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Earlier this year, I had the chance to interview CenterWell President Sanjay Shetty on stage and off stage at the Digital Healthcare Innovation Summit in La Jolla, California.
Last month, at Home Health Care News’ FUTURE conference in Nashville, I did the same with Kirk Allen, the president of home solutions at Humana Inc. (NYSE: HUM).
Humana is one of the largest health care companies in the country. As a payer, it is one of the largest, particularly in Medicare Advantage (MA). As a provider, Humana’s CenterWell is also a powerhouse, with home health, pharmacy and primary care segments.
While MA plans and home health organizations are often at odds, Humana and UnitedHealth Group (NYSE: UNH) are in a unique position. They are the two largest MA administrators, and also own two of the largest home health providers in the country, in CenterWell Home Health and LHC Group, respectively.
When chatting with Shetty in February, he felt as though CenterWell could leverage that position on behalf of the entire home health industry.
“I think, hopefully, that proof point will help,” he told me. “We’re still probably in the early days, … 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?”
Allen and I picked up that conversation where Shetty and I left off.
Humana’s goals within the home, and how they could affect the home health industry at large, are the topic of this week’s exclusive, members-only HHCN+ Update.
Proving the value
Some home health providers are queasy over large payers acquiring other top providers. But the best-case scenario for them would be for CenterWell Home Health, LHC Group and Amedisys Inc. (Nasdaq: AMED) to shine within Humana and UnitedHealth Group.
If they do, it could open the door for other home health providers to negotiate on higher ground with MA plans.
After all, those payers will always need more home health services than their own providers can supply.
Allen has been with Humana for seven years. He officially became the president of home solutions at the company in January.
As Shetty said, CenterWell Home Health is still early on in its quest to prove out home health care’s worth in a value-based context.
“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,” Shetty said. “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.”
Allen explained that Humana has a near-term goal of treating 80,000 home health patients under a value-based model.
That model, while proprietary, could be a blueprint for future agreements between health plans and home health providers.
“Humana is in a unique position because of the investments that it has made, to measure and prove out the impact,” Allen told me. “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.”
The 80,000 number, Allen believes, is a sufficient size and sample to prove the model out. If all goes well, the goal is to treat far more patients under the value-based model in the future.
“I do think that this can have an impact on payments in the industry at large,” Allen said.
How the model works
The value-based model is still Medicare-certified home health care. So, for instance, OASIS is still collected, and all the guardrails that other providers follow based on Centers for Medicare and Medicaid Services (CMS) direction will be followed by CenterWell Home Health.
But the freedom – and promise, ideally – comes elsewhere. Under the model, a Low-Utilization Payment Adjustment (LUPA) is not a concern, for instance.
“In our value-based construct between CenterWell Home Health, onehome and our primary care organization (PCO), there’s [an ability] to really focus on the patient and their needs at the center,” Allen said. “The PCO owns those patients, from a physician standpoint. We are the home health provider for those patients, so there’s not lots of different people involved. The first thing that occurs as a result of that is they know directly who to come to for home care, and we know directly who to go to for orders, right?”
On the PCO’s end, there’s physician “champions” that coordinate directly with home health care on the clinical side. That way, if the patient needs something, it’s delivered right away.
“The main thing is that both entities are completely responsible,” Allen said. “And it becomes about what the patient needs. And that’s what you deliver. You don’t have a sales function that you are running around. It’s more coordination of care and delivery of care than selling for care.”
The value-based model got up and running last November, and early indications are that hospitalizations are being reduced, according to Allen. More data will be available by year end, in all likelihood.
Humana has been focused on home-based care for more than a decade. Its test of value-based home health care may be one of its biggest initiatives yet, so much so that the company has publicly touted it on earnings calls in the past.
If everything goes accordingly, the new model will represent a major tailwind for Humana, CenterWell and specifically CenterWell Home Health.
CenterWell Home Health could then – as a payer-agnostic organization – turn around to other MA plans and show the true value of their services as well.
“We stay focused on providing value,” Allen said. “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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