Humana’s Blueprints for Building Its ‘Home-Centric Ecosystem of Care Delivery Assets’

In 2019, Humana Inc. (NYSE: HUM) decided to reorganize its operations and create a dedicated business segment focused on the home.

The Louisville, Kentucky-based health care organization has spent the past several months refining that home segment by fully mapping out its strategy and scope of services, according to its leader and president, Susan Diamond, a 14-year Humana veteran. Thanks to that planning, the segment is now positioned to go full-speed ahead in 2021 while testing out the hospice carve-in for the first time.

“This was done with the intent of allowing us to accelerate toward a broader ambition around the home, specifically related to home-centered care delivery models,” Diamond said at the Home Health Care News FUTURE conference last month. “When we formed the new segment, what we decided to do was set [previous strategies] aside and really take a fresh look with a much wider aperture. We formed a new opinion about the range of services that we wanted to make available, again, with a sort of home-centric ecosystem of care delivery assets in mind.”

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Broadly, Humana’s in-home care efforts can be broken down into two categories: in-house assets and external partnerships.

The health insurance giant’s internal assets include Humana At Home, Kindred at Home and Your Home Advantage, a health care management company that Humana acquired in 2015.

Meanwhile, its partnerships include joint programs with Papa, a startup focused on addressing social isolation, loneliness and other social determinants of health. They also include investments in companies like in-home primary care provider Heal and DispatchHealth, which coordinates in-home urgent care and hospital-at-home services.

The ultimate goal of having such diverse internal and external home-centric touchpoints, according to Diamond, is to create a holistic care delivery model that’s free of gaps.

“Once you build out this ecosystem of care delivery assets, there’s real power in referring patients across some of those offerings and making those services available in a smooth, simple, intuitive way, with the primary care doctors serving as the quarterback in coordination of all those services,” she said.

An ‘ecosystem of care delivery assets’

Humana has had home-focused programs for years, both in terms of medical and non-medical services provided in the home. With its minority investment in Kindred two years ago, Humana doubled down on the home — and an overarching value-based care approach.

“We’ve been working to advance and mature some of those models with a focus on a value-based mindset, particularly the Kindred asset,” Diamond said. “Our ambition around Kindred was not in the … fee-for-service home health [space]. We had the mindset of transforming that into a true value-based operating and payment model that would serve to really improve the care that can be delivered in home health. We want to address gaps, improve patient outcomes, optimize care delivery and improve patient satisfaction.”

Doing so benefits Humana’s members and patients, but it also is advantageous to the company’s bottom line.

Overall, about 20% of the Humana patients who are benefiting from a home health episode of care will eventually experience an ER or in-patient event during that episode, Diamond noted during FUTURE. Added up, those trips to the ER or in-patient facilities cost Humana about $800 million in potentially avoidable spend each year.

“We are really intentional about better understanding the quality of care delivered, the gaps in care being delivered, not through the fault of the home health agency, but just sort of the fault of the system, more broadly,” she said.

Apart from the “ecosystem of care delivery assets” Humana continues to build out, it has also worked to strengthen its risk-stratification and predictive-modeling capabilities.

Humana showcased some of its in-home strengths on Thursday when it announced the details of its 2021 Medicare Advantage (MA) offerings.

Next year, most Humana MA members will continue to have access to Go365, a wellness and rewards program designed to motivate and reward members for taking steps to improve their healthy behaviors.

Additionally, eligible Humana MA members who need help remaining independent at home will have access to their own personal care manager through Humana At Home. Humana At Home care managers will call qualifying members regularly, providing personalized education and assistance in accessing resources for medications, transportation and more. Members leaving a hospital who are at high risk to be readmitted can also get guidance from Humana at Home’s care managers.

Testing out the hospice carve-in

Next year officially marks the beginning of the demonstration project to test the inclusion of hospice in the Value-Based Insurance Design Model, often referred to as the Medicare Advantage hospice carve-in.

Among the nine insurance companies that will participate in the hospice carve-in in 2021, Humana Inc. will be the most active, data from the U.S. Centers for Medicare & Medicaid Services (CMS) shows.

“When CMS introduced the demo, we were the first ones to get excited about it and begin thinking about how we can use it,” Diamond said. “We will participate in 2021, on about 10 plans. We’re going to test it out, with the intent of scaling more broadly over the longer term.”

A total of 53 MA plans will offer increased access to palliative care and integrated hospice care through next year’s carve-in. That group will cover roughly 8% of the market, with a limited geographic footprint, according to the CMS data.

Besides Humana, Kaiser Foundation Health Plan is the only other large insurer to participate in the carve-in.

Humana has “identified a number of top hospice partners” that it’s working with, Diamond said.

“Many of us who are associated with these types of businesses tend to have a personal connection,” she added. “I had a personal experience with my mother, where she was able to benefit from hospice. A lot of us have this personal experience. I really understand and appreciate the value of the hospice model.”

Along hospice carve-in lines, Humana will also explore how palliative care fits into its long-term vision.

“We have built algorithms that predict members who are approaching end of life, but who are pre-hospice eligible,” Diamond said. “We’re also working with providers to self-identify those patients who might benefit from [palliative care]. And we intend to make available truly comprehensive palliative services for patients, creating much smoother transitions through end of life.”

Figuring out the future

Now that Humana has a relatively diverse home care network in place, its next step will be to add scale.

“Many of those sort of home-centered capabilities are still fairly nascent in terms of geographic coverage,” Diamond said. “So in the very near term, we’re going to be working with our partners to expand access to those high-quality services, the in-home primary care models, the hospital-at-home-type care.”

Humana has already made strides in reaching that goal in 2020.

In July, Humana announced it is investing $100 million into Heal to help fast-track the Los Angeles-based in-home primary care provider’s growth and propel it into new markets. A month before, it was among the investors that participated in Colorado-based DispatchHealth’s $135.8 million Series C round.

At the same time, Humana will continue following the rise of telemedicine and virtual care. The company has embraced telemedicine during the COVID-19 crisis, but more information will need to be gathered to understand the impact virtual care and telephonic visits have on individuals’ health.

“I do think that some of that will come down to reimbursement philosophy. Most payeryres, or at least many payers, made the decision to provide pay parity — [equal] rates for telemedicine and clinic-base rates during the pandemic,” Diamond said. “We’ve continued to do that through your end. But we’ve got to figure out, ‘What are we seeing from the telemedicine interactions? Are they quality interactions? What are the outcomes we’re seeing?’”

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