Humana Inc. HUM (NYSE) leaders say the investments they’ve made in value-based payment models and at-home care capabilities continue to pay off.
It continues to leverage its home health engine – CenterWell Home Health – to deliver on those value-based care initiatives.
“In home, we continue to accelerate our value-based strategy, now covering approximately 830,000 of our MA members under a value-based payment model covering home health, DME and infusion services,” Humana CEO Bruce Broussard said during the company’s second-quarter earnings call Wednesday. “We expect positive enterprise value creation from the value-based home health model in 2023 and remain on target to drive $110 to $150 million of annual enterprise value creation by 2025.”
Humana’s recent investments in home health include an expansion of value-based models in North Carolina and Virginia at the end of 2022.
In those markets, CenterWell Home Health’s hospital admission rates are about 210 basis points lower than other providers, Broussard said.
At the same time, CenterWell Home Health now manages DME spent under a value-based payment model for another 4.5 million Humana Medicare Advantage (MA) members.
“This delivers incremental value to our insurance segment,” Broussard said.
That CenterWell brand includes home health care, primary care and pharmacy services. Its home health segment has 352 locations, over 9,000 clinicians and serves more than 350,000 patients annually.
The integration of CenterWell’s assets is a key focus for Humana in 2023 and over the next several years.
“Our belief is we can deliver greater member and patient satisfaction, retention and clinical outcome for these members,” Broussard said. “This is based on our ability to further integrate clinical and operational workflows while delivering a more seamless experience for our common members and patients.”
Humana’s CenterWell segment has the ability to estimate drug costs, review plan benefits and screen for patient assistance programs for its members all under one roof.
“Our CenterWell Home Health and Primary Care teams review high-risk patients and collaborate on more comprehensive care plans, prioritizing health-related concerns that go beyond the original home health orders,” Broussard said. “This greatly reduces the risk of complications, unnecessary ER visits and avoidable admissions.”
Often, a member’s care plan can get stuck in silos. Care coordination has gained momentum in home-based care and Humana feels like it is in a great place to take advantage of being able to offer a number of services under one umbrella.
Under CenterWell, primary care physicians, social workers and home health nurses are able to work in coordination with health plans to take advantage of plan benefits.
In that vein, Broussard said a priority for Humana is having the ability to better address social determinants of health (SDoH).
“We will continue to innovate and advance towards a more integrated clinical model that leverages our collective Humana and CenterWell capabilities to deliver improved experiences and health outcomes for our members,” he said.
Home health forecast
Doubling down on what other home health leaders have said, Humana’s CFO Susan Diamond said that while the proposed payment rule from the Centers for Medicare & Medicaid Services (CMS) presents financial challenges, the company is ready to adapt clinically and operationally.
The same can be said for Humana’s primary care segment and risk model revisions coming down the line.
“While we do expect the risk model revision to have an impact on our CenterWell contribution margin performance in 2024, we are focused on advancing our clinical capabilities, driving operational efficiencies and implementing other actions,” Diamond said. “We believe those investments will largely mitigate the ultimate impact of the risk adjustment model changes that will be phased in over the next three years.”
CenterWell Home Health saw episodic admission growth of about 10% year over year, which was in part due to the acquisition of Trilogy Health, a deal completed in April.
Humana reported revenue in Q2 of $26.7 billion, up from $23.6 billion over the same time period last year. Revenue for CenterWell was reported at $4.53 billion, up slightly from $4.52 billion a year ago.
“The strong growth of our individual Medicare Advantage business — now anticipated to grow by approximately 825,000 members in 2023 and reflecting an 18% growth rate — gives us further confidence in our ability to deliver strong earnings growth in the future, while continuing to advance our strategy including scaling our CenterWell capabilities in primary care, home health, and pharmacy,” Broussard said.