CenterWell President Sanjay Shetty: ‘It’s Time To Give Home Health Its Due’

CenterWell President Dr. Sanjay Shetty knows home health care is an extremely valuable service. Unlike many other leaders, he’s in the position to prove it.

For close to a year now, Shetty has led Humana’s (NYSE: HUM) health care services division, which includes CenterWell Home Health, CenterWell Primary Care and CenterWell Pharmacy. Previously, he was the president of Steward Health Care System.

I had the chance to interview him twice at the Digital Healthcare Innovation Summit last month in La Jolla, California.

Given the more wide-ranging audience, I kept my home health bias under wraps for the on-stage interview. It was Shetty, instead, who first expressed his excitement over the home health capabilities he had at his fingertips.

Afterward, in a one-on-one, I got to lean more into those home health topics.

We covered everything from CenterWell Home Health’s growth objectives, to value-based care, to Medicare Advantage-home health relations. And much more.

This week’s exclusive, members-only HHCN+ Update includes my interview with Shetty, edited for length and clarity.

Telling home health care’s story

HHCN Editor Andrew Donlan: You mentioned that Medicare Advantage is recognizing that home health care is driving a lot of savings. That it’s a preventative service. But there’s not a great way to measure that yet. How do you plan on showing that worth to Humana, and then to other payers?

Shetty: With our pivot into value-based models for the home, we need to change the way we’re doing things, orient the teams on the ground towards the outcome, and then ultimately build the data and the fact base that we need in order to prove it out.

We’re still probably in the early days of that journey. But it’s been exciting because, again, we have a laboratory of actual patients, and actual opportunity to engage in the process.

The fundamental thing is, how do we open up the opportunity for the home health agencies to pivot into a model that relies on value and results?

How do you know that it’s going to bear out those results, once you get the data?

We don’t. I’m not going to pretend that I know what the final result is.

My inclination is … I feel very, very confident that well performed home care – with an eye toward outcomes – will drive outsized results when it comes to quality, but also access and outcomes.

I feel very confident because these are highly skilled staff in the home, who are really looking at the whole person and engaging with them in a different way than you ever could in the clinic. And you’re doing it at a time when those patients are most vulnerable, and most likely to have bad outcomes. The opportunity for intervention is huge.

I think what we have to do is avoid the temptation to sort of fall back on more is better, right? In some cases, we’re going to find that this results in us doing more care for a fewer number of patients. We’ve got to come up with a payment model that makes that sustainable. And not just say, “Well, if I can qualify them, I want to do it.”

Because, if you try to spread this intervention like peanut butter across all patients, you’re going to mix in those that probably were on the border of needing home health versus those who will absolutely benefit from home health. And I think that’s where the nuance in the study of this is.

How do we truly understand which populations the intervention will help? And then measure that intervention. And I think that’s where people will fall into traps – they’ll try to measure it across a really broad-based group and not yield the right outcomes.

But I feel confident just because it makes sense. But I also know that that’s true for a lot of things in health care, and sometimes it ends up not being true. I don’t want to presuppose I know the answer.

How do you think primary care will drive home health utilization at CenterWell, and vice versa?

I think what we’re seeing is that there is an interest for more collaboration, from the primary care physician, as well as from the home health side. Right now, I think they view it as a very transactional relationship. You need me to sign a form, you need me to approve a plan of care, it goes back, that’s it. But not so much of a, “We are now longitudinally going to follow this patient together to drive this better outcome.” That’s incredibly powerful.

When a primary care doctor owns that outcome, these value-based primary care providers – which isn’t the majority of who home health is dealing with – absolutely care whether that patient goes to an ER, goes to a hospital, would want to be available 24 hours per day to help avoid that outcome, which is great for them and the patient.

And so I think what we’re seeing is in a world where there’s an incentive to have them collaborate, in a world in which you give them a forum to collaborate, they absolutely want to do it. That’s how they’re going to start to think about this world differently.

“You signed the form, therefore I’m done with you,” or “I need you to answer the phone right now to get that done because I need something from you” as opposed to, “I’m here to proactively keep you in the loop.” I think that’s where it’s going to fail.

Part of it, too, is that I think both sides are viewing that as a “side of desk” activity. It’s not their main job, right? They think of the collaboration as being over on the side. I’ll do it when I have time, but it’s not necessarily front and center.

What I’m trying to do is bring that collaboration aspect front and center. And I think that’s something I would love for the industry as a whole to embrace, which is that collaboration with value-based primary care is transformative for home health.

We’ve got to think of it as being core to the mission and not something I need to do on the drive home at the end of the day if I get to it.

What will the learning curve look like for home health providers just beginning to engage in value- and risk-based care? And do you think you’re ahead of the curve at CenterWell Home Health?

I would argue that, in order to do this, there will be a need to invest in the analytics and data infrastructure to really understand the patients that you’re taking care of. And do that at scale, which means that you’re willing to work with your clinicians and work with your branches to drive a level of consistency, to implement clinical protocols across a wider swath.

Those are the two pieces that I think happen in different ways in different agencies right now. And if you’re not invested in the data and the analytics, and you’re not willing to try to work with your clinicians towards consistency, it’s going to be very hard to succeed under a value-based model.

What I think a lot of people get scared of is, “I don’t want to tell my nurse what to do.”

When, in fact, you’re not trying to tell your nurse what to do, what you’re trying to do is point them toward doing the right thing for the patient. And we’re going to give you the tools in order to do the right thing by the patient, because we’re seeing this work across the entire company: that these are the care models, the care pathways, the standardized protocols that drive better outcomes.

And I think I know how I am as a clinician, I know how most work, which is they’re so motivated by doing the right thing for their patients. And I think that’s the language that’s missing sometimes.

It’s standardization in the interest of driving better patient care, which can absolutely drive the right result.

What is growth going to look like at CenterWell Home Health here in the near-term future?

I think we’re always going to be in a place of looking opportunistically for what M&A activity is possible. In what really aligns with our needs, from geographic footprint, from an infill of our geographies, for entering new states – especially where we believe we have membership in our primary care organization, with Humana or just in general.

So I think M&A opportunism is going to very much be part of the conversation for us going forward.

Is there something specifically you’re looking for, whether it’s geography, risk profile, certain service lines?

We’re going to do a full assessment of every asset. What’s amazing about home health is that the assets are different, right? They’re different because of what you just described – geography, scale, etc.

They’re also different because of service mix. Some will have personal care, some will have hospice, others are more pure play home.

We tend to orient more towards home, as opposed to hospice, where we partner with Gentiva.

So, we’re going to look more towards pure play. But we’re not going to exclude anything, we’re always going to sort of think about it in the context of which of the boxes are being checked, and which deals look the most interesting at any particular moment in time.

What’s the difference between growing the home health service line compared to the other sections of CenterWell?

Each is their own beast.

The way that we’re thinking about home health growth is through a couple of different vectors. There’s only a subset of patients who are going to qualify for traditional home health care.

That is always going to be a cap on how many people will use CenterWell Home Health in a year. We’re never going to get to a place where 100% of our Humana patients are using CenterWell Home Health, right? That would be a huge mistake.

So growth there just looks different because it is serving a subset of the population, but trying to serve them better. I think what’s interesting about growth in home health is then, as we think to broaden the boundaries of what home health represents, there may be a vector of growth in that direction as well. Thinking beyond the traditional home health episode into other capabilities and services in the home would be another way in which I would be thinking about growing home health.

Primary Care is just in a different place right now because the need for high-quality primary care for seniors is so acute in certain parts of the country. But there are a lot of markets that are just woefully underserved by primary care. And so there’s an inherent demand built into so many markets, that for us, the limiting factor there is around: is it an acquisition, is it a de novo build and how long will it take to get to that target number of patients?

Humana owns CenterWell Home Health, which is one of the largest home health entities in the country. UnitedHealth Group could own two of the other largest home health entities at some point this year. What do you think that means for the home health industry at large? Do you think that’s a good thing? Do you think it’s a bad thing?

I think it would be simplistic to call it good or bad. I think it’s an opportunity for us to continue to evolve the thinking around home health, which is giving home health its due for driving outcomes along the entire continuum of care. And I think the payer involvement in home health is a recognition of that, one that will continue to evolve.

I also think the nice thing about the integration with payers is it allows for the investments that I talked about, with respect to data and analytics, with respect to standardization. It also allows more organizations to weather stroke-of-the-pen risk that exists in home health. Those are the positives I see.

The negatives – and I feel very strongly that CenterWell isn’t going to fall into this trap – are around keeping the clinician at the center of what we’re doing. And I want to keep the clinician and the patient at the center of the decisions and the direction we’re headed. I feel very good that many organizations that are making these investments now have that same philosophy, but it’s something that we as an industry would want to maintain. How do we always make sure that we’re advocating for our patients first? How are we advocating for our patients in ways that could also support the business and make it sustainable? How do we avoid falling into a trap of “the way we were doing things before is the only way we can do this”?

Because my worry is that if all you are is a nail, and they’re a hammer, you’re going to keep getting hit down. We’ve got to be creative and say there’s a different approach. And we’re willing to embrace the different approach for the good of our patients, but also for the good of other stakeholders, that can also support a sustainable business.

Also, if you prove that positive home health data out to Humana and UnitedHealth Group, that could have a positive effect for the rest of the home health industry.

I think that’s right. I think, hopefully, that proof point will help.

The other thing that’s important to keep in mind is that CenterWell will never be able to provide 100% of care to all Humana members, even as big as we are.

We are absolutely dependent on a broad payer network and a broad provider network. Having strong providers out in the ecosystem to help serve our patients will continue to be really important.

I would hate for anyone to look at CenterWell as a threat because we’re associated with Humana.

I would rather them say, “Wow, that’s great. Somebody is telling our story inside Humana, and Humana is going to be an even better partner as a result.”

We can help them understand what tools are needed for other providers in the ecosystem to provide value-based care, for instance.

And I think the same will be true for UnitedHealth Group and others.

Are you actively creating a network of home health provider partners, and what do they need to look like?

Yes, we already do that. We have a broad-based network of provider partners.

We are absolutely thinking about who are the highest value providers, who are the ones that are necessary for Humana patients to have access to.

We have contracts with a lot of the largest providers, and we also, on the other end, take United and Aetna at CenterWell.

The Medicare Advantage plan-home health provider relationship is one of the biggest topics still in the home health industry. There’s a gap there. Do you think that gap is beginning to close?

It’s hard for me to say where it’s going, but my orientation is towards value. And I think the ones who are going to succeed in this environment are the ones that are going to be able to demonstrate their value.

Lastly, you seem very bullish on home health care. Put simply, why is that?

For me, I believe that home health is going to play an ever-increasing role in the delivery of care for seniors in this country. I think it serves a need for the patients, it serves a need for their families, and it serves a need for society at large because it can be done at a lower cost.

I think we still have to unlock all of the ways in which the home can be used in the care continuum, because I think we’re still focused on too few use cases. And I think we need to try to foster a place to innovate, to allow us to think differently about how home care can be delivered in the settings in which it isn’t. But I’m bullish on it, because I think it’s a necessity.

I think, if we default to everything being in the hospital, we’re going to be dead in the water.