Humana At Home President: The Industry Will Adapt to PDGM

With a focus on addressing the social determinants of health through non-medical care, health insurance giant Humana Inc. (NYSE: HUM) has set its sights on care in the home.

In addition to Humana At Home, the company sends almost 50,000 nurses into the home daily through Kindred at Home, the largest provider of home health and hospice services in the country. Humana acquired an ownership stake in Kindred at Home in 2018.

Home Health Care News recently caught up with Kirk Allen — who took over Louisville, Kentucky-based Humana’s home operations as president of Humana At Home in 2017 — at the Senior Care 360° Strategy and Solutions Conference in National Harbor, Maryland.

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During HHCN’s conversation with Allen, the executive touched on Humana’s focus on social determinants of health, the company’s growth trajectory and what the Patient-Driven Groupings Model (PDGM) could mean for home health business at large.

These and other highlights are below, edited for length and clarity.

HHCN: In 2014, Humana launched the “Bold Goal” initiative to address social determinants of health. The goal was to improve the health of certain communities 20% by 2020. Now that we are closer to 2020, can you talk about this?

Allen: There’s a big focus on social determinants of health. It definitely has an impact on how a member receives and manages care or even access care. I know there’s been a lot of work done there.

What is next for Humana At Home in terms of growth?

Our biggest focus right now is integrating clinically between Humana and Kindred to better leverage the information we gain from both the provider side and the insurer side to ensure better care for our Humana members that are either in Kindred or Curo hospice. That’s our growth focus right now.

We had five pilots [hospice and home care] markets, and we are taking the early lessons from our work in those markets and applying them to operations in six states: Georgia, North Carolina, South Carolina, Virginia, West Virginia and Kentucky

Our clinical integration team is housed within Humana At Home, and that team is taking information and best practices from Humana — and best practices and information from Kindred — and working with the local agencies to ensure those practices and information make it into the member’s care plan.

With PDGM coming in 2020, do you have any views on what this could mean for your business going forward?

PDGM is definitely a shift in care. We are seeing a change in the care being driven largely by how much therapy is provided to payment being shifted to multiple chronic condition members. We think that’s the right direction for health care. It’s where a lot of health care costs are.

We think with appropriate care in the home — interventions for that chronic population — we can see more value delivered. We can see costs reduced. We can see a reduction in hospitalizations. We can see a reduction in ER utilization.

Overall, we see PDGM as positive.

It’s a challenge for the industry, but we are confident the industry will adapt.

There is increasing emphasis on addressing patients’ non-medical needs among policymakers, providers and payers. How does this change the game?

We are seeing what appears to be a willingness to have a loosening of the regulations around what you can provide from a supplemental benefit standpoint. It’s pretty clear that social determinants have an impact on people’s health and their ability to access care. The degree to which we can use the supplemental benefits to be able to help intervene those social determinants, we think, is going to have a positive impact on people’s health overall.

Humana is a payer that has become a health care provider — even when it comes to hospice. What insights have you gained through that experience?

We have learned that there is a real depth in the clinical relationship that exists between the hospice care providers and the hospice patient and the patient’s family, as well as how holistic the benefits of hospice are. There is a medical component. There is a spiritual component. There is bereavement care for the family following the patient’s death.

We are learning to take a look at those interactions and consider how we can leverage that time we spend with the [Humana] member in their homes, and how we can take full advantage of that moment of influence to really help serve that member.

Additional reporting by Jim Parker

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