‘Delivering Value Requires Transformation’: How Humana Is Tearing Down Silos, Accelerating Home-Based Care Innovation

When you’re already one of the biggest health insurance companies on the block, what’s the next move?

For Humana Inc. (NYSE: HUM), it’s transforming into one of the biggest home-based care companies around. But then again, the company that originally launched in the 60s as a nursing home provider is no stranger to transformation.

This year, Humana made moves to fully acquire the remaining 60% of Kindred at Home, which is being rebranded as CenterWell Home Health. The company also leveraged a number of strategic partnerships that placed it further into the home.

Not satisfied with just being one of the biggest providers, Humana has fully leaned into tearing down health care silos through data sharing and a larger shift away from traditional home-based care division categories. On top of this, the company is keeping its ear to the ground when it comes to technological innovation.

The overall goal: to drive value for Humana’s members through care in the home.

Home Health Care News recently sat down with Greg Sheff, interim segment president of home solutions at Humana, for our latest episode of “Disrupt” to learn more. Highlights from the conversation are below, edited for length and clarity.

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HHCN: Humana is an industry giant, but there are probably some people who don’t know how much your company is doing when it comes to home-based care. Can you provide some background on the home solutions segment?

Sheff: The home solutions segment is one of the operating divisions within Humana. This is where we focus all of our home-based care and our home-based delivery.

Humana actually started out about 60 years ago as a nursing home company, and then transitioned to a hospital company, then an insurance company, which for the last couple of decades is how we know it. Specifically, an insurance company that is pretty deep in Medicare Advantage (MA). You can see over the history of the company, like many companies, it transforms and reinvents itself as new opportunities and needs arise. That’s really what’s been happening over the last several years for Humana.

We really needed to be more than a health insurance company. We needed to be a health company. We need to be able to bring services and options for members and patients. We’re focused on several areas, and we can talk more about them, but one of the big areas is in the home. Humana has made a number of investments in the home, culminating this year in the acquisition of Kindred at Home, making us the largest home health and hospice provider in the nation.

We know that Kindred is being rebranded as CenterWell Home Health. Is there anything you can say about how this deal positions Humana in the broader home-based care space?

What we’re really excited about with Kindred at Home is the scale that it provides for us. Driving change and transformation in health care locally is hard enough, but then taking that and scaling it into multiple markets has always been challenging. A high-functioning backbone of infrastructure of delivering care in the home is really exciting to us. We hope to marry that up with a lot of the clinical innovation and transformation that we’re working on. This year, we acquired Kindred at Home, but we also acquired a company called One Homecare Solutions, which is out of Florida. They are really focused on value-based home health, [durable medical equipment] and infusion services. Taking some of those models and some other clinical transformation … and scaling it out across Kindred at Home’s footprint is really exciting to us.

The rebranding is to move into a Humana-focused brand and move away from the Kindred brand, which was also related to other parts of delivery that the legacy Kindred company was involved with. CenterWell is a brand that we’re using across Humana for any of our delivery services that are meant to serve patients in the community broadly, regardless of who their payer might be. Our primary care clinics, our home health, our pharmacy and other delivery services that are payer agnostic will be transitioned to the CenterWell brand over the next few years.

Humana has said it plans to only hold on to the home health part of Kindred, and maybe sell or spin off the hospice part. Any clarity on the next steps or that process?

I don’t have anything to add, other than what we’ve already publicly stated. We do believe that home health is a part of care in the home that really has a tremendous amount that it can add in terms of value for patients and for the system at large. Delivering value requires transformation – and transformation requires real focus and investment. That’s why we fully acquired and intend to hold on to the home health aspect of Kindred at Home. It will allow us to nurture, guide and invest in that transformation over time.

Hospice is an incredibly important service for patients in the community. We think it’s a very important part of the health care ecosystem, and we are very committed to supporting it as well. As we’ve stated, we would keep a minority interest if we do bring hospice outside of Humana, but we don’t believe it’s an area of health care that needs transformation in the same way. We believe that it can operate in a separate structure more efficiently and still deliver the value that it needs for patients in the community.

Throughout the public health emergency, there has been an acceleration in the acceptance of home-based care and remote care. In general, what are some of the ways you’ve seen this? How has Humana been a part of that acceleration?

We’ve seen the acceleration in both home-based care and virtual care in many different ways throughout the pandemic. As a payer, we’ve certainly seen it in the claims, how our members are seeking care, and what they’re telling us is important to them. On the provider side, we’ve also seen an increased demand for services in the home – home health and home-based primary care.

We have a relationship with a company called Heal, which provides home-based primary care. We also work closely with DispatchHealth, which provides home-based urgent care. We’re seeing more and more interest in all of these services over the last couple of years. In addition, the adoption of technology has really taken off during the pandemic.

I think home-based care has always been appealing to different folks for different reasons; sometimes it’s because somebody is truly homebound. What we’ve also seen during the pandemic is that there’s a lot of interest in the home just as a more effective and efficient site of service. Whether that’s in-person home care or virtual home care, we think that the interest and acceptance of it on the patient side has become clear during the pandemic.

Can you talk about how home-based care fits into the company’s overall mission or strategy?

At the highest level, our strategy is to be a health company – to bring not only the knowledge, the analytics and the benefits through the insurance side of the business, but also to bring actual care, whether that’s primary care, behavioral health or other care in the home.

Humana is focused on five areas. The reason we’re focused on these five areas is that we believe they’re critical to delivering health for communities, and we believe they’re areas that need continued investment and focus. One of those areas is care in the home. Another is primary care. The other areas are behavioral health, pharmacy and social determinants of health.

Humana recently conducted a survey that examined the public health emergency’s toll on seniors. Can you share some of the key findings?

One thing that we saw, not surprisingly, is that four out of five seniors reported that their lives had changed because of the pandemic. One in two reported they spent more time alone, and 43% indicated they spent less time doing the things that bring them joy. This is not necessarily surprising, given the isolation we’ve heard about. And social isolation can be particularly challenging for seniors.

Now, what was really interesting about it was the positive spin: 68% said they were going to prioritize spending more time with friends and family after the pandemic. Also, 67% said they’re going to do things that will bring them joy, and 53% said they plan to travel. You see people really zeroing in on what’s important to them.

One thing I found interesting was the role of technology. Four in five seniors said they use technology to manage their health and wellness through the pandemic. That’s a big number.

How is Humana using these findings to shape its offerings for your members?

In general, we’re going to look at lots of data and feedback from our members – and potential members – about what we can do on the plan side to create benefits that are most meaningful. On the delivery side, I talked about some of the areas that we think are historically under-attended, and how we can make sure that we’re building services.

What can we do to help members stay more connected? What we can do to help improve access to care? So plans with $0 telehealth co-pays would be an example of how we take this information on what members are doing, reflecting that back into our plans. In the end, what we’re trying to do is understand what the needs of the communities are.

On Humana’s recent earnings call, CEO and president Bruce Broussard said that within the next five years, Humana wants to have 50% of its MA population under its value-based home health model. Could you say more about this?

We talked a little bit earlier about One Homecare Solutions, which is a value-based home health provider that has a really innovative model we’re looking to scale across the Humana markets, leveraging the Kindred infrastructure. The goal is to make that available in our markets that would cover 50% of MA lives in the next few years, then continue scaling it. It’s a model that allows us to really deliver better care and better outcomes for our members, but also be more prudent with the deployment of resources and create value for the health system as a whole. It’s a really exciting model. It allows One Homecare Solutions to take a value-based payment across home health, DME and infusion surfaces, then work to innovate clinically under that payment in order to really use technology and deploy clinical services to get the best outcomes for the patients.

On top of all of the things that Humana’s doing around home-based care, the company has also formed partnerships with home-focused companies such as Heal, DispatchHealth and Papa. Can you talk about how these relationships bolster Humana’s efforts?

There’s a lot of work to be done in health care, and there’s no one single entity that’s going to be able to do all of it. There are a lot of great companies out there going at different parts of delivery and how patients can be taken care of holistically in their home. You’ve got primary care in the home through Heal, you’ve got companionship through Papa, and you’ve got high-intensity urgent care services in the home through DispatchHealth.

They can be experts and the best at what they’re doing. Then our partnerships allow us to expose our members to their benefits, but also our partners can work collaboratively to have some integration among the different services. That kind of integrated experience is really what we’re after with a lot of these partnerships. It allows us to provide more value to our patients – faster.

Something I know you’re passionate about is breaking down silos through home-based care and value-based care. For Humana, what does this mean exactly?

There are a couple of different layers to that, almost like peeling back parts of an onion. I think one part is just making sure that data is appropriately shared. For example, if you see a CenterWell primary care physician who refers you to CenterWell Home Health, you’re not going to have to re-enter all your demographics and medical history. We know that can be a challenge in health care, even in large integrated health systems.

I think the next layer of that is really going deeper on that integration and making sure there are shared clinical pathways, shared clinical goals, and that the teams are truly collaborating clinically together around that.

The next one is actually where it gets a little bit more interesting. Right now, when we talk about care in the home, we talk about primary care in the home, or hospital at home, or SNF at home, or rehab in the home. Essentially, these divisions are based on the outpatient world. The categories become a little bit semantic. It’s really the same technologies and the same clinical skills, just distributed with slightly different intensity or frequency over time. A lot of these divisions become arbitrary; you don’t really get discharged from hospital at home and get admitted to SNF at home when you’re in the home the entire time. I think the core layer of integration is when you actually get away from some of these historical concepts of how we cut up care – and start saying instead the home is where people spend the majority of their time. What we want to do is promote health in the home and prevent illness and complications. This takes some combination of technology, [non-medical] caregivers, nurses, therapists, nurse practitioners and physician assistants. How do we blend all those to meet the fluctuating needs of our patients? That’s true integration.

You’re also passionate about continued innovation in the home-based space. What are some things you would like to see transpire over the next couple of years, in terms of new technology or care models?

There’s a ton to be done, just with what we already know. And then there are all the things we’re going to learn as technology continues to evolve more quickly than many of us can imagine.

We’re learning about more advanced remote monitoring with new devices that can get hemodynamic status, or are right on the cusp of being able to get some lab values, non-invasively. Using remote monitoring, ambient monitoring, background monitoring, whether that’s hearing a change in a voice that could represent a COPD evaluation or seeing a knee or fall. There’s a ton of ambient monitoring that can be done. I think it’s going to continue to drive a lot of innovation. Learning how to deploy that efficiently, and learning how to monitor it efficiently, is also a lot of work. There’s a lot of data that comes in and out, and we need to be able to find the relevant signals within all of that data.

The year is coming to an end. What are some 2022 goals you have in place for the home solutions segment?

We’re committed to figuring out and scaling how we can drive more value for the communities through care in the home. Part of that is through the value-based home health model that we’ll be working with One Homecare Solution and Kindred on.

Labor is very much on our minds. We’re very focused on what we need to do to be the destination workplace for nurses and other clinicians that would like to give care in the home. [We] really [want to] understand what their needs are and how we can make their job both intrinsically more rewarding – and let them focus on the care they want to give. And also give them the appropriate extrinsic rewards to compensate them.

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