Rumors suggesting that Cigna Group (NYSE: CI) and Humana Inc. (NYSE: HUM) are in talks to combine are swirling.
Nothing is official yet, but the combination of two of the largest insurers in the country would have significant ripple effects on the home health industry, for a variety of reasons.
On Nov. 6, Reuters first reported that Cigna was exploring a sale of its Medicare Advantage (MA) business. At the time, there was some speculation that the move was either a reaction to increased government oversight of MA plans or its own performance in MA.
Cigna declined to comment to Reuters on the shopping of its MA business at the time. But, since then, a third possible reason for offloading cropped up: a potential combination with Humana.
Doing away with MA could, in theory, temper antitrust concerns for such a combination.
“We would see this action being one component of a potential pursuit of Humana as an acquisition target, with the divestiture being a proactive move to reduce antitrust risk,” Scott Fidel, managing director at the investment banking company Stephens, wrote in a note shared with Home Health Care News earlier this month.
Cigna only has about 600,000 MA enrollees underneath its umbrella. Humana, on the other hand, adds more than that total to its portfolio on a yearly basis.
While Cigna owns about 2% of the MA market share, Humana owns close to 20%. Humana and UnitedHealth Group’s (NYSE: UNH) UnitedHealthcare are the largest MA players in the space.
Behind them are BCBS plans and CVS Health’s (NYSE: CVS) Aetna.
Both Cigna and Humana are payviders, meaning that, in addition to being large insurers, they also have significant health care services capabilities. Humana has CenterWell, which includes home health care, primary care and pharmacy. Cigna has Evernorth Health Services, which offers pharmacy services as well as behavioral health.
The pharmacy benefit overlap could also be of antitrust concern, as STAT News pointed out.
“A combined Cigna-Humana would still have a lot of overlap with their pharmacy benefit managers,” STAT wrote, also earlier this month. “Cigna owns Express Scripts (second-largest PBM, according to Adam Fein of Drug Channels), and Humana owns the fourth-largest PBM. Given how Lina Khan’s Federal Trade Commission already is scrutinizing PBM market power, it seems like that kind of deal would be an insta-block.”
At this point, there’s considerable smoke around the Cigna-Humana rumors.
If Cigna acquired Humana, it would be significant news in the home health care space, considering all of the acquiring Humana itself has done in recent years.
Humana fully acquired Kindred at Home – now CenterWell Home Health, stripped of the personal care and hospice assets – in 2021.
CenterWell Home Health is one of the largest home health providers in the country, along with the likes of LHC Group, Amedisys Inc. (Nasdaq: AMED) and Enhabit Inc. (NYSE: EHAB).
UnitedHealth Group officially acquired LHC Group earlier this year, and is in the process of acquiring Amedisys. Enhabit, meanwhile, is in the process of a strategic review that will likely end up in a sale.
While home health providers are generally at odds with MA plans given what the latter pays for home health services, many of the biggest providers are now a part of – or about to be a part of – organizations with large MA plans.
If a Cigna-Humana deal materialized, CenterWell Home Health would be a part of an even larger insurance giant.
It’s unclear what that would mean for the entity, which has been trying to maintain its standing as one of the two or three largest home health providers in the country. Currently, CenterWell has 352 home health locations and serves more than 350,000 patients annually. In April, it acquired the Florida-based Trilogy Home Health.
Home health care has been a bright spot for CenterWell and Humana. Longtime Humana CEO Bruce Broussard – who will be stepping away from his post in 2024 – recently commented on efforts being made to further optimize the segment.
“These efforts will be deployed across our more than 350 branches, and will include automation, consolidation, technology and AI solutions,” Broussard said during the company’s third-quarter earnings call. “This will minimize administrative caps while improving clinician productivity — including optimizing their schedule. We believe these initiatives, some of which require incremental investment, will ultimately streamline our operations and lead to increased clinician productivity and satisfaction.”
The health care insider and writer Wendell Potter, formerly a communications executive at both Cigna and Human, also wrote about the speculation on Tuesday.
He, too, mentioned the forthcoming leadership transition at Humana.
“Another reason to believe there is something to the speculation is the fact that Humana last month announced it had hired former UnitedHealth executive Jim Rechtin as chief operating officer and CEO-in-waiting,” Wendell wrote. “The company said Rechtin will succeed current CEO Bruce Broussard when Broussard retires next year. In its press release, Humana noted that Rechtin also spent 14 years at Bain & Company, ‘highlighting his depth of experience in health care mergers and the overall health care sector.'”
Humana reported revenue of $26.4 billion in the quarter, while CenterWell revenue checked in at at $4.66 billion overall.
In Cigna’s recent third-quarter earnings call, the company announced revenues totaling $49 billion.
A Humana spokesperson told HHCN the company had “no comment” on the matter. Cigna did not respond to a request for comment.
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