For many Americans, myself included, managing our healthcare can feel like a second job.
That's why I spend a couple hours every six weeks talking with Medicare Advantage members about their experience navigating our healthcare system. Over time, those conversations have turned into real relationships, with room to talk openly about what’s working and what’s not.
More than one member has told me some version of the same thing: "I shouldn't need to become an expert in healthcare to use the healthcare system."
And yet, they've made something else clear, too: they value Medicare Advantage and chose it for a reason. The program matters enough to them that they're willing to spend their own time helping it improve.
Those conversations have been on my mind as Humana approaches an important milestone. This month, we turn 65—the same age Americans become eligible for Medicare.
That milestone has led me to a question:
Have we made healthcare better or have we simply asked people to get better at navigating it?
Our standard should be the former. As Humana turns 65, we owe it to our members, our shareholders, and ourselves to ask whether we’re living up to Medicare’s promise.
Medicare Advantage was built to deliver better benefits, better value, and more coordinated care for seniors with a wide range of health needs. But for the people who rely on it, the promise is even simpler: no one should have to navigate healthcare alone.
The program has delivered real value for millions of Americans by focusing on better health rather than just covering the next procedure. That's why more than half of Medicare beneficiaries now choose it. The stakes have never been higher.
Medicare Advantage works. But it must work better.
Believing in Medicare Advantage Means Improving It
Too often, the conversation around Medicare Advantage leaves little room for nuance. Critics often overlook the value the program delivers, while supporters are sometimes too quick to defend the status quo.
Neither one helps members.
The most compelling argument for Medicare Advantage isn't found in a policy paper or a statistic. It's found in the experiences of the people who rely on it.
Consider the experience of one of our members, Sheereen.
She was juggling congestive heart failure, COPD, and atrial fibrillation, and multiple specialists for each. She felt overwhelmed and kept ending up back in the hospital.
Then her Humana At-Home Nurse Care Manager stepped in. She worked alongside Sheereen and her care team.
Together, they uncovered a dangerous medication interaction no one had caught.
Sheereen later told us that first conversation “saved my life.”
For her, the difference wasn't a benefit design or a policy change. It was having someone help navigate a complicated system. That's a big part of what Medicare Advantage should do: give people a partner in their care, not another system to navigate.
But Medicare Advantage is not always experienced this way. If we're willing to celebrate stories like Sheereen’s, we also must be clear about when the experience falls short.
Complexity is a Choice
Many of the frustrations people experience in healthcare have nothing to do with the care they receive.
One member told me he had learned to ignore notices from Humana saying a claim had been denied. He knew from experience that many of those claims weren't, in fact, denied at all. They were still being reviewed and would ultimately be approved. So, he simply tuned the notices out.
That's what happens when people stop expecting the system to make sense.
We've since addressed this issue: our claims notices now say “pending” when appropriate. That fix underscores that many of these frustrations aren't inevitable. They're choices. And we have the power to make different ones.
For instance:
- We’re simplifying member communications, reducing outreach that does not help our members, and tailoring communications around each member's actual needs. A woman with a double mastectomy doesn’t need mammogram reminders.
- We’re making open enrollment information clearer and more personalized and improving digital tools and provider directories so members can more easily understand who is in network and where care is available. People shouldn't need detective skills to find a doctor.
These are meaningful steps. But they’re not enough.
We need to create an experience that's easier to understand, easier to navigate, and easier to trust. This is what it means to be a consumer healthcare company.
Removing Barriers to Care
Nobody wakes up hoping to deal with paperwork, delays, or uncertainty about whether care will be approved. And while prior authorization serves an important purpose as a check and balance that ensures care is safe and appropriate, the process is not working for members today.
The best prior authorization experience is one that patients never notice. That means reserving it for situations where it’s truly needed and working with providers to make approvals faster, simpler, and more predictable.
If we're serious about making healthcare easier to navigate, we must tackle prior authorization. Humana is doing exactly that.
- We've eliminated prior authorization requirements for hundreds of services.
- We’ve created a faster and more streamlined process for approvals: responding within one business day to 95% of requests and have expanded electronic submissions.
- We’re launching a national gold carding program later this year that would exempt providers with strong track records from many prior authorizations.
The Work Ahead
I've focused here on what Humana can control. But we don't operate in a vacuum.
The experience members have is also shaped by providers, public policy, funding decisions, and regulations that affect how healthcare is delivered.
After decades serving seniors, Humana has learned a great deal about what works, what doesn't, and where the system often falls short for the people it serves. We have a responsibility to bring this expertise to the ongoing conversation about how to strengthen Medicare for future generations.
It’s why I intend for this note to be an annual tradition – a chance to reflect on how well healthcare is serving seniors and on Humana’s role in making it better.
Those conversations won't always be comfortable. But we have a responsibility to make our healthcare system more transparent, less frustrating, and more responsive to the people it serves. That means confronting what's standing in the way and working together to change it.
After all, the goal isn't to make people better at navigating healthcare. It's to make healthcare better at serving people.
