Kirk Allen, the president of home solutions at Humana Inc. (NYSE: HUM), is living a home health veteran’s dream. Right now, he is heads down on helping create a value-based home health model within CenterWell, Humana’s provider services arm.
Home health leaders have always touted the extraordinary health and monetary value that can be derived from their services. Not many have had the opportunity to prove that out, however.
Allen does.
Humana owns CenterWell Home Health, which is one of the largest providers in the country. CenterWell also includes CenterWell Pharmacy and CenterWell Primary Care.
Eventually, CenterWell Home Health wants to have 80,000 home health patients under its value-based model. Allen and his colleagues hope that the model will drive value for Humana, while also showing the worth of a well functioning, high-quality home health operation.
But there are other goals in mind, too.
After Humana fully acquired Kindred at Home, it divested the home care and hospice assets. With the large and remaining home health footprint, Humana created CenterWell Home Health.
That rebrand was finalized in September of 2022.
Two years later, Home Health Care News sat down with Allen at the FUTURE conference to discuss the initiatives that matter most to CenterWell Home Health right now. Allen has been with Humana for seven years. Previously, he was the president of Ascension Health at Home.
Topics of the discussion included: how CenterWell Home Health plans to grow in the future, the details around its value-based model, how primary care interacts with home health care at Humana and much more.
The conversation is below, edited for length and clarity.
HHCN: What kind of barriers are you able to eliminate in a value-based home health model, like the one you’ve created within Humana?
Allen: In the model, you’re still subject to all of the Medicare requirements. We still collect OASIS, we still have to comply with Medicare-certified home care.
We are freed up, however, from things like having to look at a Low-Utilization Payment Adjustment (LUPA). So in our value-based construct, between CenterWell Home Health, onehome and our PCO, we’re able to really focus on the patient at the center, and focus on what the patient needs. Everybody is jointly taking responsibility for those patients.
So the PCO owns those patients from a physician practice standpoint, and we are the home health provider for those patients. There’s not lots of different people involved.
The first thing that occurs as a result of that is that they know directly who to come to for home care, and we know directly who to go to for orders, right? And so you have physician champions in the PCO that coordinate directly with home health on the clinical model.
If there’s something that’s needed in care for the patient, we can deliver it right away. Because both entities are completely responsible, it becomes about what the patient needs, and that’s what we deliver. You don’t have a sales function that you are running around. Because it’s more coordination of care and delivery of care than selling for care, if that makes sense.
Do you have any data that you could share on how that value-based model has fared thus far?
We haven’t released any data yet. It started in November of last year.
We’re looking at six to nine months of claims before data is available, to really be able to measure that effectively. But early indications are that we are reducing hospitalizations and that we are keeping people at home.
How will having primary care, pharmacy and home health care under CenterWell benefit patients moving forward?
When one of our members attends a primary care visit, it is typically much longer than what they would have in a routine visit with a primary care physician. It’s much more thorough. They are really getting into not just the medical and physical needs, but also the social and emotional needs.
Then you pair that up with us being in the home and seeing what is actually translating from that medical visit into the home. There’s a very comprehensive medical care visit, and then a very comprehensive home care visit. And as I mentioned before, those two are tied together because we are the home care provider. They are the physician. The information sharing makes that just incredible.
We have the ability then to also tap our pharmacy services, and they can do medical reconciliations on behalf of the patient, med rec reviews, where they’re reviewing the pharmaceuticals to make sure the patient’s on the optimal therapies. So those things coming together in the non-acute space are really powerful at preventing people from going into the acute space.
Do you think proving out some of this home health data within Humana could have a broader impact on the health care system at large, and the home health industry at large? Because you do have the home health perspective, as well as the payer perspective.
Humana is in a unique position because of the investments that it has made, to measure and prove out the impact. And to do it in a way that represents home health, MA and physician practices. I do think that can have an impact on the industry, and that’s why we are so excited about this value-based model and the fact that we have committed to cover these 80,000 members.
It will be a big sample, and we have deep actuarial support analyzing the things that we’re doing. But yes, I do think that this can have an impact on payments in the industry at large.
How does CenterWell Home Health want to grow in the near-term future?
CenterWell Home Health is still a payer-agnostic provider. We continue to grow our patients from all sources. We grow through our sales force. We grow through acquisition.
We intend to grow traditional fee-for-service home health care while we are also proving out a value-based model. Now, obviously, the results of what you find in the value-based model can alter where everybody goes in the future, but we are not solely dedicated to the value-based model.
Are there certain markets that you like better than others when it comes to home health care?
I think, thematically, we want to be in places where we can make a difference. There are not any states that come to mind that we would necessarily avoid, but we are more heavily concentrated in states right now that Humana also serves. So we have a heavy concentration in the Carolinas, in Georgia, in Florida, in Texas – some of the major population states, but we
don’t have any states that we would avoid.
What is your take on CMS’ home health rate cuts in traditional Medicare?
The rate cuts are still a big deal because the value-based model has not proliferated. It hasn’t been proven or proliferated to the point where you can say everyone’s going to run towards the value-based model.
We believe that’s where care is heading. But as we discussed earlier, we’re in the midst of both proving that out and developing it.
So the payment cuts are substantial for everybody, including us.
There’s a nursing shortage, and nursing costs are going up year over year. Your primary cost in this business is labor, and so when you’re seeing those labor costs go up every year, having a potential 2% or greater payment cut is substantial.
What else?
I would just come back to the right care, the right place, the right time, for the right amount of time.
Our focus is on outcomes. We have a huge number of five-star agencies, and we stay focused on both our star ratings and our HHCAHPS ratings being industry leading, because at the end of the day, patients need to choose you.
The outcomes that are most important are in those star measures, heavily weighted are your hospital readmissions in those star measures. So we stay focused on things like that, providing value. And I think really the thing that we’re most excited about is the proving out of our value-based model and the care that we deliver underneath.
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