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).

The post UnitedHealthcare, Humana Object To Star Rating Downgrades In Medicare Advantage appeared first on Home Health Care News.

Home health leaders have always touted the extraordinary health and monetary value that can be derived from their services. Not many have had the opportunity to prove that out, however.

Allen does.

Humana owns CenterWell Home Health, which is one of the largest providers in the country. CenterWell also includes CenterWell Pharmacy and CenterWell Primary Care.

Eventually, CenterWell Home Health wants to have 80,000 home health patients under its value-based model. Allen and his colleagues hope that the model will drive value for Humana, while also showing the worth of a well functioning, high-quality home health operation.

But there are other goals in mind, too.

After Humana fully acquired Kindred at Home, it divested the home care and hospice assets. With the large and remaining home health footprint, Humana created CenterWell Home Health.

That rebrand was finalized in September of 2022.

Two years later, Home Health Care News sat down with Allen at the FUTURE conference to discuss the initiatives that matter most to CenterWell Home Health right now. Allen has been with Humana for seven years. Previously, he was the president of Ascension Health at Home.

Topics of the discussion included: how CenterWell Home Health plans to grow in the future, the details around its value-based model, how primary care interacts with home health care at Humana and much more.

The conversation is below, edited for length and clarity.

HHCN: What kind of barriers are you able to eliminate in a value-based home health model, like the one you’ve created within Humana?

Allen: In the model, you’re still subject to all of the Medicare requirements. We still collect OASIS, we still have to comply with Medicare-certified home care.

We are freed up, however, from things like having to look at a Low-Utilization Payment Adjustment (LUPA). So in our value-based construct, between CenterWell Home Health, onehome and our PCO, we’re able to really focus on the patient at the center, and focus on what the patient needs. Everybody is jointly taking responsibility for those patients.

So the PCO owns those patients from a physician practice standpoint, and we are the home health provider for those patients. There’s not lots of different people involved.

The first thing that occurs as a result of that is that they know directly who to come to for home care, and we know directly who to go to for orders, right? And so you have physician champions in the PCO that coordinate directly with home health on the clinical model.

If there’s something that’s needed in care for the patient, we can deliver it right away. Because both entities are completely responsible, it becomes about what the patient needs, and that’s what we deliver. You don’t have a sales function that you are running around. Because it’s more coordination of care and delivery of care than selling for care, if that makes sense.

Do you have any data that you could share on how that value-based model has fared thus far?

We haven’t released any data yet. It started in November of last year.

We’re looking at six to nine months of claims before data is available, to really be able to measure that effectively. But early indications are that we are reducing hospitalizations and that we are keeping people at home.

How will having primary care, pharmacy and home health care under CenterWell benefit patients moving forward?

When one of our members attends a primary care visit, it is typically much longer than what they would have in a routine visit with a primary care physician. It’s much more thorough. They are really getting into not just the medical and physical needs, but also the social and emotional needs.

Then you pair that up with us being in the home and seeing what is actually translating from that medical visit into the home. There’s a very comprehensive medical care visit, and then a very comprehensive home care visit. And as I mentioned before, those two are tied together because we are the home care provider. They are the physician. The information sharing makes that just incredible.

We have the ability then to also tap our pharmacy services, and they can do medical reconciliations on behalf of the patient, med rec reviews, where they’re reviewing the pharmaceuticals to make sure the patient’s on the optimal therapies. So those things coming together in the non-acute space are really powerful at preventing people from going into the acute space.

Do you think proving out some of this home health data within Humana could have a broader impact on the health care system at large, and the home health industry at large? Because you do have the home health perspective, as well as the payer perspective.

Humana is in a unique position because of the investments that it has made, to measure and prove out the impact. And to do it in a way that represents home health, MA and physician practices. I do think that can have an impact on the industry, and that’s why we are so excited about this value-based model and the fact that we have committed to cover these 80,000 members.

It will be a big sample, and we have deep actuarial support analyzing the things that we’re doing. But yes, I do think that this can have an impact on payments in the industry at large.

How does CenterWell Home Health want to grow in the near-term future?

CenterWell Home Health is still a payer-agnostic provider. We continue to grow our patients from all sources. We grow through our sales force. We grow through acquisition.

We intend to grow traditional fee-for-service home health care while we are also proving out a value-based model. Now, obviously, the results of what you find in the value-based model can alter where everybody goes in the future, but we are not solely dedicated to the value-based model.

Are there certain markets that you like better than others when it comes to home health care?

I think, thematically, we want to be in places where we can make a difference. There are not any states that come to mind that we would necessarily avoid, but we are more heavily concentrated in states right now that Humana also serves. So we have a heavy concentration in the Carolinas, in Georgia, in Florida, in Texas – some of the major population states, but we

don’t have any states that we would avoid.

What is your take on CMS’ home health rate cuts in traditional Medicare?

The rate cuts are still a big deal because the value-based model has not proliferated. It hasn’t been proven or proliferated to the point where you can say everyone’s going to run towards the value-based model.

We believe that’s where care is heading. But as we discussed earlier, we’re in the midst of both proving that out and developing it.

So the payment cuts are substantial for everybody, including us.

There’s a nursing shortage, and nursing costs are going up year over year. Your primary cost in this business is labor, and so when you’re seeing those labor costs go up every year, having a potential 2% or greater payment cut is substantial.

What else?

I would just come back to the right care, the right place, the right time, for the right amount of time.

Our focus is on outcomes. We have a huge number of five-star agencies, and we stay focused on both our star ratings and our HHCAHPS ratings being industry leading, because at the end of the day, patients need to choose you.

The outcomes that are most important are in those star measures, heavily weighted are your hospital readmissions in those star measures. So we stay focused on things like that, providing value. And I think really the thing that we’re most excited about is the proving out of our value-based model and the care that we deliver underneath.

The post 2 Years After Its Rebrand, CenterWell Home Health Is Set On Tackling Big Goals appeared first on Home Health Care News.

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.”

The post How CenterWell Can Prove Home Health Care’s Worth Within Humana appeared first on Home Health Care News.

“Adam has the right mix of leadership, HR expertise, and people focus to help enable business growth and drive our culture forward,” GE HealthCare CEO Peter Arduini said in a press release. “His experience leading HR teams spans a variety of global companies and industries, including healthcare, and it will help us further serve our people, patients, and customers.”

GE HealthCare is a global medical technology, pharmaceutical diagnostics and digital solutions provider. The company does significant work in home-based care.

Amedisys, on the other hand, is one of the largest home health and hospice providers in the country. It agreed to be acquired by UnitedHealth Group (NYSE: UNH) last year.

Holton has more than 20 years of HR leadership experience. Prior to his time at Amedisys, he worked at GE HealthCare, when it was still a part of General Electric (NYSE: GE). He also serves on the board of directors for Sierra Delta, an organization that supports military service members and veterans with physical and emotional needs. Holton is a veteran himself.

Former Humana exec joins Highmark Health

Mona Siddiqui, formerly the senior vice president of clinical operations for Humana’s (NYSE: HUM) home solutions business, has joined Highmark Health to lead the organization’s home and community services segment.

Based in Pittsburgh, Highmark Health is a non-profit health care company and integrated delivery network. Its home and community services segment is dubbed Helion.

“I am thrilled to share that I am joining Highmark Health,” Siddiqui wrote in a LinkedIn post. “I will be leading their segment on Home and Community Services, an enormous area of focus for Highmark as it enables a shift from acute to in-home care. Scaling care in the home requires working closely with hospitals and providers, to work collaboratively to ensure the right level and quality of care and to deploy the needed technology that can create an integrated experience.”

Siddiqui was at Humana for four years, and prior to that, she worked for the U.S. Department of Health and Human Services (HHS).

HRS names new CEO

Health Recovery Solutions, a remote patient monitoring provider and technology platform in the home-based care space, has a new CEO. 

Jason Comer – who has been a part of the company’s leadership team for seven years – is taking over the reins. He spent four years as CFO, and eight months as president.

He will replace Jarrett Bauer, the longtime CEO of the company. Bauer is a co-founder of the company and its current chairman.

“Jason’s ascent from an advisor role to the CEO of HRS is a narrative of dedication, insight and leadership,” Bauer said in a statement. “His contributions have been invaluable, and his strategic vision has been a driving force behind our success. I am immensely proud of what he has accomplished and am excited to see him lead HRS into a new era.”

HRS has over 250 health care clients, including home health agencies, payers and health systems.

“As CEO, my core commitment is to consistently prioritize patients in every strategic move we make, actively seeking out and integrating cutting-edge technologies and services that enhance care at home and define new standards of excellence in Remote Patient Monitoring,” Comer said. “I envision HRS as the pivotal force in digital healthcare transformation. But realizing this vision goes beyond innovation; it demands that we provide substantial value to our clients, lifting their operations to new heights of success. Our aim is to be more than a provider; I see us serving as a strategic partner for our clients, leveraging our years of extensive experience to advise them on best practices for improving patient outcomes, reducing costs, increasing efficiency and expanding their reach.”

Alivi Health’s new chief growth officer

The benefit management company Alivi Health has a new chief growth officer in Aaron Crowell.

Crowell is the former chief growth officer at the home health analytics company Medalogix, as well as a former founding executive of Uber Health.

“We are thrilled to have Aaron join the Alivi Health team,” Alivi Health CEO Magdiel Rodriguez said in a statement. “Aaron’s extensive industry experience and proven ability to drive growth through innovative solutions make him an ideal fit for this role. We are confident his leadership will propel Alivi Health to new horizons, while highlighting our tailored, value-based solutions approach to the health care landscape.”

As chief growth officer, Crowell is tasked with the nationwide expansion of the Miami-based Alivi Health, which helps fulfill benefits such as Non-Emergency Medical Transportation (NEMT), vision, dental, chiropractic, physical therapy, occupational therapy, speech therapy, ABA therapy and home health care.

“I am honored to join Alivi Health as the Chief Growth Officer,” said Aaron Crowell. “I look forward to working with Alivi’s talented team to develop and implement strategies that enhance the member experience, close care gaps and address key pain points for health plans.”

The post Adam Holton Leaves Amedisys For GE HealthCare; Former Humana Exec Joins Highmark Health appeared first on Home Health Care News.

Ultimately, the CEO succession plan had been in place at Humana for a while. Broussard has served in the CEO chair since 2013, and Rechtin was named his successor in October of last year.

“When the board began the search, we were really looking at a few things, including character traits and experience. Those were obviously two major areas,” Broussard said at the B of A Securities Healthcare Conference Tuesday. “Jim really fit both of the buckets quite well.”

The board was looking for someone with a great “capacity to deal with complexity,” according to Broussard.

“The ability for him to deal with details quite extensively, and also the ability to really listen,” he continued. “Those were really important traits as the board looked at the purpose-driven parts of the organization, in addition to just the complexity and diversity of the business.”

Part of the experience that stood out for Rechtin was his familiarity with Medicare Advantage (MA), as well as provider services.

Rechtin was the president and CEO of Envision Healthcare, and before that, the president of UnitedHealth Group’s (NYSE: UNH) OptumCare. He also spent more than a decade at Bain & Company.

The Louisville, Kentucky-based Humana is one of the largest insurers in the country. It has over 6 million MA members. In addition, it is one of the largest home health providers in the country. CenterWell Home Health, CenterWell Primary Care and CenterWell Pharmacy make up Humana’s provider services division.

Rechtin – who is currently president and COO at Humana – will also join the Humana board on July 1. Broussard will remain a strategic advisor to the company into 2026.

“We’re at a good breaking point,” Broussard said. “We are finalizing bids, those are going to be submitted over the coming weeks. And we’re in the administrative process time as opposed to any decision making, which was a couple of weeks ago, and which we were both part of. As we enter into the summertime, it begins the strategic planning cycle. We have a board meeting in October. The management team has a meeting in the middle of August that wraps around the strategic processing aspects. So, it’s a good break point.”

In a tough MA rate environment, Humana leaders said they are “pricing for profitability,” and making some tough decisions in terms of moving out of select markets.

Rechtin will take the helm in that tough environment, but also at a time when Humana is much more than just an insurer. CenterWell is one of the main strategic initiatives of the organization at this point.

“The last thing that we’ve seen is [Jim’s] ability to really dig deep and be a really good operator,” Broussard said.

Broussard and Humana CFO Susan Diamond also mentioned that, while adjustments would be made to its MA plans, it did not expect to lose significant membership – either to competitors or to traditional Medicare.

The post Why Humana Chose Jim Rechtin As Its Next CEO appeared first on Home Health Care News.

Rechtin joined Humana as president and COO in January, and will also join the board of directors on July 1 when he transitions to CEO.

“I am incredibly excited to be named CEO of Humana and humbled to have the opportunity to lead 65,000 dedicated teammates as we seek to provide better health outcomes at lower costs for our members and customers,” Rechtin said in a statement. “I appreciate the trust and confidence shown to me by the Humana Board, Bruce and the entire leadership team. As an enterprise, we have tremendous growth prospects, driven by a differentiated value proposition and attractive market fundamentals. I am committed to innovating and improving our operations even further, finding better ways of working and providing equitable access to high quality health care while generating long-term shareholder value.”

Humana is one of the largest insurers in the country, and has about 6 million Medicare Advantage (MA) members underneath its health plans. In addition, Humana has its provider services arm CenterWell, which includes home health, pharmacy and primary care.

Broussard is responsible for Humana diving into home-based care services over the years, and, in turn, other insurers grabbing onto home-based care capabilities. He will exit the board of directors on July 1, but will remain a strategic advisor for the company into 2026.

Rechtin was formerly the president and CEO of Envision Healthcare. Prior to that, he was the president of UnitedHealth Group’s (NYSE: UNH) OptumCare. Before entering into the health care sector, he spent 14 years with Bain & Company.

“Since joining Humana, Jim has embedded himself in our business and quickly connected with our employees and customers,” Kurt Hilzinger, the chairman of the Humana board, said in a statement. “He has brought a collaborative, thoughtful and innovative leadership style to our organization, and his extensive healthcare experience brings new insights into Humana’s approach to integrated care. The onboarding process has been progressing well, and the board is confident that Jim is ready to assume the CEO role on July 1 and lead an exciting new chapter for the company.”

The CEO transition has been “long-planned,” Humana said in October and on Monday.

The post Jim Rechtin To Take Over For Bruce Broussard As Humana CEO This Summer appeared first on Home Health Care News.

Thanks to impactful, large-scale transactions over the last decade, the collective face of home-based care has changed forever.

Traditional providers in both home health care and personal home care have merged. Payers became involved in the home-based care space like never before. Of late, retailers have too.

But it’s often easy to forget how the current landscape became what it is.

Below, Home Health Care News takes a look at some of the most important and impactful deals in home-based care over the last decade – deals that explain, in part, where the home health and home care industries are today.

‘Big time’ provider deals

This past decade’s first blockbuster remained one of the most impactful throughout the last 10 years.

In 2014, April Anthony’s Encompass Home Health & Hospice was acquired by HealthSouth Corporation for $750 million. HealthSouth took a swing at home health and hospice, merging an in-patient facility business with a post-acute care business.

Four years later, HealthSouth would rebrand completely, taking on the home health and hospice entity’s name. Encompass Health Corp. (NYSE: EHC) still exists today, but is again without post-acute care capabilities.

The HealthSouth-Encompass deal is like a few other deals in home health care, in that it set off a domino effect and a winding life cycle of a home health entity.

Anthony left Encompass Health in 2021, and after her home health and hospice company operated as a segment within the larger organization for nearly a decade, Encompass Home Health & Hospice was spun off into its own public company: Enhabit Inc. (NYSE: EHAB).

That happened in 2022, and two years later, Enhabit may land in the hands of a different owner after it concludes its own strategic review. Anthony now runs VitalCaring, which is backed by her, The Vistria Group and Nautic Partners.

Over the decade, larger health care organizations like Encompass Health have also bundled up services, and also unbundled them.

For instance, Brookdale Senior Living (NYSE: BKD) had one of the largest home health footprints for a long time. After COVID-19 woes, however, it offloaded that to a health system eager to get into home health care: HCA Healthcare (NYSE: HCA). LHC Group would later acquire some of the assets jointly owned by Brookdale and HCA Healthcare.

Ascension Health, too, teamed up with TowerBrook to buy the home health and hospice provider Compassus in 2019.

A theme that has been a mainstay, and will likely remain a mainstay, is health systems changing course on their strategic planning – and deciding whether to own home health care themselves or focus on core operations and partner with home health care instead.

“You’re seeing a lot of these facility-based providers divesting or spinning off assets,” Chaz Bauer, director at Fifth Third Securities, told Home Health Care News. “They realize they have fundamentally two different businesses. They’re very related and intertwined. But fundamentally, you have these facility-based businesses that are very centralized models, very capital intensive. Whereas home-based care businesses, they’re very decentralized; they’re very capital-light. Part of the motivation there – in unbundling – is they can unlock value for their shareholders by splitting those businesses.”

But then there’s the M&A that has come from within the home health sector itself.

For instance, “the merger of equals” that turned LHC Group into a true home-based care powerhouse.

In late 2017, LHC Group agreed to merge with Almost Family in a $2.4 billion transaction. A straight line can be drawn from that deal to UnitedHealth Group’s (NYSE: UNH) acquisition of LHC Group, which was finalized in 2023.

LHC Group and Almost Family’s merger is not an anomaly, either. Not long after, Great Lakes Caring, National Home Health Care and Jordan Health Services combined in a three-way merger to create another one of the largest home health companies in the U.S.: Elara Caring.

That deal was powered by the PE firms Blue Wolf Capital Partners and Kelso & Company.

PE money in home-based care has turned a lot of sizable providers into powerhouses. The aforementioned PE firms – Blue Wolf, Kelso, Vistria and Nautic – have all played a part in that, in the transactions mentioned already and otherwise.

That will also continue, particularly as some of the holding periods of the largest companies turn over. There’s also a chance, however, that PE firms direct more attention to other parts of home-based care – like personal care – given the uncertainty surrounding home health payment rates.

In home care, Vistria and Centerbridge Partners uplifted Help at Home, turning it into one of the largest providers of home- and community-based services (HCBS) in the country.

Waud Capital recently acquired the large home care franchise Senior Helpers. Wellspring Capital Management acquired Interim HealthCare’s parent company Caring Brands International in 2021. Last September, The Halifax Group acquired Comfort Keepers from Sodexo.

PE has always been involved in home care. Bain Capital’s 2018 creation of Arosa, one of the largest non-franchised home care companies in the country, is one past example.

In the future, it’ll be interesting to see if PE will drive more large-scale, impactful deals like it has in home health care over the last decade.

Payers enter the fold

Any commentary on the biggest deals in home-based care over the last decade needs to note increased payer involvement.

Enter Humana Inc. (NYSE: HUM).

When people think of the company’s home-based care investments, most go straight to its takeover of Kindred at Home.

But let’s take a step out of the last decade, just for a second.

In 2011, Humana acquired the home-based care provider SeniorBridge, which was doing just $72 million in annual revenue at the time. When that deal was announced, it was not exactly frontpage news. But one could argue that kickstarted a chain of investments that changed the M&A landscape in home-based care forever.

“SeniorBridge fills a growing market need and is consistent with Humana’s focus on delivering clinical care for seniors in their homes,” Michael B. McCallister, Humana’s chairman and CEO at the time, said in a statement. “Acquiring SeniorBridge will immediately expand Humana’s existing clinical capabilities with the addition of SeniorBridge’s national network of 1,500 care managers. The company does a terrific job of reducing hospital readmissions and emergency-room utilization, all while helping seniors achieve lifelong well-being.”

Humana’s home-based care thesis was already there, but the SeniorBridge deal was likely the deal that set the stage for what eventually became CenterWell.

“The deal was a game changer. I was initially surprised by the size of the transaction. It was pretty small by Humana standards,” Mertz Taggart Managing Partner Cory Mertz told HHCN. “It didn’t take long for Humana to tout the savings SeniorBridge created for their membership, saving it billions of dollars within the first couple years of the deal, by keeping their members at home and out of the hospital.”

Nearly 13 years later, Humana is one of the largest home health providers in the country through CenterWell Home Health.

The company, with the help of the PE firms TPG Capital and Welsh, Carson, Anderson & Stowe (WCAS), acquired and merged Kindred at Home and Curo Health Services. Yet another home health and hospice powerhouse was formed, this time under the watch of one of the largest payers in the country.

In 2021, Humana opted to take over a remaining 60% of the enterprise (it had previously owned 40%), which was worth over $8 billion at the time.

In 2022, it divested the hospice and home care operations of Kindred to Clayton, Dubilier & Rice (CD&R). Those divested assets became what is now known as Gentiva, led by David Causby, the former CEO of Kindred at Home.

The home health assets Humana held onto are now under CenterWell Home Health. CenterWell, overall, includes primary care, pharmacy and home health services.

In 2024, most large payers – namely the ones with large MA memberships – have some sort of home-based care capabilities. That was not the case when Humana acquired SeniorBridge way back when.

“This has been an ongoing development, and it’s really just vertical integration,” Bauer said. “The thought is: why not get into that downstream, and then be able to more directly control those costs and quality outcomes on the payer side?”

The other heavily involved payer is the only one that has a leg up on Humana in MA: UnitedHealth Group.

UnitedHealth Group’s Optum already had a variety of health care provider assets, but it decided to make its first big home-based care splash early in 2022 when it announced the $5.4 billion acquisition of LHC Group.

While payers liked the thought of vertical integration, large providers like LHC Group were also recognizing an existential threat to home health business: MA penetration. More MA beneficiaries meant fewer traditional Medicare beneficiaries, which meant a less sturdy financial leg to stand on.

UnitedHealth Group further cemented its interest not long after, when it made a $3.3 billion all-cash offer for Amedisys. That deal was agreed to in June of 2023, but is still pending.

Though UnitedHealth Group may have to divest some Amedisys assets to finalize the deal, the company will most likely have the largest home health market share when that deal closes. Estimates suggest Optum will have about 10% of the U.S. home health market under its belt.

Not only are payers now involved in the home health industry, but they are also creating scale.

“You can make an argument that Optum acquiring LHC group, and now Amedisys, is a scale transaction, like ones we’ve seen before,” Bauer said. “Because it puts together two of the largest providers to make an industry leader.”

New kids on the block

Like payers before them, another group of companies is now firmly involved in home-based care investment: retailers.

In fact, they’re so invested, they may not be labeled as just retailers five to 10 years from now.

CVS Health (NYSE: CVS) has a new health care services segment dubbed CVS Healthspire. Walgreens Boots Alliance (Nasdaq: WBA) has the same with its U.S. Healthcare segment.

Both of those segments are arguably the future of their respective parent organizations. And both include home-based care services.

Payers and retailers have different business models, but tend to want the same thing: pharmacy, primary care and home-based care services.

In 2020, Walgreens made an over $1 billion investment in VillageMD, a home- and community-focused primary care provider. After subsequent investments, it has backed VillageMD with over $6 billion.

After that, Walgreens found its next health care services asset in the health-at-home solutions platform CareCentrix. Though he is no longer in the position, CareCentrix’s former CEO, John Driscoll, was the initial leader of Walgreens new U.S. Healthcare segment.

“We continue to see strong results and potential for growth from our partnership with CareCentrix. Our full acquisition further accelerates our transformation to become a consumer-centric health care company, leveraging innovative platforms that extend our capabilities into fast-growing segments of health care,” former Walgreens CEO Roz Brewer said at the time. “CareCentrix is key to offering services to our patients at every stage of the care continuum, and to driving long-term, sustainable growth as part of our U.S. Healthcare strategy.”

Not to be outdone, CVS Health agreed to acquire the home- and value-based care enabler Signify Health in 2022 for $8 billion. Shortly after that, it got its primary care provider, too, with the over $10 billion acquisition of Oak Street Health.

While none of these assets are traditional home health or home care assets, this retailer involvement represents a seismic change in U.S. health care – and home-based care is a major part of it.

These companies could go after more assets in the future, or they could become major partners for those traditional providers.

Honorable mentions

It’s impossible to highlight every deal, but there are some that don’t fit perfectly into “themes” that are still worth mentioning.

The home care technology company Honor acquired the home care franchise brand Home Instead in 2021, for instance. In lieu of strictly partnering with providers to see its vision through, Honor opted to purchase Home Instead to speed up the process. The jury is still out on that deal, however.

Prior to agreeing to become a part of Optum, Amedisys also made plenty of deals that turned it into a multi-billion-dollar business.

It acquired the hospital-at-home platform Contessa Health in 2021 for $250 million.

It acquired Compassionate Care for $340 million in 2018, and AseraCare Hospice in 2020 for $235 million. Those two deals significantly bolstered its hospice arm.

Modivcare (Nasdaq: MODV) entered into the personal care game in a real way with its $575 million acquisition of Simplura Health Group in 2020 and its $340 million deal for CareFinders Total Care in 2021.

BrightSpring and PhaMerica completed a merger in 2019 that eventually led to today’s BrightSpring Health Services (Nasdaq: BTSG), which is now a public home-based care company.

Finally, Aveanna (Nasdaq: AVAH) – formerly a pediatric provider – entered into the home-based senior care world with its $345 million acquisition of Comfort Care Home Health in 2021 and its acquisition of Accredited Home Care for about $200 million later that year.

Addus Homecare Corporation (Nasdaq: ADUS) has executed several high-profile transactions of its own, most recently acquiring Tennessee Quality Care in a $106 million deal.

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AccentCare has promoted Dr. Balu Natarajan to the roles of executive vice president and chief medical officer (CMO), effective immediately.

“In his almost two decades with our company, Dr. Natarajan has been an invaluable asset to our team, demonstrating exceptional leadership and medical expertise,” AccentCare CEO Laura Tortorella said in a statement. “With his proven track record of putting patients first and building best-in-class clinical teams, I am confident that Dr. Natarajan will continue to advance our delivery of high-quality, consistent, and connected care.”

AccentCare is one of the largest home health and hospice providers in the country. The Dallas-based company also provides personal home care, palliative care and other home-based care services. Its footprint includes 250 locations across 31 states and the District of Columbia, and it serves more than 200,000 individuals each year.

In his new role, Natarajan will be responsible for overseeing all of AccentCare’s clinical care operations and patient experience initiatives.

“Our team will continue to be guided by the patient’s voice and put patients at the center of everything we do as we deliver high-quality care,” Natarajan said in the statement. “From coast to coast, patients and their families are counting on providers to help them navigate a complex health care system. I look forward to working with our clinical teams and partners to develop and implement strategies that promote innovation and drive successful patient experiences and outcomes. I am excited about working with Laura and the entire team as we continue to treat our patients with integrity, compassion, and excellence.”

Prior to his promotion, Natarajan served as CMO for the company’s hospice service line.

Modivcare names two new c-suite leaders

Modivcare Inc. (Nasdaq: MODV) has named Jeff Bennett as its chief strategy and innovation officer, and Seth Ravine as its chief commercial officer, effective December 2023.

“I am incredibly excited for the appointment of these two positions, underscoring our commitment to building a top-notch leadership team that will steer Modivcare’s strategic course and drive success in this dynamic landscape,” Heath Sampson, president and CEO of Modivcare, said in a press statement. “The addition of Jeff and Seth’s roles reinforce our dedication to providing innovative and cohesive healthcare solutions with an enterprise mindset.”

The Denver-based Modivcare offers technology-enabled health care services and provides non-emergency medical transportation (NEMT). The company’s Modivcare Home division includes its personal care, remote patient monitoring and nutritional meal delivery service offerings.

Bennett joined Modivcare as part of the company’s acquisition of Higi, where he previously served as CEO.

Ravine joined Modivcare in 2021 as the senior vice president of strategic solutions through the acquisition of VRI.

Androscoggin appoints chief human resource officer

Sarah Conroy has joined Androscoggin Home Healthcare and Hospice as the company’s chief human resource officer.

The Maine-based Androscoggin is a nonprofit operator that employs 500 workers across all 16 counties in the state.

Prior to her new role, Conroy was an HR business consultant, and also served on the Maine State Society of Washington, DC Foundation.

Special Touch Home Care makes several leadership appointments

Special Touch Home Care has made changes to its leadership team.

Evan Ostrovsky has been named CEO and executive director of traditional home care services.

“I’m deeply honored to assume this role and continue our family’s legacy in delivering top-quality home health services,” Evan Ostrovsky said in a press statement. “I want to extend my heartfelt appreciation to my father, Steven Ostrovsky, for founding this remarkable organization, and his unwavering dedication to our mission ever since. Looking ahead, we remain committed to innovation, enhancing care quality, and supporting our devoted caregivers.”

Founded in 1984, Special Touch Home Care is a home health services provider in New York State. The company employs more than 5,000 home health aides.

David Ostrovsky — who previously served as vice president — will take on the role of chief strategy officer and executive director of the company’s consumer directed personal assistance program.

The company also named Jasmin Arias its chief operating officer, and Steven Ostrovsky transitioned from CEO to the role of executive chairman.

Humana names president of enterprise growth

Humana (NYSE: HUM) has named David Dintenfass president of enterprise growth, a newly created role.

In his new role, Dintenfass will lead the company’s growth plan, with an emphasis on customer acquisition, retention and experience. He will focus on the growth of Humana’s insurance businesses initially, but will also partner with CenterWell.

“David has a 30-year track record of delivering outstanding financial and organizational results across a range of businesses,” Bruce Broussard, president and CEO of Humana, said in a press statement. “He knows how to leverage digital capabilities to enhance the customer and broker experience and drive growth. He’s a strategic leader who is customer obsessed, digitally savvy and data driven and can help us maximize investments and act on current and future trends.”

Prior to joining Humana, Dintenfass served as executive vice president, head of products and emerging growth markets. He will step into the role on February 5, 2024.

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An increase in Medical Advantage (MA) costs driven by “higher than anticipated” hospitalization costs were the main culprit for Humana’s grim outlook coming out of the fourth quarter.

The significant uptick in utilization in Q4 has impacted the entire health care sector. Despite efforts to mitigate costs, Humana couldn’t fully offset the headwinds.

“The Medicare Advantage sector is navigating a complex and dynamic period of change as we are all working through significant regulatory changes, while also absorbing unprecedented increases in medical cost trends,” Humana CEO Bruce Broussard said during the company’s fourth-quarter earnings call Thursday. “The increase in utilization that emerged late in the fourth quarter was a significant deviation from an already elevated level impacting the industry.”

Humana cited an increase in outpatient services and a rise in inpatient care in November and December among patients enrolled in Medicare Advantage.

The insurer reported a loss of $591 million in Q4. That compares with a loss of $71 million during the same period a year ago.

“We take our commitments seriously and are disappointed with where we are, unable to fully offset these higher cost trends despite our best efforts to identify mitigation opportunities throughout the year,” Broussard continued.

Despite near-term challenges, Broussard and other Humana leaders reiterated confidence in the company’s long-term vision. They noted Humana is actively evaluating pricing actions for MA in 2025 and expects earnings growth in other lines of business.

One of those businesses is Humana’s home health arm, CenterWell Home Health.

“In terms of the long-term margin outlook, we had really moved away from setting a specific target for individual MA recognizing that we will work very hard to maximize the margin contribution across the enterprise,” Humana CFO Susan Diamond said during the call. “Which becomes increasingly important as we continue to expand and scale the CenterWell capabilities, and so we remain very focused on that.”

Humana’s CenterWell brand includes home health care, primary care and pharmacy services. Its home health segment has over 350 locations, over 9,000 clinicians and serves more than 350,000 patients annually.

In order for Humana to rebound, Broussard believes a big contributor to the insurer’s success will come from CenterWell.

“We do find that the growth and the scalability and the integration of CenterWell offers us that opportunity to continue to expand — not only our services that we find are much more effective in clinical outcomes and satisfaction — but also the ability to continue to drive better and better value for the enterprise overall,” Broussard said. “We really view the ability to continue to drive the membership growth in the total value of what we offer. And that’s around our brand and our quality — in addition the relationships that we have with value-based providers and feel that that will carry the day for the foreseeable future.”

Looking ahead, Humana knows that it needs to hit its growth goals for both the health plan and its services side of the business. Diamond emphasized the need for progression in both aspects.

“As we think about 2025 and the benefit adjustments we’re going to have to make, we are being very intentional around which markets do have further integration opportunities and where we have CenterWell assets, particularly primary care,” Diamond said. “I think you will see us prioritize those markets to ensure that we can drive disproportionate growth in those markets to a greater degree going forward, and support that enterprise integration and margin expansion that we’ve been talking about.”

During 2024, Humana expects to roll out its home health utilization management services in additional states, increasing the share of Humana MA membership covered by approximately 13% to 3.4 million by year end.

Humana expects to serve nearly all of its CenterWell Primary Care patients who utilize
home health via its owned CenterWell Home Health and onehome agencies where there is
overlapping coverage by the end of 2024, driving a 25% increase in value-based home
health admissions on a year-over-year basis, according to the company.

Humana also on Thursday announced the hiring of David Dintenfass as president of enterprise growth.

The initial focus for Dintenfass will be on the growth of Humana’s insurance businesses, but it will “evolve over time” and integrate with the company’s care delivery offerings through CenterWell. That evolution will include advancing Humana’s integrated health strategy of increasing the penetration of health plan members utilizing CenterWell primary care, home solutions and pharmacy offerings.

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Providers of all shapes and sizes are looking to achieve wellspan, and executives at organizations like Humana Inc. (NYSE: HUM) and Lifespark are doing so by leveraging data, care coordination and more.

For Humana, a major component of achieving wellness is enabling people to stay in home and community-based settings.

“[Wellness] is a holistic definition and a set of services that enable people to stay home and avoid unnecessary utilization of the health care system,” Mona Siddiqui, senior vice president of clinical operations for Humana’s home solutions business, said at Aging Media Network’s Continuum conference last month.

Humana’s unique business model allows the organization to facilitate this.

Based in Louisville, Kentucky, Humana is one of the largest insurance companies in the U.S. The company has roughly 5.8 million Medicare Advantage (MA) members. Its health care services arm, CenterWell, includes pharmacy, home health care and primary care. CenterWell Home Health has more than 350 locations.

“That connection of information across the benefits and the care services side has been so powerful and transformative for these patients to be able to have that holistic experience across the two sides,” Siddiqui said.

At Humana and Lifespark, executives are seeing ROI as a result of their wellness-focused strategies.

On its end, Lifespark has made a commitment to taking on full global risk. This means that the company takes on the full medical loss ratio, degradation, surplus or deficit.

“I think it’s the right thing to do for business, and more importantly, it’s the right thing to do for humanity,” Joel Theisen, founder and CEO of Lifespark, said at the Continuum conference. “It’s the right thing to do for what we’re trying to accomplish.”

Lifespark is a Minnesota-based company that offers home care, home health, hospice, primary care options and senior living. It’s one of the few home-based care companies that has ventured out into the worlds of senior housing and skilled nursing facilities, a testament to its mission of providing a full continuum of care in the name of wellness.

Despite Lifespark’s success with taking on full risk, this isn’t a move that every organization is equipped to pull off.

Providers that want to take on full risk need to have a strong data infrastructure in place and keen understanding of their patient population, Siddiqui noted.

When considering different programs, two key factors are top of mind at Humana. The company is looking to implement programs that will achieve the best outcomes for beneficiaries and programs that will also yield ROI.

“You’re looking for [a significant] ROI for both the time and level of investment that you’re putting into these programs,” Siddiqui said.

Interoperability is also important to driving the cross-continuum integration that companies are trying to embrace as part of their wellness focus.

At a multiple pronged-organization like Humana, the challenge is to bring together these segments in order to offer holistic services to its beneficiaries. In order to do this, breaking down silos will be necessary.

“Talking about providing holistic services is easy, but actually creating that integration is much tougher inside these organizations,” Siddiqui said. “Sharing how we’re all doing that is really key for moving the entire industry forward.”

Theisen stressed that executives need to center the patient perspective when trying to improve interoperability at their organizations.

“Think about it from the client’s use case, because most people don’t do that,” he said. “We miss the actual person we’re trying to serve many times in our models, because we get enamored with our own business case.”

Companies also have to be ready to adapt to change, according to Siddiqui.

“When I did this at HHS, and the tech integration across the different agencies, the biggest challenge was culture,” she said. “Technology was probably the last thing I worried about. It was really getting everyone aligned, and comfortable. If you’ve done the same thing, the same way for 20 years, changing the way you do it takes an enormous amount of inertia.”

Overall, Theisen believes that companies are well-positioned to step up and embrace change.

“Our boomers are demanding a different type of optionality,” he said. “They’re not going to be okay with the current product offerings, in the way they’re getting offered. I think it’s really upon all of us as leaders to take the bull by the horns and wrestle this opportunity to create that longitudinal wellspan.”

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