UnitedHealth Group Archives - Home Health Care News Latest Information and Analysis Tue, 15 Oct 2024 20:32:19 +0000 en-US hourly 1 https://wordpress.org/?v=6.6.2 https://homehealthcarenews.com/wp-content/uploads/sites/2/2018/12/cropped-cropped-HHCN-Icon-2-32x32.png UnitedHealth Group Archives - Home Health Care News 32 32 31507692 Facing Headwinds, UnitedHealth Group Remains Focused On Value-Based Care https://homehealthcarenews.com/2024/10/facing-headwinds-unitedhealth-group-remains-focused-on-value-based-care/ Tue, 15 Oct 2024 20:32:18 +0000 https://homehealthcarenews.com/?p=29065 The Centers for Medicare & Medicaid Services’ (CMS) Medicare rate cuts, state-driven Medicaid member redeterminations and the Change Healthcare cyberattack. These are just three disruptions that UnitedHealth Group’s (NYSE: UNH) leadership has had to factor in when setting future growth objectives. “It’s a distinctive part of the culture of UnitedHealth Group that we continue to […]

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The Centers for Medicare & Medicaid Services’ (CMS) Medicare rate cuts, state-driven Medicaid member redeterminations and the Change Healthcare cyberattack. These are just three disruptions that UnitedHealth Group’s (NYSE: UNH) leadership has had to factor in when setting future growth objectives.

“It’s a distinctive part of the culture of UnitedHealth Group that we continue to strive to deliver on our financial commitments to you through changing environments and unforeseen challenges,” UnitedHealth Group CEO Andrew Witty said during the company’s third-quarter earnings call on Tuesday. “As we look to 2025 … we remain in a dynamic period for the health care sector. Amid this, it’s important that we continue to invest in the durable value creating capabilities of this company that support our 13% to 16% long-term growth objectives.”

Despite this current operating environment, Witty expressed optimism about the company’s ability to grow in the years to come.

The company already owns the home health giant LHC Group, and is in the process of acquiring Amedisys Inc. (Nasdaq: AMED), another one of the largest home health providers in the country.

One of the elements laying the groundwork for growth is UnitedHealth Group’s commitment to the transition of the health system to value-based care, Witty noted.

“At UnitedHealth Group, we’re purposefully organized to support the transition to value-based care,” he said. “It requires deep engagement with patients, setting the foundation to move to more coordinated care, connecting patients to primary care earlier, driving clinically accurate diagnoses more effectively, recognizing and managing chronic conditions and slowing disease progression. We’re seeing the benefits of this work come to fruition.”

Specifically, individuals who receive care services under Optum’s value-based models are more likely to receive cancer screenings. Optum is UnitedHealth Group’s health care services arm.

These individuals are also better positioned to control their diabetes and hypertension, compared to those under fee-for-service Medicare. Plus, they are 10% less likely to visit the emergency room, or be readmitted to hospital.

UnitedHealth Group’s value-based care models incorporate home-based care services, such as house calls, home health care and other in-home visits.

For the third quarter of 2024, UnitedHealth Group brought in revenues of $100.8 billion, a $8.5 billion increase over the prior year period.

Optum’s Q3 revenue was $63.9 billion, a $7.2 billion increase over the prior year.

“This was driven by an increase in both the number and type of care services we offer and the patients we serve, especially in the home and among those with complex needs,” John Rex, president and CFO of UnitedHealth Group, said during the call.

UnitedHealthcare’s Q3 revenue was $74.9 billion, a $5 billion increase over the previous year.

“Indications are tracking favorably as we head into 2025, reflecting continued strong uptake of UnitedHealthcare’s innovative offerings,” Rex said. “Our Medicare Advantage plans, on offer this fall, balance providing as much benefit stability as possible for seniors, while contending with the CMS funding cuts, IRA changes and expected care patterns.”

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UnitedHealthcare, Humana Object To Star Rating Downgrades In Medicare Advantage https://homehealthcarenews.com/2024/10/unitedhealthcare-humana-object-to-star-rating-downgrades-in-medicare-advantage/ Fri, 04 Oct 2024 17:17:35 +0000 https://homehealthcarenews.com/?p=29014 The Centers for Medicare & Medicaid Services (CMS) dealt a blow to UnitedHealth Group (NYSE: UNH) and Humana Inc. (NYSE: HUM) – the two largest Medicare Advantage (MA) administrators – by lowering their star ratings for 2025. Broadly, MA plans are rated on a scale from one to five, and CMS has lowered those ratings […]

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The Centers for Medicare & Medicaid Services (CMS) dealt a blow to UnitedHealth Group (NYSE: UNH) and Humana Inc. (NYSE: HUM) – the two largest Medicare Advantage (MA) administrators – by lowering their star ratings for 2025.

Broadly, MA plans are rated on a scale from one to five, and CMS has lowered those ratings for both UnitedHealthcare and Humana, in certain cases. For UnitedHealthcare, its call center rating was reduced by a point. Humana’s ratings also went down overall, sinking the majority of their plans below four stars.

Both companies are appealing the ratings, in one form or another. UnitedHealth Group has filed a lawsuit against CMS. Humana earlier this year also challenged CMS on its Risk Adjustment Data Validation (RADV) rule, which helps dictate how MA plans are paid.

UnitedHealthcare is claiming that its call center rating was downgraded based on an “arbitrary and capricious assessment.”

As the star ratings currently stand, they are likely to affect the financial performance of both companies. Humana’s stock, for instance, is down over 20% this week.

The financial standing of MA plans could affect home-based care providers in a number of ways. A worse off rate environment could mean more low rates for home health services. Providers hope, however, that plans will use home health care as a way to lower costs elsewhere.

Home care providers that help MA plans provide supplemental benefits to members could also be squeezed out, with less room to offer benefits in the first place.

At the same time, the troubles of Humana and UnitedHealth Group are relevant due to their direct involvement in home health care. 

Humana owns CenterWell Home Health, one of the largest home health providers in the country. UnitedHealth Group owns LHC Group, another one of the largest home health providers in the country. UnitedHealth Group is also in the process of acquiring the home health giant Amedisys (Nasdaq: AMED).

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State Scrutiny Of UnitedHealth Group-Amedisys Deal Pushes Timeline Back Further  https://homehealthcarenews.com/2024/09/state-scrutiny-of-unitedhealth-group-amedisys-deal-pushes-timeline-back-further/ Thu, 19 Sep 2024 19:56:02 +0000 https://homehealthcarenews.com/?p=28917 UnitedHealth Group’s (NYSE:UNH) acquisition of Amedisys (Nasdaq:AMED) is still pending. That could be due to a variety of factors, but one is clear: the Oregon Health Authority’s (OHA) ongoing review, which is expected to continue until at least the end of November. OHA’s Health Care Market Oversight (HCMO) program reviews health care business deals to […]

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UnitedHealth Group’s (NYSE:UNH) acquisition of Amedisys (Nasdaq:AMED) is still pending. That could be due to a variety of factors, but one is clear: the Oregon Health Authority’s (OHA) ongoing review, which is expected to continue until at least the end of November.

OHA’s Health Care Market Oversight (HCMO) program reviews health care business deals to ensure they do not harm the state’s citizens or communities. In July, both UnitedHealth Group and Amedisys submitted responses to the OHA’s request for information. The authority is still seeking public comments on this matter.

In addition to the issue in Oregon, the deal has faced scrutiny from federal antitrust regulators, including the U.S. Department of Justice (DOJ).

Amedisys and UnitedHealth agreed to sell certain locations to Dallas-based VitalCaring Group, likely to address those antitrust concerns. That deal is contingent on the UnitedHealth Group-Amedisys deal closing, however.

“On an antitrust perspective, a number of states have adopted enhanced transaction notice requirements,” Les Levinson, partner and co-chair of the Transactional Health Law Group at Robinson+Cole, said during a recent Home Health Care News webinar. “There is a heightened interest in agencies being subject to a higher regulatory review. I think it’s something we have to pay attention to.”

UnitedHealth Group first agreed to purchase Amedisys – one of the largest home health providers in the country – in June 2023 for $3.3 billion.

According to comments published on the OHA website, the deal is not well-received by some groups in Oregon.

Mid Valley Health Care Advocates, based in Corvallis, Oregon, urged the OHA to deny the acquisition application, for instance.

“We are concerned that [UnitedHealth] as an insurer, and through Optum as a clinical provider and potentially as a home health and hospice provider, have the incentive and the ability to unfairly disadvantage competing providers and drive them from the market, reducing consumer choice,” the group said in a statement.

Another comment by the Oregon Nurses Association (ONA) read, “[UnitedHealth’s] track record of driving up profit margins at the expense of patients is not in alignment with Oregon values. Oregonians deserve high-quality, affordable health services; we are concerned that [UnitedHealth] will fail to provide that care if doing so interferes with their profitability. ONA urges OHA to reject the acquisition of Amedisys.”

With all that said, it is possible that a DOJ clearance of the deal could ultimately influence OHA’s decision, and move up the timeline to closure.

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More Home Health Providers Sunset Relationships With Largest Medicare Advantage Payers https://homehealthcarenews.com/2024/09/more-home-health-providers-sunset-relationships-with-largest-medicare-advantage-payers/ Thu, 12 Sep 2024 19:56:24 +0000 https://homehealthcarenews.com/?p=28879 Essentia Health – a regional, nonprofit health system with a substantial home health arm – announced this week that it will no longer serve as an in-network provider for UnitedHealth Group (NYSE: UNH) and Humana Inc. (NYSE: HUM) Medicare Advantage (MA) plans. It is the latest example of home-focused health care providers drawing a line […]

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Essentia Health – a regional, nonprofit health system with a substantial home health arm – announced this week that it will no longer serve as an in-network provider for UnitedHealth Group (NYSE: UNH) and Humana Inc. (NYSE: HUM) Medicare Advantage (MA) plans. It is the latest example of home-focused health care providers drawing a line in the sand with certain payers.

Those examples can still be classified as anecdotal, but they are close to forming a trend.

It’s also likely that each move like this will beget similar moves by other providers.

“Like many other health systems, we have been re-evaluating our participation in Medicare Advantage plans that place added strain on our patients by too often denying or delaying their care,” Dr. Cathy Cantor, Essentia’s chief medical officer for population health, said in a statement. “This was not a decision we made lightly. The frequent denials and associated delays negatively impact our ability to provide the timely and appropriate care our patients deserve. This is the right thing to do for the people we are honored to serve.”

Headquartered in Duluth, Essentia Health provides care across Minnesota, Wisconsin and North Dakota. Its network includes about 15,000 employees, 14 hospitals, 78 clinics, six long-term care facilities, six assisted living and independent living facilities, and much more.

It also has a robust home health and hospice business.

The company has informed patients that it will no longer serve as an in-network provider for the above-mentioned MA payers beginning Jan. 1. Open enrollment for MA begins on Oct. 15 and ends on Dec. 7. Essentia specifically called out other plans that patients can join in network prior to the year turning over.

Sanford Health, a health system based in Sioux Falls, South Dakota, announced a similar plan this week.

“This is a difficult decision, but ending our partnership with Humana Medicare Advantage is the right thing to do for our patients,” Martha Leclerc, vice president of corporate contracting for Sanford Health, said in a statement.

These comments mirror remarks made by home health leaders over recent years. The national plans have drawn the most ire from home-based care organizations.

This week’s exclusive, members-only HHCN+ Update ties these topical news items to the MA struggles that home health providers face.

‘Care delayed is care denied’

Humana and UnitedHealth Group’s UnitedHealthcare are the two largest MA administrators in the country. According to KFF, Humana has 16 million MA members, or about 29% of the market, while Humana has 6 million members, or about 18% of the market.

That market share gives the two companies some semblance of leverage with providers, and also makes it hard for providers to walk away from them.

But providers are beginning to take that step, as evidenced by the Essentia Health and Sanford Health decisions this week.

While both those organizations provide home health care, the largest example of walking away thus far in the industry was Enhabit’s (NYSE: EHAB) decision to terminate its contract with UnitedHealthcare last month.

Enhabit CEO Barb Jacobsmeyer further explained that decision last week.

“It’s important to remember that the reason we created are payer innovation strategy, about two years ago, was because at that time we had United as a large payer and then a few regional smaller contracts that had come along with acquisitions over the years,” Jacobsmeyer said during a discussion at the 2024 Wells Fargo Healthcare Conference. “Those combined contracts had us at about a 40% discount to Medicare. Obviously, that’s not sustainable. We started the payer innovation strategy to have more and better contracts.”

Enhabit’s issue with UnitedHealthcare was payment for services being at a 40% discount compared to Medicare fee-for-service payments. Essentia and Sanford mentioned denied and delayed care.

But generally, providers have told me their issues with MA plans are two-pronged – it’s about claim denials and prior authorization hurdles, but also about payment, too.

“The prior authorization process should be based upon the patient’s primary diagnosis and have a standard number of visit authorizations based upon evidence-based medicine,” Intrepid USA CEO John Kunysz told HHCN in 2022. “Care delayed is care denied.”

A few providers terminating contracts won’t make a huge dent in these payers’ pockets.

But those terminations could embolden other providers. And that could turn this into a larger trend.

“I would just say that my heart was warm the other day when Enhabit walked away from the table with UHC,” Pinnacle Home Care CEO Shane Donaldson told me last month at HHCN’s FUTURE conference. “I think that we’ll look back on that as being a significant event.”

An interesting wrinkle is the fact that both Humana and UnitedHealth Group have recognized the value of home health care through acquisition. Humana owns CenterWell Home Health, while UnitedHealth Group owns LHC Group and is in the process of acquiring Amedisys Inc. (Nasdaq: AMED).

Home-based care leaders within those organizations do believe that their work will ultimately lead to better payment and value recognition from payers over the long term.

Broadly, and for now, home health providers currently don’t see their value being recognized by these large payers.

“We’re all tasked with the same problems,” Vanderbilt Home Care Services President Amy Harrison told me at FUTURE. “Humana has denied hundreds of thousands of dollars of our claims, because they claimed that we billed before we had the plan of care signed and all the orders signed. But we’ve clearly submitted all the medical records to them with proof. They send you in circles. It’s like they’re incentivized to not pay you.”

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Medicare Advantage Plans’ In-Home Health Assessments Remain Under Fire https://homehealthcarenews.com/2024/08/medicare-advantage-plans-in-home-health-assessments-remain-under-fire/ Tue, 13 Aug 2024 21:02:12 +0000 https://homehealthcarenews.com/?p=28685 Last week, UnitedHealth Group (NYSE: UNH) defended its utilization of in-home health assessments, which are visits used widely by Medicare Advantage (MA) plans looking to fill gaps in patient care. Detractors of this type in-home visit have suggested that plans use them to up risk scores for MA members, which helps maximize reimbursement. In July, […]

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Last week, UnitedHealth Group (NYSE: UNH) defended its utilization of in-home health assessments, which are visits used widely by Medicare Advantage (MA) plans looking to fill gaps in patient care. Detractors of this type in-home visit have suggested that plans use them to up risk scores for MA members, which helps maximize reimbursement.

In July, a study published in Health Affairs argued that these in-home health risk assessments increase coding intensity in MA, which, in turn, leads to higher payments from the Centers for Medicare & Medicaid Services (CMS).

Then, earlier this month, the Wall Street Journal published a story criticizing the financial gains UnitedHealth Group specifically has derived from these in-home visits.

UnitedHealth Group responded, arguing that these in-home risk assessments help members access the care they need, and help plans gain greater insight into a patient’s whole health picture.

“It’s a critical touchpoint in the care continuum, supplementing annual physician visits — not replacing them — and ensuring people have access to needed services, including housing, food and social support,” UnitedHealth Group wrote. “The professionally licensed and highly trained HouseCalls clinicians — many of whom have been dedicated to visiting Medicare Advantage seniors for years as part of this program — perform health, home and environmental assessments and offer preventive services, but they do not prescribe or order treatments. They may refer members to other services or providers, but they always direct members back to their chosen, treating physician for treatment.”

UnitedHealth Group is one of the largest health care companies in the country. It is one of the largest payers via its UnitedHealthcare arm, and is also one of the largest health care services providers via its Optum arm.

The company’s HouseCalls program, specifically, is what the company defended in its release last week.

The Health Affairs study specifically broke down the financial impact that in-home risk assessments and “chart reviews” have. The author of the study wrote that encounter-based risk scores for MA enrollees were 7.4% higher when in-home health risk assessments or chart reviews were used.

UnitedHealth Group refuted the idea that the “HouseCalls program is simply a way to add codes and increase payment,” and said that the majority of its in-home visits do not result in elevated risk adjustments.

“HouseCalls provides one-on-one, in-home clinical assessments to more than 2.7 million patients each year,” the company wrote. “It allows advanced practice clinicians to identify and address gaps in care, ensuring patients receive important health screenings and connecting them with needed care. Within 90 days of a HouseCalls visit, 75% of patients receive additional primary care in a clinic. Last year, the program closed more than 3 million gaps in care by addressing medical, behavioral and social needs.”

UnitedHealth Group is not alone in this matter, either. CVS Health (NYSE: CVS), for instance, leverages Signify Health’s in-home visits to close gaps in care for Aetna members.

Health plans see these visits as a way to ensure members are getting all of their health needs fulfilled. Skeptics see the visits as a way to extract more money from CMS.

“Medicare Advantage is more affordable for patients and reduces costs for the broader health system,” UnitedHealth Group wrote. “Seniors in MA save 45% on premiums and out-of-pocket costs each year, which translates to an average savings of $2,800 annually compared to those in fee-for-service (FFS) Medicare. In 2023, 73% of MA enrollees, including those in UnitedHealthcare plans, pay no monthly premium.”

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What Comes Next After Enhabit’s UnitedHealthcare Contract Termination https://homehealthcarenews.com/2024/08/what-comes-next-after-enhabits-unitedhealthcare-contract-termination/ Thu, 08 Aug 2024 19:56:02 +0000 https://homehealthcarenews.com/?p=28665 Enhabit Inc. (NYSE: EHAB) CEO Barb Jacobsmeyer said Wednesday that the company would terminate its contract with the country’s largest Medicare Advantage (MA) payer, UnitedHealth Group’s (NYSE UNH) UnitedHealthcare. UnitedHealthcare accounts for 9.4 million MA beneficiaries, or 29% of all enrollees, according to the Kaiser Family Foundation. Humana Inc. (NYSE: HUM), which is the second-largest […]

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Enhabit Inc. (NYSE: EHAB) CEO Barb Jacobsmeyer said Wednesday that the company would terminate its contract with the country’s largest Medicare Advantage (MA) payer, UnitedHealth Group’s (NYSE UNH) UnitedHealthcare.

UnitedHealthcare accounts for 9.4 million MA beneficiaries, or 29% of all enrollees, according to the Kaiser Family Foundation. Humana Inc. (NYSE: HUM), which is the second-largest MA payer, only owns 18% of the market, for context.

It’s hard to overstate how large of a strategic gamble this is for Enhabit. On one end, you can’t “negotiate” for better contracts if you’re unwilling to walk away from a bad one. On the other end, as Enhabit tries to build up its non-Medicare revenue (or MA revenue), reducing access to members of the country’s largest payer comes with inherent risks.

Broadly, Enhabit has been adjusting its revenue mix over the last couple of years to become a better partner to referral sources and set itself up for the future. When it spun off of Encompass Health (NYSE: EHC), close to 80% of its business was tied to traditional Medicare. Now, that number is closer to 60%.

As it takes on more MA – which now insures about 54% of Medicare beneficiaries – its goal is to mostly take care of patients under its improved (“payer innovation”) contracts. Over the last two years, Enhabit has been renegotiating contracts with MA plans, aiming to get higher rates, or at least higher-upside agreements.

UnitedHealthcare clearly fell short during negotiations.

“As we look to the future, the quickest way to get the majority of our non-Medicare business to the payer innovation contracts is to continue to focus on referrals within the payer innovation contracts, negotiate improved rates with non-payer innovation contracts, and, when necessary, terminate the lower reimbursing contracts,” Jacobsmeyer said Wednesday on the company’s second-quarter earnings call. “After over nine months of unsuccessful negotiations with UnitedHealthcare, we submitted our termination notice on August 1. We will dedicate our clinical resources to fee-for-service Medicare patients, and those members of the 68 favorable contracts. We remain committed to providing our strong quality of care to UnitedHealthcare members, if at some point they decide to contract with acceptable rates.”

Enhabit putting its foot down on UnitedHealthcare, and what it means for itself and the home health industry at large, is the topic of this week’s exclusive, members-only HHCN+ Update.

Putting a foot down

Enhabit said that moving away from UnitedHealthcare is squarely in line with its overall payer innovation strategy.

“In quarter one of 2023, 58% of admissions were in combined Medicare fee-for-service and payer innovation contracts, which left 42% of admissions in unfavorable contracts,” Jacobsmeyer explained. “In 2024, the percent of admissions in Medicare fee for service and payer innovation contracts has grown to 71%. This will continue to accelerate with the recent decision to terminate this national agreement.”

The Dallas-based Enhabit is one of the largest home health providers in the country. In total, it has 256 home health locations and 112 hospice locations across 34 states.

Capacity is the most cherished part of home health operations. Staffing is a barrier to growth, so what companies do with the staff they do have is of utmost importance.

It also happens to be providers’ best bargaining chip. Providers don’t want to leave home health-needy patients in the middle of contract wars, but MA members need home health access, and providers can take that away from plans.

With home health access dwindling – due to MA penetration and fee-for-service rate cuts – MA plans need reliable home health partners. They need to enable easy transitions from the hospital to the home, avoiding referral rejections when they can.

Enhabit’s termination of the UnitedHealthcare contract, and its coinciding public announcement of that, has drawn significant attention from Home Health Care News readers.

Providers have complained that, while UnitedHealth Group recognizes the value of home health care – considering its acquisition of LHC Group and its pending acquisition of Amedisys Inc. (Nasdaq: AMED) – it does not show it through UnitedHealthcare’s home health rates.

A move like this, from a provider as large as Enhabit, may serve as a wake up call to UnitedHealthcare. It will definitely serve as a point of reference and confidence for home health providers that are considering walking away from bad contracts themselves.

“As a regional provider of home health services, we had to look at those margins and how we best deploy our nurses and our therapists,” Jet Health’s then-CEO Stacie Bratcher said last January. “We were under water with one of our large providers. We had to decide, do we stay in-network with some really poor rates that were under what our per-visit rate was, or do we exit?”

Even if payers recognize the value of home health care, the departments that negotiate rates are sometimes incentivized to keep low rates in place. Jacobsmeyer has explained this dynamic on earnings calls before.

The current home health payment environment has providers turning every stone, looking for ways to keep a viable bottom line.

At some point, the juice is not worth the squeeze on bad MA contracts – both for struggling, smaller providers and for larger ones like Enhabit, which finally has better deals in place elsewhere.

“A year or so ago, we would not have been in the position to terminate that contract,” Jacobsmeyer said. “But now, with 68 agreements, including two national agreements, we feel confident that we’re going to be able to replace that census. Our current non-Medicare conversion rate is only at 48%, so we do have some non-Medicare that we don’t convert. So it’s really now going to be about replacing that census over this notice period.”

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Amedisys’ High-Acuity, Non-Medicare Revenue Skyrockets As It Waits For UnitedHealth Group Deal To Close https://homehealthcarenews.com/2024/07/amedisys-high-acuity-non-medicare-revenue-skyrockets-as-it-waits-for-unitedhealth-group-deal-to-close/ Wed, 24 Jul 2024 21:20:39 +0000 https://homehealthcarenews.com/?p=28564 Amedisys Inc. (Nasdaq: AMED) is waiting for multiple big-time transactions to come to fruition by year end. In the meantime, it continues to grow its non-Medicare revenue and its high-acuity care business considerably. The company released its second-quarter earnings on Wednesday, without an accompanying call. It has not held an official earnings call since UnitedHealth […]

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Amedisys Inc. (Nasdaq: AMED) is waiting for multiple big-time transactions to come to fruition by year end. In the meantime, it continues to grow its non-Medicare revenue and its high-acuity care business considerably.

The company released its second-quarter earnings on Wednesday, without an accompanying call. It has not held an official earnings call since UnitedHealth Group (NYSE: UNH) agreed to acquire it in June of 2023, which is customary.

Home health revenue checked in at $377.4 million in the second quarter, reflecting a nearly 8% year-over-year increase. Hospice revenue checked in at $204 million, reflecting an over 2% year-over-year increase.

Amedisys’ non-Medicare home health revenue grew significantly once again, to $161.3 million in the quarter. That represents a 24% year-over-year increase.

High-acuity care revenue, meanwhile, checked in at $9.8 million, reflecting a 145% year-over-year increase. Amedisys acquired Contessa Health – an at-home, high-acuity care provider – in 2021 for $250 million. Admissions in that line of business were up 57% year over year, according to Amedisys. It now has 9 joint ventures contributing to growth, as well as 33 referring hospitals.

Overall, the Baton Rouge, Louisiana-based Amedisys has 519 care centers across 37 states and the District of Columbia.

It has been over a year since UnitedHealth Group’s Optum agreed to acquire Amedisys for $3.3 billion. Amedisys recently agreed to divest a number of locations to VitalCaring, the home health provider led by April Anthony.

That divestment is contingent on the UnitedHealth Group-Amedisys deal going through. In all likelihood, the divestment is being made to ease antitrust concerns regarding the deal. Optum already owns LHC Group, another one of the largest home health providers in the country.

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Optum’s Home & Community Business Reportedly Hit With Layoffs https://homehealthcarenews.com/2024/07/optums-home-community-business-reportedly-hit-with-layoffs/ Fri, 19 Jul 2024 19:48:41 +0000 https://homehealthcarenews.com/?p=28508 UnitedHealth Group’s (NYSE: UNH) Optum has reportedly conducted a round of layoffs, specifically within Landmark Health, which is an in-home medical care operator. Optum agreed to acquire Landmark Health early in 2021. Optum also acquired the in-home medical group Prospero Health early in 2023, rolling it into Landmark Health. While the layoffs are not isolated […]

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UnitedHealth Group’s (NYSE: UNH) Optum has reportedly conducted a round of layoffs, specifically within Landmark Health, which is an in-home medical care operator.

Optum agreed to acquire Landmark Health early in 2021. Optum also acquired the in-home medical group Prospero Health early in 2023, rolling it into Landmark Health.

While the layoffs are not isolated to Landmark, they account for a “sizable portion,” according to Fierce Healthcare. Specifically, at least 100 licensed social workers have been dismissed across the country. Social work managers were also affected.

Landmark is also exiting close to 20 markets, according to anonymous employees who spoke with Fierce.

Episource – another Optum subsidiary – was also impacted by the layoffs. Optum laid off employees within its Optum Home & Community Care division earlier this year. Landmark falls under the Home & Community Care umbrella.

In May, Optum laid off employees in other areas of its business outside of home-based care.

Home Health Care News reached out to Optum for comment, but had not heard back by the time this story was published.

UnitedHealth Group has battled significant headwinds of late. Another one of its subsidiaries – Change Healthcare – was hit with a massive cyberattack earlier this year. It has also been the subject of a DOJ antitrust investigation.

All the while, it continues building out its home-based care portfolio. It already owns LHC Group, one of the largest home health providers in the country. It’s in the process of acquiring Amedisys Inc. (Nasdaq: AMED), another one of the largest home health providers.

Originally, the Amedisys deal was also targeted by antitrust regulators. But Amedisys has agreed to divest a certain amount of its locations to VitalCaring, in a move that could clear the path for the deal to get done.

UnitedHealth Group brought in revenues of $98.9 billion in the second quarter, an over 6% year-over-year increase.

Optum brought in $62.9 billion in the quarter, good for a nearly 12% year-over-year increase.

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UnitedHealth Group Touts In-Home Visits As Amedisys Deal Lingers  https://homehealthcarenews.com/2024/07/unitedhealth-group-touts-in-home-visits-as-amedisys-deal-lingers/ Tue, 16 Jul 2024 21:13:41 +0000 https://homehealthcarenews.com/?p=28489 The home remains a strategic focal point for UnitedHealth Group (NYSE: UNH), which is still in the process of acquiring the home health giant Amedisys Inc. (Nasdaq: AMED). Last year, the company’s medical professionals achieved 2.5 million home visits through Medicare Advantage (MA). “As a direct result, our clinicians identified 300,000 seniors with emergent health […]

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The home remains a strategic focal point for UnitedHealth Group (NYSE: UNH), which is still in the process of acquiring the home health giant Amedisys Inc. (Nasdaq: AMED).

Last year, the company’s medical professionals achieved 2.5 million home visits through Medicare Advantage (MA).

“As a direct result, our clinicians identified 300,000 seniors with emergent health needs that may otherwise have gone undiagnosed,” UnitedHealth Group CEO Andrew Witty said Tuesday during the company’s second-quarter earnings call. “They connected more than 500,000 seniors to essential resources to help them with unaddressed needs such as food insecurity, medication, affordability, transportation and financial support. They also identified and helped close more than 3 million gaps in care that made a real difference in people’s lives.”

Witty added that within 90 days of a home visit, 75% of patients receive follow up in a clinical setting.

Plus, UnitedHealth Group found that MA patients with chronic conditions, who are receiving these home visits, have more stable health outcomes. They spend less time in the emergency room and other hospital settings than fee-for-service patients, according to Witty.

“The bottom line — our home visit programs help patients live healthier lives, and save taxpayers money,” he said. “It is only [MA] that makes programs and results like this possible.”

In-home health evaluations are a differentiator for MA plans. They can help plans recognize chronic conditions and keep members out of the hospital, but they also – at times – allow MA plans to boost profits.

During the call, UnitedHealth Group’s leadership team also commented on the Change Healthcare cyberattack again, which occurred at the start of the year. Change Healthcare is a U.S. billing and payment system, and a subsidiary of UnitedHealth Group.

“Our focus has centered on the patients, care providers and customers who rely on us to keep the health system running,” John Rex, president and CFO of UnitedHealth Group, said. “Payment and claims flows for most care providers are back to normal, but we know that is not the case for some. We continue to work with those who are not there yet. UnitedHealth Group has provided more than $9 billion in loans, and advanced payments to help providers mitigate the impact of the attack, all at no cost to them.”

Rex noted the Change Healthcare cyberattack had an impact on UnitedHealth Group’s results.

“This largely encompasses the loss of revenues, combined with the cost of keeping these capabilities fully ready to serve,” he said. “Notably, these effects are not excluded from adjusted earnings.”

For the second quarter of 2024, UnitedHealth Group brought in revenues of $98.9 billion, a nearly $6 billion increase over the prior year period. 

Optum — UnitedHealth Group’s health care services arm — has Q2 revenues of $62.9 billion, which grew by over $6 billion compared to the prior year. This increase was led by Optum Rx and Optum Health.

UnitedHealth Group did not comment on the ongoing Amedisys acquisition. But Amedisys recently agreed to divest locations to VitalCaring, which could clear the way for deal closure.

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Amedisys To Divest Certain Home Health Locations To VitalCaring, Clearing Path For UnitedHealth Group Deal https://homehealthcarenews.com/2024/06/amedisys-to-divest-certain-home-health-locations-to-vitalcaring-clearing-path-for-unitedhealth-group-deal/ Fri, 28 Jun 2024 22:13:22 +0000 https://homehealthcarenews.com/?p=28455 Amedisys Inc. (Nasdaq: AMED) filed paperwork Friday with the U.S. Securities and Exchange Commission saying it has agreed to divest “certain” locations to an affiliate of home health and hospice company VitalCaring. The divestiture was a way for Amedisys to avoid further antitrust concerns from regulators prior to it joining UnitedHealth Group (NYSE: UNH). UnitedHealth […]

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Amedisys Inc. (Nasdaq: AMED) filed paperwork Friday with the U.S. Securities and Exchange Commission saying it has agreed to divest “certain” locations to an affiliate of home health and hospice company VitalCaring.

The divestiture was a way for Amedisys to avoid further antitrust concerns from regulators prior to it joining UnitedHealth Group (NYSE: UNH).

UnitedHealth Group’s Optum agreed to purchase Amedisys last June for a purchase price of $3.3 billion. Optum already owns LHC Group, another one of the largest home health companies in the country.

The Baton Rouge, Louisiana-based Amedisys has 521 care centers in 37 states and the District of Columbia. It offers home health, hospice, palliative and home-based high-acuity care.

In May, a report surfaced that UnitedHealth Group and Amedisys were working with regulators on a divestment package over “over 100 locations.”

A short time after, a “private equity-backed” buyer for those locations emerged. Home Health Care News reported that buyer was VitalCaring, the Dallas-based home health and hospice company led by April Anthony. VitalCaring is backed by The Vistria Group and Nautic Partners.

VitalCaring then reportedly backed away from the deal, due to disagreements over the worth of those locations once they left the Amedisys network, sources told HHCN.

HHCN also reported at the time that it was likely both parties would come back to the table. VitalCaring is one of the few growing home health providers with enough capital backing to pull off an acquisition of this magnitude.

Now, the deal is agreed upon between the two parties, though details are minimal. A purchase price was not listed in Amedisys’ 8-K filing, nor was the number of locations.

According to the financial filing, the divestment agreement being finalized is dependent on the UnitedHealth Group deal going through.

“Consummation of the Divestiture is contingent on a number of conditions, including the consummation of the previously announced merger transaction (the “Merger Transaction”) contemplated under the Agreement and Plan of Merger, dated June 26, 2023 (the “Merger Agreement”), by and among UnitedHealth Group, Aurora Holdings Merger Sub Inc., a wholly owned subsidiary of UnitedHealth Group (“Merger Sub”), and Amedisys, pursuant to which Merger Sub will merge with and into Amedisys (the “Merger”) upon the terms and subject to the conditions set forth in the Merger Agreement, with Amedisys surviving the Merger as a wholly owned subsidiary of UnitedHealth Group,” the filing states.

The transaction is expected to close in the second half of 2024.

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