After Successful PDGM Transition, Humana Projects ‘Further Operating Model Advancement’ for Kindred at Home

Humana Inc. (NYSE: HUM) continues to make significant investments when it comes to building a home-based care strategy.

Currently, the Louisville, Kentucky-based company’s in-house home-based care business lines include Humana At Home and Kindred at Home, the largest home health provider in the U.S., according to LexisNexis. The insurer complements those capabilities with a wide range of external partnership agreements across the continuum of care.

In terms of investing in the home setting as a care-delivery site, Humana has increasingly zeroed-in on offering primary care and post-acute care services, the company leadership said Wednesday during a fourth-quarter 2020 earnings call.


“We’ve made important investments in our strategy to offer primary care and post-acute services in the home through minority investments in Heal, a pioneer of in-home primary care, and DispatchHealth, a provider of emergent in-home medical care,” Humana President and CEO Bruce Broussard said during the call.

Specifically, Humana invested $100 million in Heal, a Los Angeles-based primary care startup in July. As part of the agreement, Humana at the time said it planned to help Heal expand its geographical footprint. That goal became a reality with Heal’s four-state expansion on Tuesday.

Most recently, Humana formed a partnership with DispatchHealth, a Denver, Colorado-based company that offers mobile high-acuity services through its emergency medicine-trained teams. Moving forward, Humana will work with Dispatch to launch hospital-at-home programs for its members living with multiple chronic conditions.


For now, those hospital-at-home services are only available in Denver and Tacoma, Washington, but the companies plan to expand into the Texas, Arizona and Nevada markets later this year.

During Wednesday’s call, Humana leadership also pointed to Kindred at Home’s successful transition to the Patient-Driven Groupings Model (PDGM) as a high point of 2020. Humana CFO Brian Kane noted that the company’s home business — led by Kindred at Home — is anticipated to perform well in 2021 and beyond.

Broussard likewise touted Kindred’s position.

“Kindred at Home successfully managed to transition to the new CMS payment model while also implementing a new operating system in 2020, setting it up to drive further operating model advancement in 2021,” the CEO said.

For Humana, addressing the social determinants of health of its members has also become somewhat of a calling card.

Humana’s Medicare Advantage (MA) membership includes 4.6 million beneficiaries. It projects to grow that total by 11% in 2021.

In particular, equity in health care has become an area of focus for the company, as Medicare Advantage has become more popular among low-income communities plus racial and ethnic minorities, according to Broussard.

In fact, 28% of MA beneficiaries are racial and ethnic minorities, compared to 21% in traditional Medicare. Medicare Advantage has roughly 26 million members overall.

With this in mind, Broussard believes Medicare Advantage plans are “uniquely positioned” to address disparities in health care for underserved populations.

“Humana is committed to leveraging our business platforms to support local communities in their efforts to lower social and health disparities,” Broussard said. “This includes enhancing access to care by continuing to expand and build primary care centers in underserved markets, offering supplemental benefits including over-the-counter medication coverage, transportation, dental and vision, as well as taking a leadership role enhancing innovative solutions aimed at addressing social determinants from Medicare and Medicaid.”

Last month, Humana subsidiary Partners in Primary Care (PiPC) announced plans to open 20 new primary care centers this year. After setting up shop in Texas, Louisiana, Nevada and Georgia, the senior-focused primary care provider will soon have a total of 80 locations.

PiPC’s goal is to have 100 primary care centers in the U.S. by 2023.

As part of its focus on health disparities, Humana is also making strategic leadership moves. Last month, Dr. Nwando Olayiwola joined the company as its first senior vice president and chief health equity officer.

Overall, Humana reported consolidated revenues of about $19.06 billion for Q4 2020, a 17% increase compared to $16.3 billion in the same period last year.

Humana’s health care services segment — which includes Kindred at Home — brought in $128 million in Q4, a 28% dip compared to $178 million in the same quarter of 2019.

For the full year, Humana reported consolidated revenues of roughly $77.15 billion, a 19% increase from $64.88 billion in 2019.

Looking ahead, the company believes that 2022 will likely be a return to relative normalcy aided by the COVID-19 vaccine.

“As we get into the spring and summer, we expect the vaccine to take hold and COVID utilization to decline, allowing non-COVID utilization to trend back to more normal levels, enabling providers to see our members in the ordinary course and appropriately document their clinical conditions, resulting in more normalized medical costs and revenue expectations for 2022,” Kane said.

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