The rise of value-based care models — or approaches to care that prioritize quality more than quantity — has meant primary care physicians have had to rely on a team-based approach to stay connected to patients in their everyday lives.
That’s why, according to Humana Inc. (NYSE: HUM) leadership, the future of health care is in the home.
Louisville, Kentucky-based Humana — which, along with two private equity firms, acquired Kindred at Home earlier this year — has repeatedly underscored the importance of home health within the broader continuum of care. The health insurance giant did so again on Tuesday as part of its latest progress report on value-based care adoption.
“You have to go where the member or the patient is,” Humana Chief Medical Officer Roy A. Beveridge told Home Health Care News. “Patients spend 98% to 99% of their time in their homes, so for us to believe that we can help someone in their health and not be where they are most of the time doesn’t make any sense.”
By and large, Humana’s value-based care report detailed substantial progress in terms of increasing preventive care, improving health outcomes and lowering health care costs for the insurer’s millions of Medicare Advantage (MA) members.
A major way Humana has been able to accomplish those goals has been by reaping the benefits of comprehensive home health services and keeping people out of the hospital.
Humana MA members affiliated with physicians in value-based agreements experience 7% fewer emergency room visits and 5% fewer hospital admissions per thousand compared to the standard MA setting in 2017, according to Tuesday’s progress report.
About 66% of Humana’s 2.9 million individual MA members are affiliated with primary care physicians in value-based agreements.
In addition to avoiding hospitalizations, Humana’s value-based care initiatives have also contributed to lower health care costs. Specifically, medical costs for patients who are affiliated with physicians in Humana MA value-based agreements were 15.6% lower than original Medicare FFS, according to the report.
Home health’s ‘top-of-license’ advantage
Value-based care alters the model of medicine for the primary care physician from an encounter-based relationship to one focused on holistic patient care. Additionally, as physicians in value-based models shoulder more financial accountability, it, in turn, pushes them to connect with patients outside the office, Beveridge said.
A perk of having a strong home-based care presence: the flexibility to let physicians and nurses tackle the skilled health challenges for which they were trained.
“If you have somebody from home care going into the patient’s home and taking care of a diabetic foot ulcer, then reporting back to the doctor, then they’re doing what they’re trained to do,” Beveridge said. “The nurse is doing what she’s trained to do. Let’s get everybody working at the top of their license, which is going to improve care, reduce cost and improve outcomes.”
While Humana’s value-based care report detailed continued progress, it also emphasized how chronic disease and other factors still pose serious challenges.
About nine out of every 10 Humana MA members have at least one chronic health condition, according to the report. About eight out of every 10 MA members have at least two chronic conditions.
On average, Americans with five or more chronic conditions spend 14 times more on health services than people with no chronic conditions, a 2017 RAND Corporation report found.
The U.S. Centers for Medicare & Medicaid Services (CMS) is currently testing home health providers’ ability to slash health care costs and keep individuals with multiple chronic conditions out of the hospital through a nine-state value-based purchasing demonstration.
The shift from fee-for-see to value-based care comes at a time when the U.S. health care system continues to see ballooning costs. Health care spending reached roughly $3.3 trillion in 2016, or about 18% of the country’s gross domestic product.
“What we’re seeing with the value-based report is that we’re still in this transition, and getting people through the transition will be crucial,” Beveridge said. “I don’t think we should over-promise anything. But I think we’re going to get people to understand the need for value-based care in the next couple of years.”
Humana’s chief medical officer spoke with HHCN following a physician panel discussion in Chicago. The panel was sponsored by Humana and concluded shortly before the value-based care report became public on Tuesday.
“What I’ve learned in my 31 years as a general internist is the importance of the care team to delivering the care,” Dr. Christine Sinsky, vice president of professional satisfaction at the American Medical Association, said during the discussion. “The importance of continuity, comprehensiveness and attention to all of the details.”
Moving forward with Humana At Home, Kindred at Home
Humana has taken multiple steps toward investing in its integrated care delivery strategy ultimately aimed keeping individuals with Humana MA plans stay in their homes and away from costlier settings.
None of those steps was bigger than its move to acquire Kindred at Home, which sees more than 570,000 patients daily across 41 states, making it the largest provider of home health services in the country. TPG Capital and Welsh, Carson, Anderson & Stowe first announced they were acquiring Kindred for about $4.1 billion in December 2017.
Moving forward, Kindred at Home will operate in tandem with Humana’s legacy home health segment, Humana At Home.
“Kindred at Home will be the extension in the home in terms of touching and caring,” Beveridge said. “Humana At Home will remain what it is now, which is helping to use the analytics, using the telephonic connection and having various folks going into the home, but not allowed to treat the patient.”
Written by Robert Holly