Count Humana Inc.’s chief medical officer (NYSE: HUM) among those who think the coronavirus is accelerating the U.S. health care system’s shift toward the home.
Since the COVID-19 outbreak began to ramp up in March, the Louisville, Kentucky-based insurance giant has seen a substantial demand for all sorts of in-home care services, including telehealth-powered primary care visits, home-delivered meals and more. Internally, Humana has been building around the home for years, with Humana At Home and Kindred at Home serving as two prominent examples of those efforts.
Kindred at Home is currently ranked as the No. 1 largest home health provider in the country, according to LexisNexis. Humana — along with private equity firms TPG Capital and Welsh, Carson, Anderson & Stowe — acquired Kindred at Home in 2018 for $4.1 billion.
In light of the coronavirus, Humana’s home care business is now at a “unique” and “transformative” moment, CMO Dr. William Shrank told Home Health Care News during a recent one-on-one interview.
“At a time where patients don’t necessarily feel safe going to health care facilities, the concept of being cared for in the home — whether it’s in person, by a home care provider, by leveraging digital technology or through some combination of all of the above — seems to be … accelerating,” said Shrank, who joined Humana in April 2019. “Patient demand for those visits is rising. We’re seeing much more demand for in-home visits and in-home assessments. And we think that this is a moment that is going to help really expand the way in which our home care business meets the needs of our members and patients, generally.”
The coronavirus is accelerating movement toward home-based care in a couple of key ways, he mentioned.
On a high level, individuals — especially older adults — are trying to stay out of crowded facilities, places where their exposure to the virus is potentially heightened. Additionally, apart from its obvious health consequences, the coronavirus brings a confluence of behavioral and social challenges.
For seniors, for example, social distancing and sheltering in place may mean being alone for longer periods. That loneliness, in turn, can lead to worsening behavioral health conditions, according to Shrank.
“We’re seeing just a massive amount of depression and anxiety,” he said. “If you’re already depressed, there’s a good chance your condition is exacerbated. If you’re anxious at baseline, there’s a good chance that your condition is going to be exacerbated.”
Additionally, a need to stay at home may force some older adults to avoid grocery shopping, causing their nutritional intake to suffer. To prevent that from happening, Humana has teamed up with a variety of partners to provide over half-a-million home-delivered meals over the past couple of months.
In-home care can help alleviate both behavioral health challenges and nutritional challenges, while fostering some degree of normalcy during an uncertain time.
“This is the pandemic of the century,” Shrank said. “It’s extraordinary how disruptive this has been to the lives of essentially all Americans.”
A timeline
Humana — a company that falls into the increasingly popular “payvider” label — has addressed the coronavirus in several different ways, Shrank said. He walked HHCN through all of them during the recent interview, starting at the very beginning.
In mid-March, Humana announced it was expanding the availability of telehealth services for its Medicare Advantage, Medicaid and commercial employer-sponsored plans to reduce COVID-19 exposure risk. Around the same time, the company began waiving costs associated with coronavirus testing.
“The two main activities we did at the outset were eliminating cost sharing fo all coronavirus-related tests and eliminating cost sharing for telehealth — not just for COVID-19-related telehealth, but for primary care, urgent care and behavioral health,” Shrank said. “We wanted to make sure that we were facilitating access to health care in the safest possible setting. And for many members, that meant being able to offer care from their home.”
As the COVID-19 crisis worsened, Humana began taking more aggressive measures.
In late March, Humana announced that — in addition to testing — it would cover costs related to COVID-19 treatment. Strategically, the company also began restructuring its outbound phone calls to high-risk members, with the Humana At Home team helping to carry out the proactive outreach.
“Rather than having more disease-focused [calls] or calls for chronic-disease management, it was much more proactive and open-ended,” Shrank said. “We were calling high-risk members and saying, ‘How are you doing? What do you need?’”
It was “extraordinary” to see how frequently those calls involved complaints about social needs, the CMO noted.
After initially waiving COVID-19-related costs, Humana announced on May 5 it would waive all cost sharing — including copays, coinsurance and deductibles — for in-network primary care, behavioral health and telehealth visits for the remainder of the calendar year. The company simultaneously revealed it would send safety kits — complete with masks and health guidance — into members’ homes.
Besides keeping members safe, the goal of the kits was also to support Humana’s provider partners, Shrank said.
“We expect this will help our home care providers feel safe,” he said. “Our home care providers, ideally, they have personal protective equipment (PPE) for themselves. But clearly, many don’t have PPE for their patients, for their caregivers. This is one way to kind of create a safer environment for those face-to-face interactions in the home.”
Provider actions
While Humana has taken multiple steps to keep its members safe and reduce financial barriers to care, it has likewise taken steps aimed at streamlining paperwork and administrative burdens for providers.
First, Humana implemented simplified and expedited claims-processing practices to get reimbursement payments to providers as quickly as possible. Additionally, the company expanded its policy of suspending prior authorization and referral requirements, instead requesting notification within 24 hours of outpatient and in-patient care, the latter of which includes both acute and post-acute care services.
“We turned off all prior authorization around getting patients out of the hospital to post-acute care settings,” Shrank said. “The last thing we wanted to do is something that would gum up the system at a time we’re trying to reduce constraints on health care capacity because of the virus.”
Most recently, Humana teamed up with Uber Health, Papa, the Coalition to End Social Isolation and Loneliness, and the NASA-funded Translational Research Institute for Space Health (TRISH) to launch the “Far from Alone” public health awareness campaign.
Generally, the campaign was created to address health-related social needs and promote understanding of loneliness and social isolation.
“A person’s health encompasses much more than doctor’s visits and medications,” Lauren Steingold, head of strategic initiatives at Uber Health, said in a statement. “It includes access to food and exercise, education and financial stability, and – especially during times like these – socialization and community engagement.”
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