Advances in home-based care capabilities and being able to properly address social determinants of health for older adults and chronically ill populations are among “the most impactful” influences on the U.S. health care system, according to Bruce Broussard, CEO and president of Humana Inc. (NYSE: HUM).
Shifts in primary care, pharmacy services and behavioral health are among other major forces, he said Thursday during a presentation at the Goldman Sachs Annual Healthcare CEO Conference.
“If you think about these five areas, they are the most effective areas in deciding downstream use of the health care system, but also [identifying] where there’s an intervention that goes toward the prevention of something negative,” Broussard, who joined Humana in 2011, said.
In addition to highlighting home-based care, social determinants of health and the other influences during his presentation, Broussard also touched on value-based purchasing, the role of technology and a potential Medicare for All model, along with rumors of Humana and Walgreens taking equity stakes in each other.
While Brossard addressed all these topics on Thursday, Humana’s general focus on the home setting largely dominated the conversation.
Other Humana executives, including Chief Medical Officer Roy A. Beveridge, have repeatedly emphasized the importance of home-based care to Home Health Care News as well.
“Site of care, we continue to believe, is going to move from an institutional mindset, where everything is done institutionally, to a much lower-cost setting, including the home and digital,” Broussard said. “We see everything focused on, ‘How do we get this un-institutionalized?’”
Value-based purchasing and emerging technologies
Humana has made leaps and bounds in building its coordinated care model in the past couple years, mainly through the acquisitions of Kindred at Home and Curo Health Services, both of which were completed with private equity groups TPG Capital and Welsh, Carson, Anderson & Stowe.
The one-two punch has effectively turned Humana into a leviathan payer-provider combination with its sights set on “owning the home,” some have described.
In turn, Humana has made substantial progress along value-based purchasing lines, improving health outcomes and lowering health care costs for millions of the insurer’s Medicare Advantage (MA) members in the process.
About 66% of Humana’s 2.9 million individual MA members are affiliated with primary care physicians in value-based agreements, according to company statistics. Overall, these Humana MA members have saw a 7% decrease in emergency room visits and 5% reduction in hospital admissions per thousand compared to the standard MA setting in 2017.
They’ve also reported higher satisfaction scores, Broussard said.
“What we see in the value-based payment models is higher satisfaction of 15% to 20%, higher quality scores, or about the same, in addition to a much lower medical expense ratio,” he said. “We see outcomes with much more significance when we’re in relationships with providers that are aligned with quality and cost.”
Besides prioritizing value-based purchasing, Humana has also made strides — and will continue to focus on — technology advancements, especially when it comes to technology that helps the insurer understand what’s going on in the home, Broussard said.
Currently, the major challenges to broader adoption of technology — such as remote-patient monitoring or telehealth — include interoperability and consumer usage. Indeed, patient data often lives in silos, making it difficult for home-based care providers, health systems or payers to coordinate care.
“Whether it’s a scale in the home, whether it’s a blood pressure cuff or other measurements where you can get real-time [information], that’s a really important part of it,” Broussard said. “The more we penetrate that and get people to use [the technology], the more effective we can be and start seeing conditions progressing.”
Foot ulcers, in particular, are an example of how Humana is looking to use predictive analytics to improve outcomes and cut cuts.
Humana spends about $500 million per year on foot ulcers, which “are completely preventable,” according to Broussard.
The MA opportunity and Walgreens venture
When it comes to utilizing expanded in-home care services on the supplement benefit MA front — which became possible after a Centers for Medicare & Medicaid Services (CMS) rule change in April — stakeholders will have to “walk before they can run,” according to Broussard.
Additionally, progress in rolling out expanded supplemental benefits will need to be provider led, he said.
“Long-term, to compete in MA, you have to be able to manage risk, population risk, you have to have clinical capabilities and you have to be consumer-centric,” Broussard said. “To me, those are three things you need to continue to build and develop.”
In November, rumors surfaced that Humana and Walgreens Boots Alliance (NYSE: WBA) were in talks to expand their business relationship by possibly taking equity stakes in each other.
Humana launched a collaboration with Walgreens in 2018. The collaboration related to providing primary care — with a focus on seniors — in two Walgreens locations in the Kansas City, Missouri, area. The partnership, in many ways, reflects the industry-wide efforts to help older Americans age in place in their homes and communities.
Those rumors “were more speculation than anything else,” according to Broussard, noting that Humana expects to open up more locations through the Walgreens collaboration in 2019.
Humana is predominately exploring scalability with its Walgreens partnership in the meantime, he said.