Humana Avoids ‘Zero-Sum Game’ in Home Healthcare with Pay-Bidder Structure

Humana Inc. (NYSE: HUM) has cemented its position as a leader in home care.

The company has achieved this primarily through the acquisition and building of CenterWell Home Health, as well as many other initiatives in the home, including strategic partnerships.

Humana is now focused on accelerating value-based care and integrating all services that fall under the larger CenterWell brand, including home care, primary care and pharmacy services.

Introducing Dr. Andrew Aguunobi, President of Humana’s Home Solutions Business. He first joined the company last year and is a top executive who believes his home is a key place to integrate the care delivery experience for patients and members.

Home Health Care News caught up with Agwunobi on the latest episode of Disrupt. During the conversation, he talked about Humana’s home care plan, the benefits of being a payer and provider, and more.

The conversation is below, edited for length and clarity. Subscribe to Disrupt to be notified when new episodes are released. Listen now on Apple Podcasts or SoundCloud.

HHCN: Humana’s home business obviously includes CenterWell Home Health, one of the largest home care businesses in the country. Outside of that business, what else does Humana focus on at home, and what is it specifically about at home?

Agnubi: We are extremely proud of CenterWell Home Health (formerly Kindred at Home). As you said, it’s the largest home healthcare provider in the country. With 352 locations and more than 9,000 clinicians, we serve more than 350,000 home care patients each year.

In addition to that organization, we have a post-acute management services organization, which we call One Home. This is an organization that helps manage providers’ networks, including utilization management, network management, and coordination of durable medical equipment and home infusions such as oxygen and wheelchairs. It’s also a big part of what we do.

We are also focused on clinical innovation and aim to reduce the total cost of care. Therefore, it is important not only to go to the home to provide care, but also to try to reduce the number of hospitalizations and emergency department visits that may occur during or after the home visit.

We also partner with organizations like DispatchHealth. DispatchHealth is an organization that enables paramedics and other health care providers, including doctors, to be dispatched to your home to provide emergency care, emergency department care, and even home hospital services. We partner with organizations like Heal that provide primary care at home. He also owns his 40% stake in Gentiva, a hospice company.

The idea here is to make the home the center of care. To do that, we need to provide all the different services along the continuum of care so that we can serve our patients.

CenterWell is at the heart of our strategy to maximize the potential of home care.

What is the highest point Humana has achieved at home?

We’ve talked about the size and scale of CenterWell Home Health, and this is important because we want to be able to serve many people. But what matters most to us is the quality, satisfaction and seamlessness of the care we provide to our members and patients.

We maintain a 4-star rating in patient satisfaction surveys and have 21,000 hospital and 43,000 physician-provider partnerships. That’s the important part for us. It’s really all about providing care at home, serving healthcare providers, and meeting hospital needs, all of which are very important.

Expansion of acute-phase MSO models is also important. I talked about usage management, network management, DME, etc. and spread it to as many Humana members as possible. It’s really important to us too.

You noted that the medical community is recognizing the fact that providing care at home is often the best way to ensure quality outcomes. Are there any metrics you can share regarding outcomes related to Humana’s home care?

For example, according to our statistics, 40% to 60% of emergency room visits can be treated at home. If we can find an alternative to it, we will be able to treat other clinical competencies that can be treated at home.

Medicare Advantage members who partner with value-based physicians and also receive home care services have also been found to have a 60% lower risk of readmission within 30 days of hospital discharge. There was a 45% lower risk of readmission within 60 days compared to members with remuneration-based physicians. In addition, the care of these members reduced total healthcare costs by 11% over a 90-day period.

At home, the so-called social determinants of health come into view. Only 20% of health outcomes are accounted for by clinical care, and his 80% of outcomes are due to social determinants of health. When you’re home, you can see what’s going on and intervene.

As our listeners know, CenterWell is more than just home medicine. It also includes primary care. One of the things we’ve written about at HHCN is how home care and primary care can work together. Has there been any crossover in your efforts to serve older adults by having both under CenterWell?

CenterWell Senior Primary Care, along with Conviva Care Center, is the largest senior-focused, value-based primary care platform in the United States.

It’s really great to have the largest home healthcare provider and also the largest senior-focused value-based primary care platform. It currently operates approximately 249 primary care centers serving 266,000 patients. This is very nice.

Most importantly, those patients are receiving value-based care.

Our vision is to integrate primary care, pharmacy and home care. The home is a great place of care for integrating the patient care delivery experience. For example, if a member does not have a primary care provider, CenterWell Home Health may offer the member not only CenterWell Senior Primary Care but other value-based primary care options in the community.

CenterWell Home Health also serves as an extension of primary care. If someone goes to a primary care office and needs home care, we can act as an extension of that. If a member would benefit from home delivery of medicines, CenterWell Home Health can help the member set up a mail order to her CenterWell pharmacy. All of these services build upon each other to give you complete visibility into your patient’s care.

It’s not just when you come to the clinic. That’s what’s happening in your house.

As we look to a future that includes more value-based care, let alone alternative forms of payment such as MA, how can we continue to have a successful paid home health care business?

It’s not easy. We believe you are focused on both. You are focused on building a strong core home healthcare business while creating a transition to clinical innovation.

To do this, it’s important not to lose sight of the big picture. The overall picture of home health care is that Medicare Advantage penetration is increasing while overall initial Medicare episodes are declining. Over time, more people are opting for Medicare Advantage.

We always have to take a step back and say, “Yes, it’s hard, but the future is there.” We have to find a solution there.

From an outcome perspective, there are many statistics that show that value-based care yields better outcomes than fee-based care. We must also keep that in mind. I think it is important to always work from the customer’s point of view. What are your customer needs and how do you build clinical capabilities to meet those needs?

What are the benefits of Humana being both a payer and a provider?

Since we are both on the payer side and the giver side, together we can start thinking about how to avoid a zero-sum game where a portion of the organization’s gains is a portion of the organization’s losses.

Another thing is that having large organizations with large amounts of data gives us the ability to transform and find ways to deliver clinical capabilities that drive value-based care.

What are your goals for your organization in the next few years?

Growth – Growth through mergers and acquisitions, organic growth. Add innovation to deliver value-based care.

Integration between various organizations. Moreover, it essentially just satisfies the customer’s needs. Everything under that umbrella is my goal and that of the team that works with us here.

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