Gwen gazed down at her last remaining dinner, a mug of chicken broth. Days had passed since she’d tasted a real bite of food. Her pantry was empty.
Even worse, Gwen was stranded alone. She had no family near her Tennessee home. She couldn’t drive due to her failing eyesight. And she feared that catching a ride to the market with a friend would expose her to COVID-19. So she sipped broth.
Then the phone rang. To Gwen, the call seemed out of the blue. It wasn’t, but the timing was perfect.
Heather, a Humana care manager, was checking on Gwen, one of the insurance company’s 17 million medical members. Amid the pandemic, Humana nurses and social workers contacted members to assess their health and prescription needs. Turned out, hundreds of thousands of those same people were hungry.
Gwen told Heather she needed butter and more broth. Instead, Heather arranged for 14 nutritionally balanced breakfasts, lunches and dinners to soon arrive at Gwen’s doorstep.
“I don’t know how to thank you,” Gwen said.
That care package marked a tiny slice of the 1.5 million meals Humana has provided to 90,000 people through its Basic Needs program.
Launched in February 2020, the initiative aims to lift Humana members out of food insecurity, which experts define as lacking reliable access to affordable, nutritious meals. Most of the meal recipients are members of Humana’s Medicare Advantage program.
“Food insecurity in America probably hasn’t received the attention it should,” says Dr. Andrew Renda, vice president of population health strategy at Humana, which is based in Louisville, Kentucky. “It tends to have a higher prevalence among seniors, people with disabilities and single parents with children, but it’s ubiquitous.”
For centuries, hunger has occupied often-unseen corners of America, affecting people in the margins then roaring into public view during economic crashes. By 2019, declining U.S. poverty and unemployment rates had reduced food insecurity to a 20-year low – one in nine people.
COVID-19 reversed that progress. As businesses closed, jobs vanished and bills mounted, one in seven Americans – including one in five children – faced food insecurity, according to Feeding America, a nonprofit network of food banks and food pantries.
“In a country that wastes billions of pounds of food each year, it’s almost shocking that anyone in America goes hungry,” Feeding America states on its website. But tens of millions of Americans “are forced to choose between spending money on food and medicine or medical care.”
Early in the pandemic, Renda and other Humana executives began to detect a new surge in that crisis. As stay-at-home orders widened, Humana care managers contacted members to ensure they still had access to their medical providers and prescriptions. Those chats revealed an alarming theme.
“A lot of our members told us, ‘Yes, all that is important but I’m also food insecure now,’” says Renda, who leads Humana’s Bold Goal, a population-health strategy that seeks to improve the health of people and communities served by the company. “We started getting more and more of these calls.”
The company responded by swiftly creating its Basic Needs program: Humana members who are struggling to buy and eat healthy food receive 14 home-delivered meals containing fresh or shelf-stable groceries and ingredients. Members can request additional meals as needed.
At first, speed was everything. Millions of people, many of them seniors, urgently required food. Some couldn’t afford healthy groceries. Others couldn’t venture out due to lack of transportation, compromised immune systems or other factors. All were hungry.
As COVID-19 cases peaked in the U.S. last year, Humana received about 2,000 requests per day for emergency meals.
“The need is absolutely still there,” he adds. “The pandemic is not over.”
But the program’s frenetic, early days required a rush of highly manual work, from fielding calls and documenting members’ needs in spreadsheets to collecting addresses and arranging deliveries. (Basic Needs is a collaborative effort between several Humana teams: Bold Goal, digital health and analytics, and retail.)
“It was a herculean effort and not sustainable. We didn’t have time to plan, so we did what we could,” Renda says. “Errors were occurring.”
To add efficiency to the program’s urgency, Humana used Microsoft Power BI, a data visualization tool, to construct an assessment and tracking system, and it used Microsoft Azure to create AI-powered, predictive models.
With Power Apps and Power BI, Humana employees scientifically assess the food insecurity of individual members. Employees ask the members a series of specific questions based on a U.S. Department of Agriculture screening tool, as well as the Charlson comorbidity index. Members’ responses are logged into Power BI dashboards.
The USDA’s Hunger Vital Sign tool uses a series of scripted questions to identify people who lack reliable access to food. The Charlson comorbidity index estimates a person’s one-year mortality risk, based on the presence of certain health conditions, such as heart disease or cancer.
Once the needs are evaluated, employees use Power BI dashboards to coordinate and track food deliveries like beef stew, chicken teriyaki, vegetable stir-fries and cheese lasagna, at no cost to Humana members. For those shipments, Humana partners with Feeding America, as well as with Mom’s Meals, which provides fully prepared, refrigerated meals to homes nationwide.
“Power BI allowed us to drastically scale our food-delivery capabilities,” says Slawek Kierner, a senior vice president of enterprise data and analytics at Humana.
“For our health care mission, it is paramount to understand the social determinants of health (such as food insecurity), and treat those rather than only treat diseases,” Kierner adds.
As part that effort, Humana is relying on Microsoft Azure to help create “highly accurate” predictive models that anticipate when food insecurity may affect someone’s health, Kierner says.
Humana operates a cloud-based, machine-learning platform called Florence AI – a name inspired by Florence, Italy, birthplace of the Renaissance – to help foresee potential health declines among members facing food insecurity, Kierner says.
“The better we can predict those things, and the more we can avoid those events by dispatching food deliveries, the better we can prevent those health declines,” he adds.
Indeed, Humana has committed to a fresh approach to fostering better health – addressing the needs of the whole person. That’s the mantra of its Bold Goal program and it is a passion for Renda, who earned his medical degree from the Royal College of Surgeons in Ireland.
As a medical resident, he trained in psychiatry. And he began to learn a lifelong lesson as he spoke with patients and their families.
“It’s not always about treating the patient in front of you,” Renda says.
Illnesses are often rooted in the basic building blocks of a person’s life, such as where they were born, where they live and work, their education level, their social ties and their socioeconomic situation. Academics call these “the social determinants of health.”
“Increasingly, there’s a recognition that you can’t solve somebody’s health issues without taking a more holistic, whole-person view on their health,” Renda says. “It’s not just the clinical conditions they have, it’s taking into account their physical health, mental health and social health.”
At Humana, Renda and his colleagues are working to improve public health by providing members with better food, better access to transportation and better connections to people who can offer a friendly ear or a warm conversation.
The doctor acknowledges that within the medical field, this type of work was long considered beyond realm of providing good medicine.
“There was an inherent bias (among doctors) because there wasn’t training for this,” Renda says. “There was an attitude that it wasn’t really in our domain to intervene.
“But the reality is, social determinants like food insecurity are often an important factor as to why people aren’t achieving their best health.”
All photos are courtesy of Humana.