Humana (NYSE: HUM) is leaning even further into the home and its focus on social determinants of health, according to CEO Bruce Broussard.
He hinted that the Louisville-based insurer could be placing even more importance on home- and community-based care in the years to come.
“[With home-based care,] you have this holistic view of the customer, so you can create an intervention based on personal needs, clinical needs and [personal] preferences,” Broussard said. “All of those, I think, will make a great health care system a decade from now.”
Broussard’s comments came Monday during a Medicare Advantage (MA) Summit hosted by the Better Medicare Alliance in Washington, D.C.
Already, Humana sends about 50,000 nurses into the home per day with Kindred at Home, the single largest provider of home health and hospice services in the country, which is 40% owned by the insurer.
Humana — along with private equity groups TPG Capital and Welsh, Carson, Anderson & Stowe — acquired Kindred last year for $4.1 billion.
Since then, Kindred at Home has given Humana new insight into managing the health of beneficiaries in the home.
“A nurse or a social worker in the home has so much influence on the individual’s care model,” Broussard said. “They have so much influence because it’s convenient, they see the holistic aspect of how an individual is living, and they build a deeper relationship.”
Broussard only expects access into the home to expand in the years to come, he told summit attendees, pointing to regulatory changes and technological advancements as catalysts.
“We see home [care] evolving in a few ways,” he said. “We see home [health care] … moving from a therapy-based model that reimbursement has always oriented to therapy — and that’s really where the rewards were — to a nursing model where you can take care of a more expensive population — COPD, CHF, diabetes.”
Industry-wide, that evolution is already in the works, thanks to the Patient-Driven Groupings Model (PDGM), which takes effect Jan. 1. PDGM eliminates therapy-visit volume as a determining factor in calculating reimbursements, meaning therapy will no longer automatically drive revenue for home health agencies.
Broussard lauded the move and its role in incentivizing value-based care.
“So you see the organization today — we’re in six states now — moving in that direction,” he said. “We’re paying for reduction of ER visits, reduction of hospitals stays and improvement in some quality measures.”
On top of delivering better care, Broussard shared his belief that Kindred will soon be able to provide care to a wider population.
“We see technology being able to facilitate a much broader delivery model and capturing deeper intervention that [leads to] better intervention down the road.”
Broussard’s keynote came just days after Humana named Susan Diamond the next leader of its ever-evolving home business segment.
Humana’s home business segment aligns all of the insurer’s home care elements into a single operating unit, according to the company.
“Humana’s home solutions business will help our members receive simpler and personalized care they need in their homes,” a spokesperson told HHCN. “In addition to bringing physicians and clinicians to meet our members where they are, through the power of technology, we can virtually bring the physician into the home to engage the member and the clinician, which helps them understand the non-health factors that affect a person’s life.”
Tackling Social Determinants
Even before Humana acquired Kindred at Home, the insurer had already started to pay attention to how beneficiaries behaved at home and in their communities.
In 2014, the insurer launched its “Bold Goal” initiative to address social determinants of health such as loneliness and food access in select communities. The goal of the program is to improve the health of those communities 20% by 2020 by focusing on members’ clinical and social needs alike.
“A large part of how people’s health evolves is around their lifestyle,” Broussard told attendees. “We’ve found that their communities have a large impact on their lifestyle, such as access to parks, food or social programs.”
While Humana has spent the past several years building a community infrastructure through relationships with food banks and social programs, the insurer is now focused on identifying beneficiaries who can benefit from those services, Broussard said.
He used a Miami-based beneficiary as an example.
“She said I cannot afford [my prescriptions], … so it’s my drugs or my food,” Broussard said. “I put her on hold, called the Miami office and said, ‘Can we get the food bank to deliver food to this individual?’ That day, we have 20 days of food delivered, and she did not have to make the choice.”
Broussard praised regulatory flexibilities — such as those forthcoming in MA in 2020 and beyond — for allowing plans to do more to address social determinants of health. Similarly, he sees opportunities for MA itself to boom.
“If we do our work the right way, I can see Medicare Advantage being the payment model that is being used … to fill that need where people don’t have an employer plan and they’re not being covered by Medicaid,” Broussard said. “I’m biased as hell. But I just think Medicare Advantage has all the elements, and how can we take that and bring that in line with other coverage, cost and quality.”