamentally change what we do to serve up insights and what you can do with those insights. So social determinants is just one great example.

Heather Cox:

There are no, as I’ve learned, ICD codes for things like social determinants. So they’re sitting in notes. Well, if we can consume those notes and find what’s in there. That might be you’re not coming to your appointment because your sister who always used to bring you has passed away. You have no access to transportation. And so the last time we saw you, we learned that. And now we’re not going to see you again. But if we actually know that, we can actually push services to you to make sure you actually can get your in-person services. Or push services to you like an in-home visit and do an assisted telehealth visit back to your PCP. That’s the future of this. Again, what I talked about before. Physical to digital, digital back to physical, it’s got to be elegant. It can’t be all or nothing.

Charles Rhyee:

I think we’re coming up on the time here and I really enjoyed this conversation. Maybe at the end though, obviously as we increasingly leverage technology into healthcare, anything we should be careful about? Is there anything that worries you about as we push more technology to healthcare?

Heather Cox:

Yes. I think I’m back to my AI, AI, AI conversation. So the beauty and power of it there is a flip side that we’ve got to be really conscientious about and focused on. Which is ensuring that we have the right diverse perspectives when we are building these models. That we monitor and create oversight mechanisms for these models. And that we have explainable AI that comes out the other side. Meaning when it says, “This is the answer for that individual,” we can actually trace back why we got to that answer. So automation is going to be a beautiful part of accessing the 80% of unstructured data in healthcare. But the flip side, we got to make sure bias doesn’t creep in.

Heather Cox:

And so ensuring that we’re really focused on this is a top priority for us. We recently took a pledge with an organization called EqualAI to make sure that… We can’t say we’re going to prevent bias from creeping in, but we’re going to stay on the cutting edge and do whatever we can with the leading companies in the world to ensure ethics of AI is a high priority for the organization. And if bias does creep in, that we are focused on getting it stamped out and rebuild and redone and market. And we’re asking, by the way, now partners that they join us to actually take the same pledge. So that we actually create an ecosystem that is really focused on this in healthcare.

Charles Rhyee:

Yeah. Well, that sounds great. And obviously, a lot is lots going on here. It seems like a lot of great things are happening here at Humana and looking forward to seeing how that all continues. I think we’ll stop here. And Heather, thanks so much for joining us today. It was really great catching up with you here and really enjoyed the conversation. And really looking forward to seeing how everything works out.

Heather Cox:

Thank you. And I want to thank all my colleagues at Humana. They’re doing incredible work to help us move these elements into production and moving them to scale and helping us really drive this transformation. But Charles, I also want to really thank you. You have been one of those friendly folks in healthcare that has welcomed me in. And you always ask hard questions, but it’s in the search of seeking to understand and wanting to know what we can do to continue to push the boundaries of the digital revolution here. So I really appreciate that.

Charles Rhyee:

I appreciate that as well. And certainly, we’ll get you back on again soon to find out how things are progressing. And I look forward to having you join us on future podcasts.

Automated:

Thanks for joining us. Stay tuned for the next episode of Cowen Insights.

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