Humana Leaders Discuss Shifting Business Model In Home Health Care

Humana Inc. (NYSE: HUM) – despite looming cuts and potential clawbacks from the Centers for Medicare & Medicaid Services (CMS) – still sees Medicare Advantage (MA) as a major growth opportunity.

“What we’ve seen, and the way we’ve structured our benefits, is to really try to understand what the top benefits are, and not alter those as much … so we continue to have a strong view that this will be another good growth year for MA because of the value proposition,” Humana CEO Bruce Broussard said Wednesday at the Wells Fargo Healthcare Conference.

Currently, more than half of eligible Medicare beneficiaries — 30.8 million people — are enrolled in an MA plan, according to KFF data.


Humana operates one of the largest MA plans in the U.S.

Additionally, Humana’s provider arm – CenterWell – includes home health care, pharmacy and primary care services.

During the discussion, the company also touched on how its Medicaid business is performing amid Medicaid redetermination.


“We’ve seen better utilization in the Medicaid area, and that has persisted for the last few quarters,” Broussard said.

Humana also shed some light on headwinds the company is seeing in the fee-for-service environment with CenterWell Home Health.

“There are some challenges within the fee-for-service business,” Humana CFO Susan Diamond said. “I think home health agencies on the fee-for-service side are seeing some pressure.”

Diamond also noted that Humana expects to see a negative ultimate rate impact for 2024.

“All of this reinforces for us the belief we’ve always had: that we need to migrate from a fee-for-service model to more of a value-based model, broadly within home health,” she said.

Moving forward, Humana will continue to look for ways to introduce those value-based payment models and principles.

“Whether that’s through case rate payment models versus a pay-per-visit model, which then reinforces and aligns incentives on really focusing on overall total cost of care and health outcomes,” Diamond said. “Underlying all of that is a need to really improve the clinical model relative to what we see in the fee-for-service world today.”

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