Humana’s Plans For Value-Based Care, Home Health M&A

Over the years, Humana Inc. (NYSE: HUM) has been vocal about prioritizing value-based care.

On Wednesday, it released its annual “Value-Based Care Report,” which affirms why its been crucial to the company’s Medicare Advantage (MA) beneficiaries.

Overall, MA members who are getting care through value-based arrangements received more time with their primary care physician. These individuals were also more likely to receive preventive care, and have less hospitalizations.


“The data are clear — value-based care works,” Dr. Kate Goodrich, chief medical officer at Humana, said in a press statement. “As our report shows, this smarter health care model improves outcomes for [MA] members and allows primary care physicians to practice medicine at the top of their license and develop meaningful relationships with patients. At Humana, we are proud to lead the way on value-based care for our [MA] members, and we will continue to look for ways to expand this approach into other lines of business.”

Based in Louisville, Kentucky, Humana is one of the largest insurance companies in the U.S. The company has roughly 5.8 million MA members. Its health care services arm, CenterWell, includes pharmacy, home health care and primary care. CenterWell Home Health has more than 360 locations.

The report found that 85% of value-based care patients, compared to only 75% of non-value-based care patients, saw their primary care physician at least once in 2022.


Plus, there was a 30.1% decrease in in-patient admissions for value-based care patients compared with traditional Medicare beneficiaries last year.

Additionally, value-based care patients completed preventive screenings at a 14.6% higher rate than MA members who were not in a value-based care arrangement.

Source: Humana Inc.

“Aging creates more complexity and challenges,” Dr. Misha Rhodes, market chief medical officer for Kentucky and Indiana at CenterWell Senior Primary Care, said in the report. “80% of seniors have at least 1 chronic condition, while 70% have 2 chronic conditions. Time spent with your primary care provider is crucial — time to address the patient’s concerns, to educate, and to address social determinants of health that impact their health outcomes.”

The report also found that MA beneficiaries were less likely to receive low-value care — medical services that offer little to no clinical benefit — compared to traditional Medicare members in 2019.

Source: Humana Inc.

Humana wants to beef up CenterWell

In addition to releasing its report covering value-based care, Humana CFOSusan Diamond opened up Wednesday about the company’s strategy around CenterWell during a presentation at the Stephens Annual Investment Conference.

Broadly, Humana is focused on continuing to beef up its pharmacy, home health care and primary care verticals.

“From a capital deployment perspective, you’ll see us continue to do tuck in M&A across both primary care and home [health],” Diamond said. “We’ve been able to build a nice funnel with primary care, partly due to our health plan contracting strategies over the years.”

Diamond also noted that Humana sees value in creating greater density in the home health space.

In terms of home-based care, Humana is also focused on value-based models there, and excited about what’s possible with those capabilities.

“Today, it’s more in a traditional sense — home, DME and infusion — and where we can reduce costs and improve outcomes,” Diamond said. “I would say, we’re doing a great job creating value through more traditional levers by network contracting, [utilization management] and some of those things. The team continues to work on the clinical innovation, which we think is the real unlock, and where there’s substantially more dollars to be generated across the enterprise. I’d say we’re still early innings. They’re still trying to figure out exactly what interventions are necessary, and how to best deploy them to really realize the value.”

This could mean embracing models like SNF-at-home in the future, according to Diamond.

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