Legacy Care Partners Acquires Superior Home Health and Superior Hospice of Texas

Legacy Care Partners – which also owns Advanced Home Care – has acquired Superior Home Health and Superior Hospice of Texas.

Terms of the deal were not disclosed.

“We extend a warm welcome to Superior Home Health and Superior Hospice into the Legacy Care Partners family,” Legacy Care Partners President and CEO Brian McDonald said in a statement. “This strategic acquisition positions us to broaden our impact in Texas, ensuring that more communities have access to the high-quality healthcare services they deserve.”

Based in Wisconsin, Legacy Care Partners provides a wide range of health care services across four states, also including Florida, Michigan and Texas.

It has expanded its footprint significantly through the Super Home Health and Superior Hospice acquisition, as the latter has seven locations across Texas and serves 50 counties and 500 cities.

“As Superior approaches its 20th anniversary, this business combination enhances and leverages synergies, expanding and strengthening the Superior brand as a subsidiary of Legacy Care Partners,” Super Home Health and Superior Hospice President Belinda Juarez said in a statement.

SSM Health Acquires Visiting Nurse Association of Greater St. Louis

SSM Health, a Missouri-based health system, has acquired the Visiting Nurse Association of Greater St. Louis.

Terms of the deal were not disclosed.

“We are excited about the opportunity to unite with this highly respected health care organization to further expand access to high-quality compassionate health care services across the full continuum in the St. Louis region,” Denise Gloede, president of continuum of care at SSM Health, said in a statement. “Together, we’ll be able to serve more patients and families who are depending on us.”

The Visiting Nurse Association of Greater St. Louis provides a range of home-based care services, including home health, hospice, palliative care and private-duty care. It will now fall under the umbrella of SSM Health at Home.

SSM Health, meanwhile, is a nonprofit health system that provides care across four states: Missouri, Illinois, Oklahoma and Wisconsin. The organization already had a home health and hospice operation prior to the acquisition.

“I could not be prouder of the exceptional health care legacy we’ve built at the VNA and the decision to join SSM Health was not made lightly,” VNA President and CEO Nesa Joseph said in a statement. “Our missions, values and cultures are very similar – focused on employee and physician partnership, continuous quality improvement, and patient-centered care with a special concern for the poor and vulnerable. Ultimately, we believe SSM Health is the right partner to ensure we’re able to continue meeting the growing and evolving needs of the individuals and families we serve.”

IntellaTriage’s NurseLine acquisition

The Brentwood, Tennessee-based IntellaTriage has acquired NurseLine, a provider of home health and hospice triage services.

Terms of the deal were not disclosed.

“NurseLine has built a remarkable reputation for delivering high-quality hospice triage,” IntellaTriage CEO Daniel Reese said in a statement. “This acquisition aligns with our long-term goals to advance healthcare through cutting-edge technology and expert clinical support. Together, we are well-positioned to offer unparalleled solutions to post-acute providers, improving patient outcomes, reducing nurse burnout, and increasing operational efficiency.”

IntellaTriage provides nurse triage shortages throughout the day and night. It partners with health care providers, including home health agencies, to “reduce burnout and improve patient experience.”

In 2022, IntellaTriage received funding from Pacific Lake Partners, among others. Now, with the like-minded NurseLine underneath its belt, it has begun expanding its reach.

“We are excited to join forces with IntellaTriage, a company that shares our commitment to delivering exceptional care to patients and their families any time of day,” NurseLine CEO Devang Patel said in a statement. “Together, we will continue to redefine the future of after-hours care, providing health care providers with the support services they need to deliver high-quality, patient-centered care.”

Cigna Offloads Medicare Advantage Business

The Cigna Group (NYSE: CI) is selling its Medicare insurance plans to Health Care Service Corp., a Blue Cross Blue Shield insurer. The price tag was $3.7 billion.

In the deal, Health Care Service Corp. will take on about 600,000 Medicare Advantage plan members, in addition to Medicare beneficiaries who have Medicare-based prescription drug plans with Cigna.

Though the price tag is large, Cigna was not a major MA player in comparison to its peers. For instance, UnitedHealth Group (NYSE: UNH) has close to 9 million MA beneficiaries, while Humana Inc. (NYSE: HUM) has nearly 6 million.

At one point, when Cigna and Humana were considering combining, offloading the MA business seemed like a way to avoid antitrust issues. Those talks came to an end in December, however, and Cigna still went ahead with the sale.

It appears, in the end, that the juice from MA business was simply not worth the squeeze for Cigna.

The post Transactions: Legacy Care Partners Acquires Superior Home Health; SSM Health Bolsters Health at Home Arm appeared first on Home Health Care News.

Released last week, Pitchbook’s Q4 health care services report shines a light on the Biden administration’s antitrust and private equity stances, and how those may be affecting dealmaking.

For instance, the Humana Inc. (NYSE: HUM) and Cigna Group (NYSE: CI) combination rumor ended late last year with the insinuation that the two massive payers couldn’t agree to a price tag. But Pitchbook – and its lead health care analyst, Rebecca Springer – believe that a heightened antitrust focus from the president’s administration also could have played a role.

In late November, initial reports came out regarding Humana-Cigna conversations. By Dec. 11, those conversations had ended.

“Cigna and Humana call off merger talks, which were first reported in November,” the Pitchbook report noted. “Antitrust opposition is believed to have contributed to the deal’s demise. Many payers are under pressure due to rising utilization, slowing growth, and changes to the Medicare Advantage (MA) program.”

UnitedHealth Group (NYSE: UNH), and its subsidiary Optum, are in the process of navigating this more complex regulatory landscape as well.

A prolific acquirer, Optum is beginning to meet more pushback on its acquisitions. Its deal for the home health and hospice provider Amedisys (Nasdaq: AMED) has already received scrutiny from lawmakers. If it acquired Amedisys, Optum would own about 10% of the home health market, having already acquired LHC Group.

At the same time, its planned takeover of the Corvallis Clinic in Oregon is also receiving significant pushback.

Elsewhere, on Dec. 7, the Biden administration released a fact sheet condemning certain PE activity in the health care space, including in home-based care.

“Private-equity ownership in the health care industry has ballooned, with approximately $750 billion in deals between 2010 and 2020 – in sectors including, but not limited to, physician practices, nursing homes, hospices, home care, autism treatment and travel nursing,” the fact sheet read. “Too often, aggressive profiteering by private equity-owned practices can lead to higher patient costs and lower quality care.”

Though interest rates likely remain the no. 1 deterrent to activity, this dynamic also appears to be playing a role.

While there are more PE-backed health care companies than ever, new investments and new exits have waned over the past few years.

“The key effect of the Biden administration’s scrutiny of PE in healthcare is not direct antitrust risk, but headline risk,” Springer wrote. “We have been struck by the sudden change in tone among investors on this topic. While the interest-rate environment remains the most important driver of the pace of dealmaking, we also believe sponsors will be somewhat more cautious in 2024 about entering any provider categories that primarily serve vulnerable populations, including home-based care, post-acute care, high-acuity behavioral health, intellectual & developmental disabilities (IDD) care and autism treatment.”

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Instead, in 2023, home health providers saw another year defined by payment struggles, with both the Centers for Medicare & Medicaid Services (CMS) and Medicare Advantage (MA) plans.

Home care providers, meanwhile, were still grappling with high billing rates on the private-pay side. On the Medicaid side, home- and community-based services providers dealt with some rosy rate increases, but also some regulatory concern with a proposed wage mandate provision from CMS.

But, in a year that had a historically low M&A volume, home-based care transactions grabbed the headlines more than ever.

Reflect back on this year in home-based care by revisiting 10 of HHCN’s most widely read stories.

1. Optum Lures Amedisys Away From Option Care Health With $3.3B All-Cash Deal (June 26)

The sale of Amedisys Inc. (Nasdaq: AMED) – one of the largest home health providers in the country – is still pending. But the saga grabbed many of the top headlines on HHCN in 2023.

First, Option Care Health (Nasdaq: OPCH) agreed to acquire the provider, in hopes that it could create an “end-to-end” continuum in the home. Ultimately, UnitedHealth Group’s Optum lured Amedisys away with an all-cash deal.

2. $5.4 Billion LHC Group-Optum Deal Closes (Feb. 22)

Optum’s acquisition of LHC Group – another one of the largest home health providers in the country – was one of the top stories in 2022. It remained a top story in 2023, however, as the deal closed in February.

If Optum is able to finalize its deal with Amedisys, it will own about 10% of the home health market.

3. Rumors Swirl Around Potential Cigna Group-Humana Combination (Nov. 28)

This top story was all for naught. Humana Inc. (NYSE: HUM) and Cigna Group (NYSE: CI) were in talks to combine, but eventually could not agree on a fair price.

Humana was also linked to Walmart (NYSE: WMT), but it’s unclear if those talks have advanced.

In the end, if Humana – which owns CenterWell Home Health, another one of the largest home health providers – is acquired, it is sure to be one of the biggest home-based care stories of 2024.

4. CMS Finalizes 0.8% Home Health Payment Increase For 2024, Additional PDGM Cuts (Nov. 1)

CMS first proposed a 2.2% decrease to home health payments for CY 2024 in June, but ultimately ended up finalizing a meager 0.8% bump to aggregate payments.

Providers remain unhappy with CMS’ rate cuts, which were still included in the final rule despite the pay bump.

“Immediately, you feel a little sigh of relief as an operator just because we were expecting the full proposed cut,” Healing Hands Healthcare CEO Summer Napier said of the rule. “But then the further you read, you’re like, ‘This is trash. I’m not going to accept this for 2025 and beyond. It’s not happening.’”

5. Humana’s CenterWell To Acquire Trilogy Home Health (April 24)

CenterWell Home Health acquired the Florida-based Trilogy Home Health in April in what was one of the first big splashes the provider made under Humana ownership.

HHCN had the exclusive on the deal, which added 11 locations to CenterWell’s home health portfolio.

6. Details Emerge Around Home Health Titan April Anthony’s New Venture, VitalCaring (Feb. 2)

April Anthony, formerly the CEO of Encompass Health’s (NYSE: EHC) home health and hospice arm, was not away from the industry for long.

Early in the year, details finally emerged around her new venture, VitalCaring, which is funded by Anthony, The Vistria Group and Nautic Partners.

The home health and hospice company has grown significantly in its first year.

7. The Potentially Dire Long-Term Impact Of Home Health Agency Closures (Jan. 17)

The amount of home health agencies has slowly declined over the last decade.

In recent years, agencies have closed due to rate cuts and MA penetration. This article detailed some of those stories, and also explained the significance of those closures.

8. Honor Lays Off 15% Of HQ Staff, Including Long-Time Home Instead Employees (June 27)

In June, Honor – the home care technology company that owns Home Instead – announced that it would be laying off 15% of its HQ staff, which included many longtime Home Instead employees.

9. CD&R-Backed Gentiva Agrees To Acquire ProMedica’s Home Care, Hospice Assets For $710M (Feb. 27)

When Humana acquired Kindred at Home to create CenterWell Home Health, it divested the home care and hospice assets. Those assets turned into Gentiva.

Gentiva – which has made palliative care a major focus – made its first big splash with the $710 million acquisition of ProMedica’s home care and hospice assets.

10. New CMS Dementia Care Model Opens Doors Of Opportunity For Home-Based Care Providers (Jul. 31)

CMS announced a new dementia care model this year – the GUIDE Model – which excited home care providers across the country.

Over the next decade, providers will have the chance to be paid by the government to help care for dementia patients across the country.

The post The Top 10 Home Health Care News Stories Of 2023 appeared first on Home Health Care News.

Home health providers have griped with their Medicare Advantage (MA) plan partners for years over poor rates, claim denials and increased administrative burden.

Providers have stopped short of banding together to deny coverage for these plans, but some of the top companies have reallocated capacity to “preferred payers.”

In the end, though, it may not be the provider push that’s mattered most. That push, instead, may be from other parties – including patients.

A few of the largest insurers in the country have been hit with class-action lawsuits recently. For home health providers, the story is less about the lawsuits themselves, and more about what they may mean for future relationships with MA plans.

Humana Inc. (NYSE: HUM) was hit with a class-action lawsuit Tuesday, from MA beneficiaries alleging that the company “systematically deploys an AI algorithm to prematurely, and in bad faith, discontinue payment for health care services for elderly individuals with serious diseases and injuries.”

UnitedHealth Group (NYSE: UNH) was hit with a similar lawsuit last month. Cigna Group (NYSE: CI) was hit with one earlier this year, also over claim denials.

At the same time, Cigna, Blue Cross Blue Shield and others have begun to shed certain prior authorization requirements.

All of the pressure being placed on MA plans – and their reaction to it – could make a meaningful difference for home health providers in the future.

National Association for Home Care & Hospice (NAHC) President William A. Dombi called home health providers’ uphill battle in MA a “generational battle.”

But it’s better characterized as a war. And with the recent developments in MA, the home health industry may finally be adding a few battles to its win column.

I explain further in this week’s exclusive, members-only HHCN+ Update.

Baby steps

The irony of the home health industry’s “war” against MA is that the end goal would be to have a harmonious relationship with those plans.

All sides of the disputes are counting on it: the providers, the plans, and – most importantly – the patients.

It’s akin to Rocky IV, in which the viewer sees the protagonist – Rocky Balboa – training for, and fighting against, a seemingly insurmountable Soviet foe in Ivan Drago.

But, by the end, Balboa has won the fight and won the Soviets over: “If I can change, and you can change, everybody can change,” he says.

We’re not there just yet, however. This will take time, but it’s worth taking stock of the wins when they materialize.

As the class-action lawsuits unfold, home health providers are – to some extent – having their issues with plans’ claim denials validated.

“Whether they’re using AI or not, their back-office revenue cycle operations are trained to intentionally request additional medical records to delay and defer payments, because what they’re hoping is that the provider misses the 30-day response window on replying to all of these requests for medical records, certification of eligibility, etc.,” Intrepid USA CEO John Kunysz told me this week. “Because, if you miss it, and you don’t turn it in 30 days, you get a, ‘Oh, sorry, claim is denied.’”

The Dallas-based Intrepid is a home health and hospice provider with more than 60 locations across 16 states.

Over 50% of Medicare beneficiaries are now under an MA plan as opposed to traditional Medicare, according to Kaiser Family Foundation. Additionally, home health providers have told HHCN that, on average, MA plans pay about 60%-70% of what traditional Medicare does for services.

Even so, Kunysz said that Intrepid’s revenue cycle management team spends 7 to 8 times more time – which also means money – on MA and commercial claims compared to traditional Medicare.

What patients want out of their lawsuits is, in essence, the same as what providers have wanted: for plans to pay properly – and in a reasonable time frame – for services that are needed.

All of the insurers thus far have denied unethical use of AI to deny care or payment.

“We use various tools, including augmented intelligence, to expedite and approve utilization management requests and ensure that patients receive high-quality, safe and efficient care,” a Humana spokesperson told me this week. “By definition, augmented intelligence maintains a ‘human in the loop’ decision-making whenever AI is utilized. Coverage decisions are made based on the health care needs of patients, medical judgment from doctors and clinicians, and guidelines put in place by CMS. It’s important to note that adverse coverage decisions are only made by physician medical directors.”

Either way, the lawsuits are likely to force insurers to reconsider why – and how – they deny claims. UnitedHealth Group has already done away with its “naviHealth” brand, which was the convener allegedly responsible for the AI that helped deny care.

Outside of those lawsuits, and on the other side of care, is the prior authorization issue.

Cigna, Blue Cross Blue Shield and other plans stripping those requirements is an acknowledgment that many of those burdensome requirements weren’t needed in the first place.

“By removing prior authorization requirements for home care services, we’ll help hospitals to expedite discharges at a time when many are struggling with overcrowding,” BCBS of Massachusetts Chief Medical Officer Dr. Sandhya Rao told HHCN last month. “This change will also reduce delays for Blue Cross members ready to transition their care from hospital to home.”

Cigna, meanwhile, is in the process of removing prior authorization for nearly 500 additional codes for its Medicare Advantage plans.

As Rao said, prior authorization ends up being a problem for hospitals. It’s also a problem for hospitals’ post-acute partners, as well as the patients in the middle.

“You end up having a situation where patients do not get timely authorizations for starts of care,” Kunysz said. “They have a medical need that sometimes isn’t addressed for seven to 14 days, with the length of time that they sit on authorizations.”

It’s also worth mentioning that MA plans are increasingly becoming the subject of more regulatory oversight.

In the end, it may not be home health providers solely that get MA plans to change their ways.

They do have allies, though. And they’ll take the baby steps of progress, however they can get them. 

“I was on a call with an executive from one of the largest MA organizations yesterday, and I think MA plans have woken up to the fact that the rejection rates are high,” VitalCaring President Luke James told me last month. “And that there’s a clear delineation in spend, readmissions and ER utilization for patients that have orders for home health coming out of a hospital – between those that actually receive care and those that don’t.”

The post Recent Medicare Advantage Developments Bode Well For Home Health Providers appeared first on Home Health Care News.

The Wall Street Journal first reported on the suspension of talks on Sunday.

Together, the two companies would have created an insurer giant worth about $140 billion. It also would have meant CenterWell Home Health – and Humana’s other home-based care entities – becoming part of an even larger payer organization.

On its end, Cigna has a health care services arm as well, which includes some home-based care capabilities.

Rumors of a potential deal began when Cigna reportedly began shopping its Medicare Advantage (MA) business in November. Ridding itself of the MA line of business, theoretically, would have created less overlap between Cigna and Humana in the event of a combination.

In the last week of November, the Wall Street Journal confirmed that the two were talking about a potential deal.

Not even two weeks later, that deal is off the table.

There’s no signs to suggest that Humana is no longer up for sale in some capacity, however. In fact, there were also rumors that Walmart had engaged in talks with Humana after Cigna did in early December. Walmart was interested in pursuing Humana in 2018 as well.

Humana did not respond to a request for comment on the Walmart rumor at the time.

“The companies could not agree on price and other financial terms,” Scott Fidel, the managing director at the investment banking company Stephens, wrote in a note Monday. “Cigna will instead turn its focus towards smaller bolt-on acquisitions and also announced it will expand its current share buyback authorization by $10 billion given the current heavily discounted stock price, bringing total authorization to $11.3 billion, equating to ~15% of the market cap.”

Cigna is also still interested in selling its MA business, according to the Wall Street Journal.

“Given pressure on CI and HUM shares since we anticipated the merger talks on 11/7, we expect both stocks could initially trade higher on the suspension of talks,” Fidel continued.

The post Cigna Group, Humana Suspend Negotiations Around A Potential Combination appeared first on Home Health Care News.

Over the last week, a potential Cigna Group (NYSE: CI) and Humana Inc. (NYSE: HUM) combination has gone from a rumor to a real possibility.

After I reported on the topic for Home Health Care News on Tuesday, Reuters and The Wall Street Journal confirmed that the two companies were in talks, on Wednesday and Thursday, respectively.

A hat tip is in order for Scott Fidel, the managing director at the investment banking company Stephens, who was the first – or at least one of the first – to mention this possibility back on Nov. 7.

Even at face value, Cigna potentially joining forces with Humana is such a large health care story that it is worth exploring for any health care audience.

But Humana and Cigna combining will also create a home-based care powerhouse akin to UnitedHealth Group’s (NYSE: UNH).

Additionally, if a combined Cigna and Humana have CenterWell Home Health, and UnitedHealth Group has LHC Group – and potentially Amedisys Inc. (Nasdaq: AMED) – it’s reasonable to wonder whether other larger payer organizations will view home health care as table stakes in the future.

In this week’s exclusive, members-only HHCN+ Update, I further break down what a Cigna-Humana deal would mean for home-based care in the U.S., and the effect it could have on other dealmaking moving forward.

Managed care moves

Cigna pulls in about $190 billion in revenue per year, while Humana pulls in just over $100 billion. Cigna insures about 18 million insured lives, while Humana insures just about 17 million.

Any deal of that size is likely to face some scrutiny. That’s why, when it was reported that Cigna was considering selling its MA business, there was speculation that that was a preemptive move to erase some of the overlap between the two companies. Humana’s MA business is significant, while Cigna’s is relatively meager in comparison.

“We believe that a CI/HUM merger has significant L-T strategic merit and believe it could survive a legal challenge by the DOJ (which is surely to come) with appropriate MA and PBM remedies,” Fidel wrote in an analyst note Thursday. “However, investors are worried that the deal structure could effectively look more like an MOE given converging market caps along with a likely extended, noisy, and stressful merger review process. Indeed, on the WSJ report, CI shares traded down another ~8%, while HUM traded -5.5%.”

Pharmacy benefit management, as Fidel mentioned, is another area where there is significant overlap that would need to be dealt with.

But there’s also overlap between the provider sides of each house in home-based care, albeit not so much that it would cause an issue with the DOJ.

Humana has CenterWell, which includes CenterWell Home Health, one of the largest home health providers in the country. It also provides home-based primary care through CenterWell Senior Primary Care, a service line it’s in the process of expanding.

Cigna, on the other hand, has Evernorth Health Services. Evernorth provides behavioral health, pharmacy benefit management solutions, medical drug management services, clinical trial solutions, fertility health services, digital health, and, of course, home-based care.

On the home-based care front specifically, Evernorth provides “in-home primary care for polychronic patients and post-acute care through care coordination and provider network management.”

Together, Cigna and Humana would be the first entity that could boast home-based care capabilities that rival UnitedHealth Group’s.

UnitedHealth Group leaders spent hours on their home-based care plans at the company’s investor day Wednesday.

Other clues

The rumor that Cigna may be getting rid of MA was the first sign. But since discussions between the two companies have been confirmed, it appears there could have been other warning signs hiding in plain sight.

Most importantly, Humana announced a succession plan for CEO Bruce Broussard in October. Jim Rechtin will join Humana as president and COO in January, and then will succeed Broussard as CEO in the latter half of 2024.

Rechtin comes from Envision Healthcare, a hospital-based physician group where he served as president and CEO. The company filed for bankruptcy in May, which made the appointment of Rechtin a bit of a head scratcher, even if he had nothing to do with Envision’s downfall.

But the Cigna-Humana deal talk brings more clarity. After all, Humana highlighted Rechtin’s dealmaking experience in its October press release.

“Prior to OptumCare, Rechtin was with DaVita Medical Group, which he joined in 2014 and played the dual roles of Senior Vice President of Corporate Strategy and President of DaVita Medical Group’s California market,” Humana wrote. “Further, he is a 14-year veteran of Bain & Company, highlighting his depth of experience in health care mergers and the overall health care sector.”

Of note, Rechtin also spent time at UnitedHealth Group’s Optum before joining Envision.

Ripple effects

Part of what Broussard ushered into Humana was an era of investment in home-based care services. The culmination of those efforts ended up in CenterWell Home Health.

UnitedHealth Group has LHC Group, and, again, could have Amedisys by the end of the first quarter of 2024. That would give it two of the largest home health companies in the country and about 10% of the overall home health market.

It’s possible that other insurers could stay out of the home health market, even if their two largest competitors are heavily embedded in it.

It’s also possible that a game of follow the leader materializes.

CVS Health (NYSE: CVS) – which owns Aetna, for instance – has already dabbled in home-based care assets with its $8 billion purchase of Signify Health. But it has also teased more core home health acquisitions in the past.

“I think, over time, we’ll look at what other assets [we need],” CVS Health CEO Karen Lynch CEO said in May. “As you think longer-term, around the corner, there might be additional opportunities in the home.”

On the other end, it’s a tough time to be a home health provider – both due to fee-for-service rate cuts and MA penetration.

Joining a deep-pocketed partner could be enticing for some of the larger home health providers out there.

“Our ultimate aspiration was to move away from the fee-for-service model and drive better outcomes through value-based care,” LHC Group President and CEO Josh Proffitt said Wednesday at UnitedHealth Group’s investor day. “But we knew we didn’t have the capabilities to do it on our own. Now that we’re part of Optum, we can. Today, we see tremendous opportunity to not only scale within Optum’s value-based strategy, but also connect into the broader capabilities of Optum’s comprehensive home care offerings.”

Enhabit Inc. (NYSE: EHAB) is the last publicly traded, at-scale home health provider that’s available. The good news for interested payers, however, is that it is for sale.

A payer looking to compete in the home with the other larger payers may see Enhabit as a perfect fit.

If they do, the largest home health companies will all effectively be owned by managed care plans.

What that may mean, for the industry at large, is a topic for another day.

The post How A Cigna-Humana Combination Could Alter Home-Based Care In The US appeared first on Home Health Care News.

Nothing is official yet, but the combination of two of the largest insurers in the country would have significant ripple effects on the home health industry, for a variety of reasons.

On Nov. 6, Reuters first reported that Cigna was exploring a sale of its Medicare Advantage (MA) business. At the time, there was some speculation that the move was either a reaction to increased government oversight of MA plans or its own performance in MA.

Cigna declined to comment to Reuters on the shopping of its MA business at the time. But, since then, a third possible reason for offloading cropped up: a potential combination with Humana.

Doing away with MA could, in theory, temper antitrust concerns for such a combination.

“We would see this action being one component of a potential pursuit of Humana as an acquisition target, with the divestiture being a proactive move to reduce antitrust risk,” Scott Fidel, managing director at the investment banking company Stephens, wrote in a note shared with Home Health Care News earlier this month.

Cigna only has about 600,000 MA enrollees underneath its umbrella. Humana, on the other hand, adds more than that total to its portfolio on a yearly basis.

While Cigna owns about 2% of the MA market share, Humana owns close to 20%. Humana and UnitedHealth Group’s (NYSE: UNH) UnitedHealthcare are the largest MA players in the space.

Behind them are BCBS plans and CVS Health’s (NYSE: CVS) Aetna.

Both Cigna and Humana are payviders, meaning that, in addition to being large insurers, they also have significant health care services capabilities. Humana has CenterWell, which includes home health care, primary care and pharmacy. Cigna has Evernorth Health Services, which offers pharmacy services as well as behavioral health.

The pharmacy benefit overlap could also be of antitrust concern, as STAT News pointed out.

“A combined Cigna-Humana would still have a lot of overlap with their pharmacy benefit managers,” STAT wrote, also earlier this month. “Cigna owns Express Scripts (second-largest PBM, according to Adam Fein of Drug Channels), and Humana owns the fourth-largest PBM. Given how Lina Khan’s Federal Trade Commission already is scrutinizing PBM market power, it seems like that kind of deal would be an insta-block.”

At this point, there’s considerable smoke around the Cigna-Humana rumors.

If Cigna acquired Humana, it would be significant news in the home health care space, considering all of the acquiring Humana itself has done in recent years.

Humana fully acquired Kindred at Home – now CenterWell Home Health, stripped of the personal care and hospice assets – in 2021.

CenterWell Home Health is one of the largest home health providers in the country, along with the likes of LHC Group, Amedisys Inc. (Nasdaq: AMED) and Enhabit Inc. (NYSE: EHAB).

UnitedHealth Group officially acquired LHC Group earlier this year, and is in the process of acquiring Amedisys. Enhabit, meanwhile, is in the process of a strategic review that will likely end up in a sale.

While home health providers are generally at odds with MA plans given what the latter pays for home health services, many of the biggest providers are now a part of – or about to be a part of – organizations with large MA plans.

If a Cigna-Humana deal materialized, CenterWell Home Health would be a part of an even larger insurance giant.

It’s unclear what that would mean for the entity, which has been trying to maintain its standing as one of the two or three largest home health providers in the country. Currently, CenterWell has 352 home health locations and serves more than 350,000 patients annually. In April, it acquired the Florida-based Trilogy Home Health.

Home health care has been a bright spot for CenterWell and Humana. Longtime Humana CEO Bruce Broussard – who will be stepping away from his post in 2024 – recently commented on efforts being made to further optimize the segment.

“These efforts will be deployed across our more than 350 branches, and will include automation, consolidation, technology and AI solutions,” Broussard said during the company’s third-quarter earnings call. “This will minimize administrative caps while improving clinician productivity — including optimizing their schedule. We believe these initiatives, some of which require incremental investment, will ultimately streamline our operations and lead to increased clinician productivity and satisfaction.”

The health care insider and writer Wendell Potter, formerly a communications executive at both Cigna and Human, also wrote about the speculation on Tuesday.

He, too, mentioned the forthcoming leadership transition at Humana.

“Another reason to believe there is something to the speculation is the fact that Humana last month announced it had hired former UnitedHealth executive Jim Rechtin as chief operating officer and CEO-in-waiting,” Wendell wrote. “The company said Rechtin will succeed current CEO Bruce Broussard when Broussard retires next year. In its press release, Humana noted that Rechtin also spent 14 years at Bain & Company, ‘highlighting his depth of experience in health care mergers and the overall health care sector.'”

Humana reported revenue of $26.4 billion in the quarter, while CenterWell revenue checked in at at $4.66 billion overall.

In Cigna’s recent third-quarter earnings call, the company announced revenues totaling $49 billion.

A Humana spokesperson told HHCN the company had “no comment” on the matter. Cigna did not respond to a request for comment.

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As part of the agreement, Cigna will pay more than $172 million to the government and will also enter into a corporate integrity agreement with the U.S. Department of Health and Human Services Office of the Inspector General (OIG).

Among the allegations, the government said Cigna used vendors to do in-home assessments of its plan members, but the nurses failed to do the tests or imaging necessary to accurately diagnose serious conditions.

Afterward, Cigna billed Medicare using billing codes associated with conditions for these unconfirmed diagnoses to secure higher payments.

“For years, Cigna submitted to the government false and invalid diagnosis information for its Medicare Advantage plan members,” Damian Williams, U. S. attorney for the Southern District of New York, said in a statement. “The reported diagnoses of serious and complex conditions were based solely on cursory in-home assessments by providers who did not perform necessary diagnostic testing and imaging. Cigna knew that these diagnoses would increase its Medicare Advantage payments by making its plan members appear sicker.”

Bloomfield, Connecticut-based Cigna is one of the largest health insurance companies in the country. It contracts with other organizations that offer certain services and products to Cigna plan participants.

Last year, the federal government filed a lawsuit against Cigna, claiming that the insurance company’s MA plans submitted inaccurate and untruthful codes between 2016 and 2021. By failing to delete or withdraw incorrect codes, the federal government sued Cigna for violating the False Claims Act.

During that time, Cigna ran a “chart review” program — going through medical records of Medicare beneficiaries in their plans. The company hired coders to find medical conditions and assign diagnosis codes, among other things.

Cigna allegedly used this process to add codes for conditions that providers hadn’t reported, aiming for more payments. The government also accused the company of failing to validate some codes

As part of the agreement, top executives and members of Cigna’s board must make certifications about the company’s compliance measures.

“These agreements fully resolve long-running legal matters enabling us to focus our resources on all those we serve and avoid the uncertainty and further expense of protracted litigation,” Chris DeRosa, president of Cigna Healthcare’s U.S. government business, said in a statement. “We are pleased to move beyond industry-wide legal disputes related to past risk adjustment practices, and we look forward to continuing to provide high-quality, affordable Medicare Advantage coverage to our customers and delivering value to the taxpayers in the years ahead.”

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“Unlike many of our competitors, we directly employ hundreds of field-based infusion nurses,” Cigna Chairman and CEO David Cordani said during the company’s second-quarter earnings call Thursday. “Today, they are located within 75 miles of approximately 90% of the U.S. population. And as they care for patients inside their homes, they provide better, more coordinated and personalized experiences, including addressing social determinants of health.”

Cigna is both an insurer and a health care services company.

Aside from seeing success with home-based clinical capabilities, Cigna is also seeing positive growth when it comes to its Medicare Advantage (MA) business. The company’s MA business grew 12% year over year.

“Our Medicare Advantage business is achieving above-market customer growth with high-quality affordable plans and targeted investments that we continue to make to further strengthen our network and offerings,” Cordani said.

Last year, the company rolled out a number of new benefits for its MA members. This included access to a companionship and support program. It also included a caregiver support program in certain markets.

“By leveraging the full capabilities of our enterprise, Cigna is able to offer Medicare Advantage customers a range of affordable, personalized plans,” Aparna Abburi, president of Medicare and CareAllies at Cigna, said in a press statement last year.

The company also made other moves in the home-based care space, specifically as a means to benefit its MA members. Last year, it partnered with Heal to offer home-based primary care services, including doctors visits, annual wellness visits, flu shots, specialist referrals, telehealth services, remote patient monitoring and more.

Total revenues for Q2 checked in at $48.6 billion, a 7% increase from the same period last year.

“We are pleased with our performance overall during the quarter and through the first half of the year,” Cordani said. “With focus on affordability and innovation, we are continuing to strengthen our competitive position and grow our businesses.”

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MA is a form of Medicare that is administered by private insurers. Over recent years, plans have received more flexibility around what they can offer. That flexibility has allowed more plans to offer in-home care services as part of their benefits.

The flexibilities come through the two pathways: primarily health-related benefits and Special Supplemental Benefits for the Chronically Ill (SSBCI).

Humana Inc. (NYSE: HUM), UnitedHealth Group (NYSE: UNH), Cigna (NYSE: CI) and more have begun to unveil what care services will be available for their members in 2023. Medicare open enrollment runs from October 15 to December 7, 2022.

Cigna

In an effort to address loneliness, Cigna’s MA members will have access to a companionship and support program.

As part of the program, members will be able to have an individual that helps them with activities of daily living or simply keeps them company. While this program was previously introduced last year, Cigna is doubling down and making it more widely available to its members.

Cigna is also offering its members a caregiver support program in specific markets. The program provides aid for the challenges that come up when caregiving. For example, stress management support and help with organizing medical records.

“By leveraging the full capabilities of our enterprise, Cigna is able to offer Medicare Advantage customers a range of affordable, personalized plans,” Aparna Abburi, president of Medicare and CareAllies at Cigna, said in a press statement.

In addition to its 2023 offerings, Cigna is also scaling its MA services. Cigna will offer MA plans in New York and Kentucky and in additional counties in Florida, North Carolina, Ohio, Pennsylvania, Texas and Virginia.

“We take a thoughtful and targeted approach to our Medicare Advantage footprint – adding new markets where we have strong provider partnerships that will ensure our customers get quality care,” Abburi said.

Humana

On its end, Humana is significantly expanding support for its two hospital-at-home models.

Similar to Cigna, Humana is still focused on companionship services for its members and combating loneliness. Its members will have access to Papa Pals.

Founded in 2017, Miami-based Papa is an in-home companionship platform that connects Papa Pals with older adults. Aside from companionship, Papa Pals provide seniors general assistance, including transportation services, light housekeeping and similar task-based help.

“When you sum up what Humana is offering this year, it’s as simple as this: Our members spoke, and we listened,” George Renaudin, Medicare president at Humana, said in a statement. “We conducted extensive research to ensure our changes align with consumer wants and needs.”

UnitedHealth Group

UnitedHealth Group also released details of its MA offerings for 2023.

“With financial pressures especially impacting older adults living on fixed incomes, we are committed to improving the benefits we offer and driving industry-leading innovations that make them easier to use for the people we serve,” Tim Noel, CEO of UnitedHealthcare Medicare and retirement, said in a statement.

Currently, more than 8.2 million people are enrolled in UnitedHealthcare MA plans. Like Cigna, the company plans to expand its service area to reach 95% of Medicare beneficiaries across the nation.

In what UnitedHealth Group calls “high-touch member support,” the company will be offering house calls. Members will have access to visits from either a licensed physician or advanced practice clinician.

These house calls can include reviewing a member’s medical history. A member will also be able to ask medical questions and get physical exams and health screenings.

“These visits also provide an opportunity to assess the social, emotional and environmental needs of a member that usually cannot be assessed in a clinic setting,” UnitedHealth Group said in a press statement.

Also under its high-touch member support is UnitedHealthcare At Home. This personalized clinical program will be available to members in certain markets. The program aims to improve health outcomes via touch points including in-home visits.

Aetna

Aetna — which is part of CVS Health (NYSE: CVS) — is expanding its dual eligible special needs plan offerings across 30 states. This includes new markets in South Carolina, South Dakota and Utah.

While coverage varies, it includes offerings such as healthy foods, additional transportation, companionship and fall-prevention benefits.

Aetna will also offer access to telehealth visits for primary care, urgent care and specialty care.

Members will also be able to have fitness memberships through SilverSneakers, which has 15,000 fitness locations.

Plus, Aetna is offering an annual healthy home visit, which includes a health risk assessment and non-invasive physical exam that takes place in the home.

Aetna’s Resources For Living program is focused on addressing loneliness and connecting members with community resources, such as transportation, housing, food programs and caregiver support.

Blue Shield of California

Blue Shield of California is another MA plan offering a house-calls care program for its MA members. It’s aimed at members with complex health issues.

The company is also addressing food insecurity with its healthy grocery benefit. This will give members a monthly allowance that can be used to buy healthy and nutritious foods.

Additionally, a concierge service that will aid members with things like scheduling appointments with primary care physicians and specialists, getting test results and medical equipment will be part of the company’s 2023 benefits.

“As a nonprofit health plan, Blue Shield has been serving Californians for more than 80 years with a track record of stability, brand integrity and mission-driven service,” Lina Saadzoi, vice president and general manager of Medicare at Blue Shield, said in a statement. “We believe that for 2023, Medicare members, prospects, and those aging in to Medicare will appreciate our heritage and the trust they can have in our service to them.”

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