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JC Scott (00:07):Welcome to The Pharmacy Benefit, a podcast that highlights the role of PBMs in serving millions of patients and consumers throughout the country. I'm JC Scott. When we think about innovation in healthcare, our first thought may be the essential innovation that happens in the development of new drugs, treatments, and cures. But there is another important area where innovation is happening every day. Innovation in the delivery of care. Because PBMs work on behalf of literally millions of consumers, they have access to enormous amounts of data, and a perch to see the evolving trends in healthcare. And they're leveraging that information to develop ever better ways to help individuals get and stay adherent to their prescription drugs and improve their overall care experience.JC Scott (00:49):Today our goal is to understand how this works, how PBMs use data to innovate and to improve healthcare. Joining me to talk about this are two members of Humana Pharmacy Solutions. Our first guest is Dr. Mona Siddiqui, the senior vice president of clinical strategy and quality at Humana. Mona joined Humana earlier this year, coming out of an impressive career of public service, most recently as the chief data officer for HHS where her work focused on building an institutional infrastructure for the department, leading the federal AI strategy, and finding new data-driven solutions to some of the nation's biggest healthcare challenges through public private partnerships. In a career spanning multiple administrations, Mona has also served in senior positions at the Center for Medicare and Medicaid Innovation, and as part of the White House Social and Behavioral Sciences Team.JC Scott (01:38):My second guest is Dr. Scott Greenwell. Scott is the senior vice-president and pharmacy solutions president at Humana. He is responsible for managing Humana pharmacy solutions while working to develop new capabilities that support improving health outcomes. During his 15 year tenure at Humana, he played an integral role in the launch of Humana's Medicare Part D benefit, Humana's mail order and specialty pharmacy, and the Humana Pharmacy Solutions clinical program. A champion of managed care pharmacy, under Scott's leadership, Humana Pharmacy has been named the best in mail order pharmacy customer satisfaction in the JD Power 2020 US pharmacy study. It's the third consecutive year that Humana has received this prestigious honor. In addition, for the third year in a row, Humana Pharmacy has won a specialty pharmacy patient choice award from Zitter Insights, a division of MMIT. Scott is also an active member of several professional associations, and is past president of the Kentucky Board of Pharmacy. Mona and Scott, thank you for joining me.Scott Greenwell (02:37):Thanks, JC.Mona Siddiqui (02:38):Yeah, thank you.JC Scott (02:39):So speaking of innovations, this is the first time that we will have two guests on our podcast. So I'd invite you to please chime in and let's make this a conversation as we go. But Mona, maybe I'll start with you if that's okay. You spent a number of years working in health policy and in pretty interesting roles with a common theme. Understanding how people use healthcare, how systems serve them, and how trends can help inform new and better ways of delivering care. So let's start out at a high level. Can you explain how that works, how understanding and looking at individual's behaviors and examining those trends can help improve the system, and how Humana is utilizing that approach?Mona Siddiqui (03:18):Yeah. No, absolutely. So first thank you for having us both here. I might start, JC, since you mentioned the White House Social and Behavioral Sciences Team, some of the work that we did during the Obama administration, really the core of the philosophy was you don't need to spend hundreds of millions of dollars in changing programs or in really implementing new programs without understanding what's effective. You can use real time data to inform the way in which you design programs, the way in which you tweak programs almost in real time.Mona Siddiqui (03:58):And we really, taking sort of large scale government programs, how do you think about embedding insights from behavioral science and behavioral economics into those government programs, then doing a large scale randomized control trials within government programs using real-time data from places like CMS or FDA or others to really understand are these changes effective in increasing uptake of the programs from all of us? Are they saving money? Are they leading to improve end user experience? And I think what we demonstrated in doing that work is that, again, low cost interventions that are informed by real time data can have enormous impacts on millions of people.Mona Siddiqui (04:51):I don't think any of us, or many of us, realized that we were doing randomized control trials within government programs. But I think you want your government and your organizations to be as data driven in informing program design as possible. And frankly, if the federal government can do it at scale in that way, really a lot of organizations can begin to think about building the data infrastructure and using that infrastructure to really design the best consumer experience and the best programs possible.JC Scott (05:25):Well, I was going to say, so translating that experience that you had on the federal government side, then over to Humana, and I'm curious as we think about Humana's overall model, right, more of an integrated company. There's been a lot of discussion in recent months and years about the more integrated approach with health plans and PBMs. I think it's one of the great things about the industry, it's really competitive, and there's a lot of different models of PBMs out there for health plans to choose from, standalone and integrated. But talk about how being part of that integrated model at Humana allows you to do similar work now in your new role.Mona Siddiqui (06:00):Yeah. I'll start, and then maybe I'll let Scott chime in as well. I think across the enterprise, if you look at the various assets that Humana has, whether it's the insurance side or the assets within the home segment, or the assets within the pharmacy segment, the question really is, what you're bringing up JC, is how do all of those work together and show up for consumers together? And oftentimes these units, for very good reasons, have been operating in silos, right? So the question is is how do we bring the data together to inform their program design?Mona Siddiqui (06:35):We can get into it a little bit more, but I would just say that a very recent example of this has been within the COVID experience as well, right? As we've been trying to figure out what are the needs of our members, the data on the pharmacy side and the PBM side has been really critical in helping us understand what members are facing, what sort of their urgent conditions are, what they're facing in terms of immediate needs, and how we go about addressing those potentially through some of the different assets across Humana. So for me, that's a really salient example of how we need to come together as an organization. Scott, I'll let you chime in here as well.Scott Greenwell (07:13):Yeah. Thanks, Mona. I think that's a great example. And certainly been an interesting year this year with COVID in bringing a lot of this to life in an accelerated way. But my entire career with Humana, which is now, it's hard to believe it's already been a little more than 15 years, has really been through the lens of an integrated PBM. And we think of our health insurance segments as an extension of the work that we do, and likewise for them. And part of that is because, A, we're able to align incentives so that we're all focused on the same end goal. And making sure that, just from a foundational perspective, we're incentivizing each other to think through the lens of Big H, which is what we kind of call Humana as an enterprise, is Big H.Scott Greenwell (08:02):So whether it'd be thinking through trend and trend benders, whether we're thinking through pipeline and impact of innovation on not just the PBM, but also our health plan segments and helping them anticipate and plan for costs that will come at them in the future, to the relation that our pharmacies have in driving better customer satisfaction scores. And JC, you mentioned JD Power as a mechanism. It really is, I think, a testament to our commitment to our customers, which are the health plan customers. And what we also know is that those that utilize our pharmacy experiences have better net promoter scores with the health plan as well. So it really becomes a symbiotic relationship between the health plan and the PBM.JC Scott (09:00):Terrific. And I'd like just to dovetail a little bit off something that Mona mentioned about the experience during COVID, and just maybe dig in there for a little bit before we come back to talk some more about the pharmacy specific work that you all are doing at Humana. But I'm curious, for either or both of you, I know Humana has done some work looking at social determinants of health, and I'm wondering what you're seeing in terms of impact on consumers and patients during COVID. It's adding to financial instability, challenges for childcare, challenges of the transportation and getting access to healthcare providers. What are you all observing from your perch at Humana, and how are you thinking about addressing that as a company?Mona Siddiqui (09:43):Yeah. Maybe I'll start, and then Scott, please chime in. So we very early on in the pandemic got a charge from our leadership to say we have to think about how we reach out to all our members and to see how we address their needs proactively. And it wouldn't be surprising, I think, to many people that those needs often were not around your missed doctor's appointments, those were basic needs around access to food, around people feeling incredibly lonely. The levels of anxiety were incredibly high. Obviously some sort of essential kind of preventive things that needed to happen for members weren't happening and things like transportation, access.Mona Siddiqui (10:32):And so I think the lesson really was, when you think about being consumer centric, it's not about addressing the needs as we're seeing them, but addressing the needs as we're encountering when we're making these calls, right? And providing the space for each of these members that we reached out to to not just go through our own checklist, but to say what are their needs and how can we help? And I think there was an enormous, and I'm sure other organizations have gone through this as well, but an enormous organizational effort to say what are our current capabilities that we can really help put towards these member needs? And what might we not have right now where we really need to be agile and build partnerships to address those needs?Mona Siddiqui (11:18):I think it was a Herculean effort to really reach out to all of those members and to make sure that there was a safety net that was getting provided. But then also to create that channel so, as those needs evolve, that they were reaching back out to us and we were building some of that muscle again. I don't think it would be a surprise. We don't have great data when it comes to social determinants of health. Right? So I think, like other organizations, there's a lot that we need to do. I think there's a lot that Humana has done with our Bold Goal efforts, but I think we probably all understand right now the social determinants of and health equity just is paramount for all of us. And we have to double down on some of those efforts.JC Scott (11:58):Thanks, Mona. And Scott, I'd be curious how you're seeing that manifest on the pharmacy side of the business.Scott Greenwell (12:05):Sure. So JC, from my lens, we have the honor and privilege to serve a pretty large Medicare population, which is also, frankly, one of the most vulnerable populations that were impacted by COVID. And we certainly saw a change in terms of expectations for how we were going to be living our lives. The concept of social distancing, which was, frankly, relatively a new idea became part of everybody's vernacular and vocabulary starting in late February and in March. And that also resonated with our seniors probably more so than anyone else. And concerns around access, concerns around how are they going to get their prescription drugs to changes that we needed to just contemplate related to policies and processes around clinical coverage and utilization management.Scott Greenwell (13:04):So we had a lot of different tactics that we really had to think through to make sure that we weren't getting in the way of our members' wellbeing. So we allowed for early prescription refills to allow our members to stockpile, so they had a supply at home. They didn't thought they needed to go out and risk exposure. We increased our ability and capabilities around mail delivery for both our mail order pharmacy, as well as from our retail partners, and making sure that they had the ability to mail to members to avoid members and patients having to come out of their homes and take that risk to specific drug coverage policies that may have required a specific test, or a certain lab value for us to do those clinical reviews.Scott Greenwell (13:54):We made a decision pretty early on to amend those policies during the pandemic to not put our members at risk so that they could go get a lab drawn or a test performed just in order to satisfy our prior authorization criteria requests. So we tried to stay flexible, and to make sure that we're really thinking member back in how we're designing our processes and keeping our members safe.JC Scott (14:22):I'm curious for either or both of your perspectives on how many of these behavioral changes and how many of these Humana policy changes you think are going to endure if and when we get out of this state of pandemic. Certainly that's kind of an existential question for so many aspects of our lives that have changed. Is it going to go back to normal, or is this the new state of affairs? But what do you see as you look down the road?Scott Greenwell (14:48):I think JC, from my lens, we keep talking about a new normal, and really by definition, that what we were doing prior to February of 2020 may likely never fully come back to the same reality that we once knew. I think the landscape has changed. And I think from some parts of it, maybe more challenged in trying to navigate how to stay socially distanced, how to stay healthy, but still have a balanced life and one that's full of wellbeing.Scott Greenwell (15:23):But then there's other things like tele, like I think mail delivery, and not just for healthcare, but broadly. We've heard from a lot of our shipping partners that they've seen an incredible uptick in volume and just the number of people buying and purchasing items via the mail. We've certainly seen it on the pharmacy side in terms of mail order utilization has come up. I don't think things like that we'll put back in the bottle. I don't think we'll put tele capabilities that have been built over the last several months, I don't see how that gets put back into a bottle because I think it's enabling better access to care, which I think the end is always a good thing for members and patients. Mona, I'm not sure if you had anything else you'd add to that.Mona Siddiqui (16:10):Yeah. No, I would just say, I think the consumer expectations have changed pretty fundamentally. I'll just give one example which really struck me. We stood up this program for enabling COVID testing in the past few months. And there's a sort of a self service option there and an option where folks can choose to have somebody from Humana call them and to help walk them through the process. And to Scott's point, our largest membership are seniors. And I was really struck that actually the option for having somebody call you seemed to be not just not preferred, but a point where people would actually stop the process. There was a desire to have an end-to-end digital experience that was seamless, that did not need an individual to call you or walk you through it to facilitate. So really I think it's Amazons and the likes have really changed consumer expectations. And if you can provide that service, I think what we're seeing is that that's where the demand really is. And from a healthcare perspective, we haven't really met that. And there's a runway there for us to get there.JC Scott (17:30):That is fascinating to me because I always thought one of the limitations to some of these more telehealth and automated programs was that lack of human interaction that people could get at the pharmacy counter or in the physician's office. But it sounds like that assumption is actually the opposite of what you all have found.Scott Greenwell (17:49):This has been a passion of ours. Because I think the reality is consumers experiences broadly is defining their expectations for what is simple in how the digital process should work. I think for a long time, the health care system had built its digital capabilities in showing members their own workflow in a digital way to members versus a purely digital native entity who designed the process in a member backed lens, not in the reverse. And consumers have become accustomed to how simple and streamlined and effortless those processes can be. And their expectation is that's how all of their digital experiences should exist. And I don't think healthcare is going to get a bye in terms of not being held to that same expectation.JC Scott (18:49):Yeah. We all expect more and more out of our technology these days. It's true. And I'm curious if you could talk, Scott and Mona, a little bit about how you're able to leverage some of those technological advances to address what have traditionally been kind of points of abrasion for people in the system when it comes to, I think Mona you touched on it earlier, things around prior auth or step therapy, or those things that used to take quite a bit of time for the back and forth between the patient, the provider, and the insurance plan. It strikes me that real-time benefit tools, some of these other innovations are starting to address some of those points of abrasion, but what's your experience been?Scott Greenwell (19:30):This is an area that we've been at for some time. I mean, Humana was probably the pioneer of leveraging the real-time benefit check transaction way back in 2015. And at the time, we made a significant investment in pursuing this level of transparency in a time where, frankly, most of the industry wasn't ready for it yet. You had most of your EHR and EMR partners were focused on the ICD-10 conversion. So we knocked on a lot of doors back in those early days, and said, "Yeah, we're interested. However, come back and see us in a couple of years when we get back to the other side of ICD-10."Scott Greenwell (20:12):But today, we are leveraging the insights that we generated in those early days to make sure that when we built that capability, it was built to be an effortless process within the physician's existing workflow. The last thing we wanted to do was to build some new process that the physician had exit their natural workflow as part of that patient visit and go somewhere else to go look something up. So we've built it in an integrated part of that physician's workflow. And really the feedback that we got from the provider community was this is what we've been expecting from EMR since day one. This is what we were sold that moving to EHRs and EMRs would bring in terms of transparency around data, transparency around costs and benefits.Scott Greenwell (21:09):And we've certainly leveraged a lot of additional relationships and are continuing to expand those capabilities beyond just the physician's tablet, to pharmacies, as well as to trying to figure out how do we put that type of capability in the members' hands. So they have a member guided tool that's leveraging kind of the real-time benefit capabilities to enhance their experiences.JC Scott (21:35):And I think it's worth reminding everyone, right, that these utilization management steps are really important as part of the overall approach to managing drug costs and trying to keep costs down for everybody within the system. But it strikes me as you can address these points of abrasion and minimize the procedural impact on patients and providers that maybe helps with people who traditionally have been unhappy with and uncomfortable with some of those tools.Scott Greenwell (22:02):That's right. We've taken all of that complexity, and in a millisecond transaction are informing the provider at that patient visit in the office, is the drug covered? If it's not covered, what are the preferred products if there are formulary alternatives? What's it going to cost? And not just at Acme pharmacy, but if there's a preferred benefit that the member may have using one pharmacy over another, it will inform them of that as well. And at the end of the day, if the provider decides that this is the most appropriate therapy for my patient, they can, in the same workflow, select a electronic prior authorization and file that all on the same screen in the same workflow. So trying to leverage as much as we can, the physician's natural workflow to make that process easy to remove as much of that friction as possible.JC Scott (23:00):If I could shift gears just a little bit, but still staying on this theme of managing costs while innovating. I know you all have had a number of disease specific clinical initiatives that you've been looking at in the PBM space. I think that's most relevant to the work we try to do around specialty drugs, which represents a pretty large share of the overall drug spend. I think the latest estimate was about 39% of the overall drug spend. And the challenge of course there is that there's not often therapeutic alternatives to leverage competition to address costs on specialty drugs. Can you talk about some of the disease specific clinical initiatives that you have underway that try to address part of that cost question, but also just the overall patient need for those clinical areas?Scott Greenwell (23:47):Yeah. And maybe just start, we'll go to the higher level, first I would say the specialty drug access and affordability challenges for members are an incredibly high priority for Humana. We know in the traditional rebate arrangements and utilization management techniques really help stabilize healthcare costs and help to drive forward ability across the across entire space.Scott Greenwell (24:16):But in the specialty world, given the small populations that frankly many specialty drugs treat, are unique and often lack competition, the traditional rebate tools and arrangements typically don't lend themselves to those same specialty categories in limited competition. So we've tried things like value-based contracting and techniques such as that. Which in some scenarios work well, in other scenarios, they do what the FDA has told us, which is they study these products and these products work, and they're approved. So a lot of times they're confirming what I think most of us already know. But we are pursuing specifically in oncology and in orphan drugs, trying to figure out if that's the right sweet spot for where value based contracting and those types of relationships can come to life.Scott Greenwell (25:10):And then in terms of the clinical programs, Humana has a program, we call it UM Ultra. And really what it's intended to do is to create a path in which we can create a personalized approach to utilization management that wouldn't normally fit your cookie cutter approach to prior auth or step therapy or other management tools. And we look at by drug, by disease state, and then ultimately to the unique member, and trying to figure out what are the cost savings opportunities for that member, whether it be dose optimization. And we see examples where our members are started out on a loading dose in a specialty drug, and ultimately that loading dose never changes. And they continue on as a maintenance dose.Scott Greenwell (26:02):So making interventions with providers to create awareness there too, trying to figure out if there's vial optimization, and making sure that we're maximizing the patient value at the drug costs. So we're constantly thinking through and leveraging different techniques to manage those utilization management opportunities by the ones in addition to our traditional prior authorization processes and the like.JC Scott (26:29):Perfect. Thanks Scott. I know we're getting close to the end of our time. I did want to shift back just to one more question related to the pandemic, and then one closing question for each of you. But I was wondering if you could talk a little, either of you, about your work to promote access to COVID testing, which has proven to be, obviously testing a key component of the ongoing effort to try and turn the tide on this virus. I know you've done some work there, and I'm curious what you can share.Mona Siddiqui (26:58):So obviously this is something I think we all have to be focused on at every level to make sure that we're addressing the pandemic head-on, and testing is a core component of that. In addition to obviously covering the cost of the COVID testing, we've stood up a program to facilitate testing for our members. So we entered into a partnership with LabCorp Pixel where any member who wanted a at-home testing kit would be able to get a home testing kit.Mona Siddiqui (27:30):And again, we've seen a significant usage of that, even by our MA members, even though the process is completely online and digital. But that has really facilitated, I think, access to testing and provided comfort, I think, for members who have been fearful, especially in the early days of this, of leaving their homes. We also entered into a national partnership with Walmart where members could go through, and now about 550 Walmart stores across the country, and go through their drive-thrus, and get a PCR test done.Mona Siddiqui (28:06):And again, we would facilitate sort of the entire process, from being able to check their symptoms digitally, to being able to refer them, take care of the authorization on the backend, and then for them to get the test results as well. I think it has been interesting that we've seen less uptake in the drive-thru process, but really significant usage of the at-home. Which again, I think has been a trend that's been accelerated in the pandemic time.JC Scott (28:35):Thanks, Mona. That's important work that you all are doing. And you surprised me again. It's interesting because we started the conversation around the value of looking at some of these behavioral trends. And twice in our conversation, I've been surprised that what you found in analyzing people's decision-making and behaviors on some of these things is kind of counterintuitive, at least for me.Mona Siddiqui (28:56):Well, I think it supports where Humana has been going for many years around our investments in the home segment, right? So how do we enable more care in in-home and community-based settings. And obviously getting the mail-in pharmacy, all of that really, I think, is the sort of Humana [inaudible 00:00:29:14]. more members would prefer to get that care in home and community based settings.JC Scott (29:20):So, final question for both of you, a little bit bigger picture. Mona, you're about six months into the job now, and Scott-Mona Siddiqui (29:27):Eight months in, actually.JC Scott (29:27):Eight months. Eight months.Mona Siddiqui (29:27):Grand total.JC Scott (29:31):It did take awhile for us to schedule this podcast. So my script is outdated.Scott Greenwell (29:35):[inaudible 00:29:37].JC Scott (29:38):Scott, you're you're about a year into your latest role with the company, is that right?Scott Greenwell (29:43):That's right. That's right.JC Scott (29:45):So what have you each found most rewarding during your time in these roles, and what are you most excited about looking ahead for your work with the company?Mona Siddiqui (29:53):So first of all, let's not compare my eight months to Scott's 14 or 15 years at Humana. Look, I really do think that Humana is, and this is why I came to Humana, that MA plan's incentives are really aligned to take care of the member in the way in which they want to be cared for. I think that Humana has made significant investments within the data and digital infrastructure, which is really the future. If you look at our partnership with Microsoft and Salesforce, I think if you look at our investments within primary care, within the home segment within pharmacy, these are all investments i how we enable that care, where the member is.Mona Siddiqui (30:39):And so to me, I think the magic really happens in being able to use the data, and the long-term investment that Humana is making to provide those digital experiences and to make Humana really show up as one. To Scott's point about Big H, how do these programs show up in a seamless way to enable a ideal consumer experience rather than point solutions, which is traditionally what healthcare has been.Scott Greenwell (31:08):And then JC, for me, just as Mona mentioned, I guess, it's so hard to believe it's been almost 16 years that I've had the opportunity to join the company. And it started out with Humana as a staff pharmacist, many, many, many moons ago. And I've had the opportunity to leverage a lot of firsts for Humana in experience and be a part of a lot of firsts. Whether it be the origination of Medicare Part D back in '06, to launching new our mail-in specialty pharmacy offerings to, frankly, countless clinical intervention programs to drive better health outcomes. And we talked about real benefits checks.Scott Greenwell (31:48):So I've had a lot of pretty incredible first opportunities. It'd be impossible for me to pick just one. But over the last year, it's really been probably twofold. One is trying to figure out how to more deeply remove those friction points out of the healthcare system and figuring out how to leverage big data and advanced analytics to start predicting decision outcomes that we would likely make. And how can we leverage those types of capabilities to remove even more friction points? I think that is going to be a bit of a game changer for us. And I'm excited that that's part of the future.Scott Greenwell (32:32):I would say the other pieces is really around, we referenced this earlier as well, is the digitization of pharmacy. For way too long, pharmacy has been forcing consumers and members and patients to navigate our messy workflow. And it is messy. Doesn't make sense to consumers. And we've been incredibly focused over the last year of how do we evolve that experience to make it one that's more consistent and more contemporary with what most consumers expect the digital experience to be. I think if we can remove the pain points of the experience, then we can get to having deeper conversations with members about their overall health and whatever pharmacy gaps or gaps in care that they may need to address. Just allows us a deeper permission space to engage in that versus the noise of the workflow process.JC Scott (33:28):Thanks Scott. And I will say from my perspective, so sitting here in DC at a association that spends a lot of time with policy makers, those points of friction are often what we hear the most about. And the policymakers' attempt to address in a very broad brush away. If you all are able to continue down the path that it seems that you're on and helping to spread the word about how those points of friction are being addressed, I think that'll be really important for the industry collectively. So thank you for your leadership on that.Scott Greenwell (33:58):Absolutely. It's a big portion of our mission, and I'm really excited with the progress we're making.JC Scott (34:03):Well, Mona and Scott, thank you both so much for joining me today. I really enjoyed the opportunity to visit with you.Mona Siddiqui (34:09):Thank you.Scott Greenwell (34:11):My pleasure, JC. Thank you.JC Scott (34:12):And I'd like to thank everybody for listening. As always, I encourage you to subscribe to The Pharmacy Benefit and download all of our podcast episodes. You can do that on Google Podcasts, Apple Podcasts, Spotify, or wherever you find your favorite podcasts. I'm JC Scott. Thanks for joining me.