Jonathan Morse, Regional President – Medicare Advantage, Humana

Invest: spoke with Jonathan Morse, regional president for Humana’s Medicare Advantage business, about the company’s near-term priorities in Raleigh-Durham and across North Carolina, from benefit stability to value-based care partnerships. “The goal is to offer benefit packages that are accessible to a broad portion of the Medicare Advantage population in the region, regardless of income levels,” Morse said.

What are your top strategic priorities for Humana’s Medicare Advantage business this year, and looking ahead to the next couple of years?

Humana has a significant presence in North Carolina, with a long track record of serving Medicare Advantage members across the state. In Raleigh-Durham specifically, we plan to continue growing that market while keeping our focus on stable, affordable, and consistent benefits for members. The goal is to offer benefit packages that are accessible to a broad portion of the Medicare Advantage population in the region, regardless of income levels. This past year, we also expanded plan options in North Carolina to give members more choice while keeping benefits stable and predictable.

We also want to be as preventive and proactive as possible in how we engage members. That means thinking about more personalized and more digital outreach and getting members connected to primary care and interacting with their own care and their providers on a regular basis. If we can address healthcare issues earlier, it supports better quality of health and better access to high-quality providers.

Over time, we are also looking at how we integrate tools that help members manage their health and benefits, including options like text messaging, wearable solutions, and other approaches that support understanding, engagement, and consistent self-management.

We’re intentional about using data and community partnerships to reduce disparities in access and outcomes across urban and rural communities in North Carolina.

Over the next few years, we’ll keep investing in data and digital tools, deepening value-based partnerships, and community engagement so members have easier access to high-quality care — no matter where they live in North Carolina. 

How is Humana adapting Medicare Advantage plan design to prioritize simplicity, stability, and quality care for members?

Healthcare costs continue to rise, so maintaining consistent benefits is a significant priority at both the national level and in markets like North Carolina. One of the central questions we focus on is what members care about most. Beyond benefit stability, we’re working to simplify the experience – clearer tools and fewer administrative hurdles so people spend less time on paperwork and more time on their health. In Raleigh-Durham, we want to understand the patient population, its makeup, and what benefit priorities members have.

We also work to create a benefit package that is predictable year over year. We aim to design benefits that feel predictable year over year, even as the broader environment changes. 

In a competitive, rapidly changing Medicare Advantage landscape, how do Humana’s plans stand out in benefits, preventive care, and the member experience?

First and foremost, Humana is widely recognized as a national leader in value-based care partnerships. That means we focus on the quality of care delivered rather than just volume. We want to make sure members are getting quality outcomes and access to primary care early and often, which can reduce costs over time and prevent more severe issues from developing.

We pay attention to how healthcare is delivered, not simply paying providers based on the number of times they see someone. We are focused on outcomes, and that means putting a huge emphasis on primary care. In Raleigh-Durham, primary care access is especially important. It is a large and sophisticated healthcare market with high-quality care for Medicare Advantage members, and we want to ensure our members can access that care consistently.

We also focus on managing common chronic and mobility-related conditions that increase with age, including diabetes, heart disease, issues connected to weight gain and mobility, and musculoskeletal challenges. The priority is to address those comprehensively and early, and to engage the right doctors and care teams. For common conditions, the objective is good access to care and consistent access for members and providers.

We continue to expand our value-based provider network and primary care network across the state. We also proudly serve the North Carolina State Health Plan, which includes retirees across the state, many of whom reside in the Raleigh-Durham region. We are focused on engaging that member population, ensuring access to primary care, and maintaining benefit structures that remain affordable and consistent.

With healthcare costs rising, how does Humana balance affordability for members while maintaining sustainable performance in Medicare Advantage?

It is tricky, and part of the answer goes back to access and early intervention. The sooner we can connect members to primary care or the correct kind of care, the more likely we can prevent higher costs down the road for members and for the broader system. We focus on encouraging members to have a primary care physician or clinician, whether that is a physician, nurse practitioner, or physician assistant, and to access that care as early as possible.

We also work to provide a broad array of services so we understand the needs within the member pool. In North Carolina, we think carefully about rural healthcare access and how to engage members who do not have as much access to care. We look at transportation services, telephonic support, and virtual care where it makes sense, with the goal of connecting people to healthcare as early and consistently as possible. We’ve made sustained investments in digital platforms and telehealth so members across North Carolina can connect with their doctors and get support from home.

Beyond cost pressures, what are the biggest operational challenges facing Medicare Advantage organizations today?

Like many organizations, we’re navigating workforce constraints across the healthcare system. That’s why our models emphasize team-based care and tools that help clinicians spend more time with patients. The population is aging, and we face complex challenges around issues like dementia care, obesity, mental health, food insecurity, and the practical realities of helping members get to the right provider in the right setting. Rural access remains a key factor in parts of North Carolina, and that adds complexity as we connect people to providers and services.

A significant part of my role is building relationships across the Raleigh-Durham and North Carolina area so we can expand access to a variety of services for members. People are living longer and want to remain in their homes with as much mobility as possible, and we want that for them as well. The question becomes how we ensure members have the right access to services that support independence and quality of life.

We also pay close attention to the regulatory framework at the federal level, since Medicare is governed in Washington, D.C. We invest in interoperability so data moves securely between payers and providers, and we aim to meet regulatory requirements early so members and clinicians don’t feel the friction. We try to anticipate challenges and track changes that could affect the program and member experience, including questions around primary care access, physician pay, and rising administrative costs.

How is Humana expanding access to Medicare Advantage offerings through new plan types and services, including for members with complex needs?

We think consistently about how to serve populations with different needs, including those who qualify for both Medicare and Medicaid. In North Carolina, we offer a DSNP, or Dual Special Needs Plan. Medicaid typically covers people who are lower income or disabled for a range of reasons, and that can include older adults who become lower income over time.

The intent is to provide plans that address both Medicare and Medicaid services and coordinate care for members. We also coordinate around home health benefits to support smooth access for members who qualify for home health services under Medicare.

Prescription needs are another major area of focus, especially with rising prescription drug costs and the emergence of new pharmaceutical interventions. We structure coverage decisions around evidence-based policies and coordinate with members’ care teams to ensure therapies are appropriate and well-managed. We are actively thinking about how to structure access to these therapies and how to coordinate care so members have the right benefits for their prescription needs. Digital reminders and care team outreach help members stay on track with medications, which is critical to outcomes and cost. 

From your perspective, what is important for business and community leaders to understand about healthcare in Raleigh-Durham and Humana’s role in the region?

Raleigh-Durham and North Carolina overall have strong access to healthcare. There are strong hospital systems and high-quality care available, and Humana has a significant footprint in the region and plays a meaningful role in serving Medicare Advantage members there. We also collaborate with community organizations in the Triangle to address practical barriers, like food insecurity and transportation, that affect health outcomes. 

Maintaining partnerships is critical. We need to be strong partners to healthcare providers and major hospital systems in Raleigh-Durham, and we hope for strong partnerships from them as well. Those relationships are essential to serving a broader membership population and sustaining the quality of care and access that make the region stand out. Our aim is to advance population health, making high-quality care easier to access for every community in Raleigh-Durham.