A few years ago, emergency room physician Dr. Amal Agarwal relied on his training, dedication and dexterity to save patients right in front of him from gunshot wounds, heroin overdoses and heart attacks. Now he employs his medical expertise and knowledge of the health care industry to help Humana save patients all over the country.
Agarwal is one of five doctors that Humana recruited into its Executive Physician Immersion Program, a two-year effort that exposes the medical experts, under the direction of the insurer’s top leadership tier, to various aspects of the business, from marketing and business strategy to health care innovation and contract negotiations with hospitals.
The insurer hopes that a broader base of medical expertise in its leadership ranks — coupled with doctors’ better understanding of all aspects of the company — will allow the company to cut costs, both by identifying the best preventive steps to keep customers healthy — and by selecting the most effective treatments for customers who get sick.
Agarwal worked in an emergency room in Chicago, where he grew up, when interest from Humana prompted him, his wife and two children to move to Kentucky. Agarwal had obtained a doctorate in osteopathic medicine from Des Moines University in 2006, and then got an MBA from the University of Illinois in 2015.
He told Insider that Humana’s program intrigued him in part because it allows him to apply his medical expertise to more patients: not only those he sees in the emergency room — but potentially millions of Humana customers.
Agarwal said that getting exposure in different Humana departments would give him and others in the program insights that better enable them to make needed changes in the health care industry.
Physicians who have completed the program already are working in areas ranging from end-stage kidney failure to chronic disease management and how to serve customers better, said Dr. Worthe Holt, a vice president in the office of the chief medical officer.
Holt said the importance of medical expertise in health insurance companies is increasing, in part because the number of paths through which the insurers can control their risks is diminishing. For example, since the Affordable Care Act, insurers can no longer turn away patients with so-called pre-existing conditions, a standard practice before the law, nor can they charge older patients more than three times more than younger patients.
Those constraints are forcing insurance companies to focus on cutting costs by delivering better care and helping customers to better manage their medical conditions.
For insurers like Humana, that also means expanding the interval during which it expects a return on investments it makes to improve health outcomes.
While many businesses focus on generating a return within a few weeks or months, Holt said that in disease management, especially in mental health or for preventive services, that approach does not work. For example, mental illness treatments, including medications and counseling, can make a tremendous difference, he said, but they also can take a very long time. Investing in those treatments can cost more in the short term, but much less in the long term — never mind that they can significantly improve the patient’s quality of life.
The Executive Physician Immersion Program aims to incorporate a physician’s mindset and focus on patients into the company’s day-to-day business operations to improve patient outcomes remain financially viable, Holt said.
The program also provides insights about Humana’s evolution from a health insurance company into a health care company.
“This expands the voices of physicians and clinicians in shaping our business strategy as a health company,” Holt said. “The investment in human capital is an important and valuable one.” The company declined to say how much it is investing in the program.
Agarwal said that every four months, he embeds in a different Humana department, spending a couple of weeks — and employing lots of one-on-one meetings — to understand that aspect of Humana before he tries to figure out how his expertise can provide the greatest help.
At the end of the two-year program, which Agarwal described as a “two-way interview,” he hopes to find a spot within the company where he can leverage his medical expertise and knowledge of the company to produce a positive impact for lots of patients.
In the ER, he could help only one person at a time but had essentially no ability to make changes systemwide, he said. At Humana, however, the insights he can offer can prove beneficial to potentially millions of people, including patients, but also doctors like him. Agarwal keeps in touch with ER docs and their challenges by spending about 20 hours per month in a hospital emergency room. Those stints also keep his physician skills sharp.
Humana is getting close to having a full cohort of six physicians in the program. Agarwal says that while it’s difficult to predict whether the company will expand the program, it’s certain that it, like the industry, will continue to evolve.
“We don’t know what health care is going to look like in five years,” he said. “But the idea is to be ready for whatever is to come.”