Study shows Healthy Days as valid method to evaluate overall population health

Humana Inc. today announced results from a study that found a relationship between patient-reported, health-related quality of life (HRQoL) and multiple objective measures of health in elderly Medicare Advantage patients with chronic conditions.

The study was published in The American Journal of Managed Care and co-authored by researchers from Humana, the Robert Wood Johnson Foundation, and the Centers for Disease Control and Prevention (CDC). The findings underscore the validity of using Healthy Days data to supplement traditional health measures in assessing health status in this population and to evaluate overall population health.

The study found that patients with six chronic conditions (coronary artery disease, chronic obstructive pulmonary disease (COPD), hypertension, diabetes, congestive heart failure, and depression) experienced a greater number of physically and mentally unhealthy days than the population average. However, those who were compliant with certain quality measures related to their chronic conditions, such as diabetic eye exams or medication adherence, reported fewer unhealthy days. Patients who reported more unhealthy days had higher health care utilization (doctor visits and hospitalizations).

The researchers used the survey instrument Healthy Days to evaluate HRQoL, a CDC measure that assesses the total burden of disease in a population, including physical, emotional, and mental health and social functioning. Healthy Days uses four questions to assess how individuals perceive their recent health and how many days over the previous month they felt physically or mentally unwell.

"This is an important study showing how Healthy Days data correlates with health indicators from administrative claims, and the findings show the survey tool is a valid method to evaluate overall population health," said Tristan Cordier, MPH, analytics manager, Clinical Analytics at Humana and lead author of the study. "These results also support Humana's decision to use Healthy Days to measure progress toward its goal of improving the health of the communities served by 20 percent by 2020."

On average, the study population reported seven physically unhealthy days and four mentally unhealthy days, with a third of patients reporting zero unhealthy days. COPD and depression had the biggest incremental impacts on HRQoL with 2.93 and 2.41 excess physically unhealthy days and 1.08 and 4.02 excess mentally unhealthy days, respectively.

Patients who reported more unhealthy days had higher adjusted health care utilization (doctor visits and hospitalizations) and higher costs.

Not completing diabetic eye exams and LDL cholesterol screening or not having good control of diabetes (measured by hemoglobin A1c) was associated with significantly more physically unhealthy days after adjusting for potential other factors affecting HRQoL. Similarly, not completing diabetic eye exams and not controlling LDL cholesterol in diabetes were associated with significantly more mentally unhealthy days. In addition, nonadherence with angiotensin converting enzyme inhibitors or angiotensin receptor blockers and oral diabetes medications was associated with significantly more physically and mentally unhealthy days.

The study evaluated a Medicare Advantage population of 55,681 individuals who had a mean age of 75 years, were 56 percent female and 87 percent white. Hypertension and congestive heart failure were the most and least prevalent chronic conditions (73 percent and 12 percent), respectively.

Humana is creating population-level health care interventions that can potentially reduce the burden of chronic disease and improve overall wellbeing. Future studies will use Healthy Days data to investigate the impact of such interventions. Humana remains committed to its Bold Goal of improving the health of the communities served by 20 percent by 2020.