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

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

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

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

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

It also has a robust home health and hospice business.

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

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

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

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

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

‘Care delayed is care denied’

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

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

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

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

Enhabit CEO Barb Jacobsmeyer further explained that decision last week.

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

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

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

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

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

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

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

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

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

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

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

The post More Home Health Providers Sunset Relationships With Largest Medicare Advantage Payers appeared first on Home Health Care News.

Humana CFO Susan Diamond said the company’s exit from those 13 markets would affect about 560,000 members, or around 10% of its individual MA membership base. Diamond did say, however, that she expects many of those members to join other Humana MA plans.

“The exit itself is positive in the sense that those plans were not contributing,” Diamond said at the conference. “If we do ultimately retain more of those members, that’s incrementally positive because the plan choices left behind are priced in a way that will be positively contributing.”

Diamond first teased this move earlier this year, after the Centers for Medicare & Medicaid Services (CMS) released its final rule for MA plans, which again included a net negative payment adjustment.

“As we think about the decisions for ‘25 bids, we do intend to exit some counties,” Diamond said at the time. “When we thought about the framework of how we make those decisions, a primary input was the profitability of the plan.”

After years of positive payment adjustments – and lower health care utilization costs during the pandemic – MA plans are now facing a harsher economic environment.

That has the chance to contribute to a “leveling off” of MA penetration, which has been steady over the last decade.

Centene Corp. (NYSE: CNC) also announced recently that it is set to pull back on MA in at least six states next year, as did BlueCross BlueShield.

For home health providers and home care providers, a tougher payment environment for MA plans could mean less leeway for higher rates for services.

At the same time, home health providers that believe subpar MA rates are a threat to their businesses could experience some respite in the near term.

The post Medicare Advantage Plans Are Contracting Heading Into 2025 appeared first on Home Health Care News.

As part of the study, Dr. Bruce Leff and his study co-authors examined the prevalence, characteristics, predictors, health service use, and mortality outcomes of 2,435,519 homebound Humana Inc. (NYSE: HUM) MA beneficiaries in 2022.

“We thought it would be useful to understand if this population exists in MA, because if it does, then we need to be thinking about how to optimize care for these people, and make sure they get the care that they need, and make this somewhat invisible population visible,” Leff, a professor of medicine and director of the center for transformative geriatric research at Johns Hopkins University School of Medicine, told Home Health Care News.

The researchers found that the prevalence of homebound individuals was 22%.

Additionally, researchers found that homebound status was independently associated with greater health service utilization and mortality.

“One thing that the study demonstrates is that being homebound is a very powerful predictor of poor outcomes, whether it’s emergency department visits, or inpatient admissions into the hospital, or skilled-nursing facility admissions or death,” Leff said.

What’s more, Leff and his colleagues were surprised to find out that homebound status was an independent risk factor.

“Beyond people having certain chronic conditions, beyond people being frail, it was still an independent risk factor for facility-based utilization and death, and that to us, spoke volumes,” he said. “We thought it would be in the mix, but were a little bit surprised by just how powerful a predictor it was. When MA plans are doing in-home wellness assessments, they’re asking a lot of questions, some of which are likely required by CMS, but adding a single question on homebound status might be really valuable.”

Arming MA plans with this knowledge could potentially encourage them to seek stronger partnerships with home-based care providers looking to enter partnerships.

Leff pointed to the study’s findings as an indicator that these types of collaborations are necessary.

“What this study suggests is the need for health systems and MA plans to collaborate with entities that know how to do things in the home, and that might be skilled home health care companies — and we’ve seen MA buying out some of the big players in the space — or it might be home-based primary care practices,” Leff said.

Leff also noted the opportunity to bring together home-based palliative care, hospital at home, skilled nursing facility care at home, home health care and home-based primary care – all as a part of a larger home care ecosystem.

“In the future, we’re going to be doing a whole lot more at home, and the hospital will become a big ER, OR and ICU,” he said.

The post A ‘Predictor Of Poor Outcomes’: Recognizing Homebound Seniors In Medicare Advantage appeared first on Home Health Care News.

Home health providers and MA plans have continually been at odds over payment for services. Humana is unique in the fact that it has one of the largest MA businesses in the country, as well as one of the largest home health providers under its umbrella.

And, at the same time, MA plans and home health providers are both aiming to prove their worth to the Centers for Medicare & Medicaid Services (CMS) in order to mitigate continued payment cuts to their respective programs.

“Let me start by just reinforcing what I think is basic truth about the business,” Rechtin said on the company’s second-quarter earnings call Wednesday. “It’s a good business, it’s good for our members and it’s good for our patients. This is well documented, in my opinion. CMS and the federal government, state government, and by extension even taxpayers are also our customers. I think we need to constantly remind ourselves of that. What we do creates value for those customers as well.”

The Louisville, Kentucky-based Humana has close to 9 million MA members, a number that puts it only behind UnitedHealth Group (NYSE: UNH). CenterWell – its provider services arm – includes home health care, primary care and pharmacy services.

“We need a regulatory environment that allows that value to be fully realized and that requires constant collaboration and adjustment,” Rechtin continued. “We need to be a proactive partner with CMS in that process, and we need to do this to make sure that we’ve got a long-term, stable Medicare, Medicaid program.”

Broadly, MA plans have undergone consecutive cuts to “core” rates from CMS. Whereas growth used to be of utmost importance in MA, payers like Humana are more often now “prioritizing profitability.”

On the earnings call, John Ransom, a managing director at Raymond James, suggested that MA plans were losing the battle in Washington, D.C. He specifically called out certain data that suggested MA costs taxpayers 13% more compared to traditional Medicare.

Rechtin, in response, insinuated that Humana does more on behalf of its members than traditional Medicare does. He indicated that it was the messaging that needed to change in Washington, D.C.

“We get better outcomes,” he said. “We deliver better health security by lowering the cost to members for the care that they receive and giving them access to more benefits. We also know, and it’s pretty well documented, that we deliver like for like benefits at a lower cost than what original Medicare does. Those two things mean that there’s a value proposition for members and for taxpayers. What we can do a better job of – and part of what I think the entire industry needs to be focused on – building the case for the second of those two things even more tightly and then better explaining and understanding what of that value does accrue back today to taxpayers.”

In the quarter, Humana brought in $29.54 billion in total revenue, an over 10% year-over-year increase. CenterWell revenues totaled $4.8 billion, an over 9% year-over-year increase.

Humana also expects a 4.2% increase in MA individual membership growth in 2024, or representing approximately 225,000 members.

Growth in the home

Later on, Rechtin expressed confidence in the CenterWell business overall, including the home health segment.

He also said the home health team is preparing for “continued rate pressure” in the space, however.

“The home business has generated high single-digit admission growth,” Rechtin said. “The team continues to improve their cost structure, anticipating continued rate pressure in that space.”

The home business also was one of the primary factors in “favorable” year-over-year growth for CenterWell, according to Humana.

“The favorable year-over-year quarter and YTD CenterWell segment revenues comparisons were primarily impacted by the following factors,” Humana wrote in its earnings press release. “Greater intersegment revenues associated with the Home Solutions business in 2Q24 and YTD 2024 as compared to respective periods in 2023 as a result of the expansion of the value-based home care model, and higher revenues associated with growth in the company’s Primary Care business, partially offset by the impact of the v28 risk model revision.”

Humana also recently announced a partnership with Walmart (NYSE: WMT), which will allow it to open CenterWell Primary Care locations within 23 Walmart Supercenter retail stores in Florida, Georgia, Missouri and Texas.

The post Humana Goes On The Defensive For Medicare Advantage, Highlights Home Health Growth appeared first on Home Health Care News.

Currently, Dr. Shrank is a venture partner with the Bio + Health team of Andreesen Horowitz, a private venture capital firm based in Menlo Park, California. In addition to his role as CMO with Humana, he has served as chief scientific officer and CMO of Provider Innovation at CVS Health (NYSE: CVS). He has also held a position at the Center for Medicare and Medicaid Innovation, a part of the Centers for Medicare & Medicaid Services, as the director of the Research and Rapid-Cycle Evaluation Group.

“Dr. Shrank is a strategic, experienced health care leader, and I am proud to have him on our board as we execute the turnaround plan for our business,” Walgreens CEO Tim Wentworth said in a press release. “As the health care and retail landscapes continue to evolve and we further enhance our focus and sharpen execution, I am confident that his background will help us elevate the value of community pharmacy and unlock opportunities for our long-term strategy.”

Walgreens has aimed its focus at health care services over the past few years, particularly under Wentworth. The company now has its U.S. Healthcare division, which includes the primary care provider VillageMD and the post-acute care platform CareCentrix.

“I am pleased to welcome Dr. Shrank to the WBA Board of Directors,” Walgreens Executive Chairman Stefano Pessina said in the same release. “I look forward to working with Dr. Shrank and know that his clinical and business insights, experience and patient-centric approach will be a strong asset for WBA, driving long-term value for our patients, customers and shareholders.”

Dr. Shrank began his career as a practicing physician at Brigham and Women’s Hospital in Boston and as an assistant professor at Harvard Medical School. He earned his B.A. in psychology from Brown University and an M.D. from Cornell University Medical College. Additionally, he holds an M.S. in Health Services from the University of California, Los Angeles.

“I have seen firsthand the trust and relationship patients have with their pharmacist, and the critical role pharmacies serve as the front door to the healthcare system in most communities,” Dr. Shrank said in the release. “Walgreens and Boots are trusted brands, and I’m honored to have the opportunity to work with leadership and the WBA Board of Directors to advance the company’s vision and strategy to transform healthcare delivery.”

The post Walgreens Boots Alliance Brings On Former Humana Executive Dr. William Shrank appeared first on Home Health Care News.

If there were ever a time for Medicare Advantage-related troubles to cool off in the home health care space, now would be it. And, heading into the summer, some of the largest home health providers in the country are scoring demonstrable wins that could lead to future success.

Virtually no one has the MA game figured out entirely, and it’s hard to imagine a day where that even becomes achievable. But there are certainly signs that the worst just may be behind providers, at least in a good portion of U.S. counties.

For one, MA plans are not in a strong financial position currently, at least for the most part. Providers are in a better position than they were three to five years ago to persuade the plans to pay more fairly for services, even if plans are less well off.

In value-based care, and in work with managed care companies in general, success begets success. Home health providers now can show their work, to one plan after another.

Instead of a woe-is-me approach, the largest providers – like The Pennant Group (Nasdaq: PNTG), Enhabit Inc. (NYSE: EHAB) and Aveanna Inc. (Nasdaq: AVAH) – are taking a more hard-lined approach.

That’s not possible for every provider, for certain. But the public companies are contributing to a new tone setting: pay fairly, or else.

“I think the payers are recognizing that this is not a commodity business, that there is a real need to partner with high-quality providers in the communities,” Pennant CEO Brent Guerisoli said Wednesday. “That’s also why these discussions have gone favorably for us, because they recognize the value of [partnering with] a quality provider.”

The latest slate of earnings calls and investor presentations from home-based care’s publicly traded providers came with a few key learnings, mostly centered around MA.

Those learnings are the topic of this week’s members-only, exclusive HHCN+ Update.

MA penetration

A better MA landscape may not just be driven by providers taking a more hard-lined approach in negotiations.

In fact, Addus HomeCare Corp. (Nasdaq: ADUS) CEO Dirk Allison said during the company’s first-quarter earnings call earlier this month that there may be a “leveling off” when it comes to MA penetration.

For the first time ever, in 2023, there were more Medicare beneficiaries under an MA plan than traditional Medicare.

That penetration occurred rapidly, according to data from Kaiser Family Foundation. For instance, in 2023, about 51% of beneficiaries were enrolled in MA. Just five years earlier, only 37% of beneficiaries were enrolled in MA.

“We continue to be affected by the movement of Medicare beneficiaries from Medicare fee-for-service to Medicare Advantage, but we feel we may be seeing a leveling off of this shift in the markets we currently serve,” Allison said. “We are continuing to work with our Medicare Advantage payers to obtain higher rates.”

The rapid penetration that took place from 2013 to 2023 led to the assumption that MA plans would continue to gain market share, and quickly. But that doesn’t seem like a sure thing anymore.

Now that the Centers for Medicare & Medicaid Services (CMS) has pulled back on MA rates, plans have less of an ability to expand and offer supplemental benefits that differentiate them from traditional Medicare.

For two years in a row, CMS has finalized unsatisfactory – from the MA plan perspective – payment rates. In 2025, plans will see a 0.16% decrease to core payments.

“As we think about the decisions for ‘25 bids, we do intend to exit some counties,” Humana Inc. (NYSE: HUM) CFO Susan Diamond said earlier this week. “When we thought about the framework of how we make those decisions, a primary input was the profitability of the plan.”

Humana CEO Bruce Broussard also added that supplemental benefits would be “less and less offered” moving forward.

So, in addition to exiting some markets, Humana – along with other insurers – are opting for profitability over growth. That could mean less stark penetration in the coming years for MA.

That would be a positive trend for home health providers. Although traditional Medicare payment is being cut, it still pays far better compared to MA plans.

MA isn’t going away, and will be a larger part of home health business for the foreseeable future. But providers are still making adjustments to account for that. If the firehose is turned down – even for a year or two – it would be of benefit.

Positive steps with plans

Over the last few years especially, providers have been constructing strategies to deal with MA penetration.

Those strategies are finally being implemented, and even if they’re still in their infancy, they’re certainly better than grasping onto what’s left of fee-for-service Medicare business.

Outside of home health care, Addus is also toying with a value-based care strategy that includes more personal care for MA beneficiaries.

“[We have] a small contract, and instead of gain-share, we’re taking some risk,” Allison said Wednesday. “Now, it’s very minimal. We’re only taking risk for our part, for our hours. We wanted to — I won’t say experiment — but we wanted to enter into a contract with a payer that we could partner together to determine if adding personal care hours can help reduce overall medical loss ratio for their patient base. We’re excited about that. We’ve only been in it less than a few months.”

Data doesn’t always persuade lawmakers. Instead, stories do. That’s not as much the case with MA plans, where data remains king.

Providers have caught up there, too.

As Enhabit shifts its home health mix to include more – and better – MA contracts, it is championing its 30-day rehospitalization rate, which is 20.5% below industry average, according to the company.

The new face on the public market, BrightSpring Health Services (Nasdaq: BTSG), said on its first-quarter earnings call that its home health services were also helping drive hospitalizations down significantly.

“Our medication management program … has demonstrated a 73% reduction in hospitalizations when utilized together with our home health,” Jon Rousseau, president and CEO of BrightSpring, said during the company’s first-quarter earnings call earlier this month.

Pennant was ahead of the game in MA, having recognized the need to take on MA beneficiaries long before a crisis arose.

Now, it is in the position to tell plans to pay up. Pennant President and COO John J. Gochnour said Wednesday that the company had achieved per-visit pay bumps from MA plans over the last two years that were above any increases it saw over the previous ten years before that.

Specifically, those rates have climbed anywhere from 10% to 15%, according to Gochnour.

It’s tough to say that the tide is turning in the MA-home health provider relationship. Providers are still struggling mightily to deal with the landscape shift.

But in a generational war like this one, all battle victories are worth taking stock of.

“Because, in the end, they still save money, right?” Gochnour said. “Because we’re the lowest-cost setting. And they make the right investment, we reduce hospitalizations, we reduce the overall cost of the care, and it’s a win-win for both.”

The post Medicare Advantage Penetration Plateau Provides Home Health Tailwind appeared first on Home Health Care News.

Earlier this month, the Centers for Medicare & Medicaid Services (CMS) finalized what MA plans considered to be an underwhelming – though unsurprising – payment rule for 2025.

“I [want to] further emphasize that we continue to believe there is strong bipartisan support for the MA program, and that the strong core fundamentals and growth outlook for MA and value-based care remain intact,” Humana CEO Bruce Broussard said on the company’s first-quarter earnings call Wednesday. “In addition, Humana’s platform, unique focus on MA and expanding CenterWell capabilities will allow us to compete effectively and deliver compelling shareholder value over the long term.”

The Louisville, Kentucky-based Humana has close to 6 million MA members underneath its belt, trailing only UnitedHealth Group, which has about 9 million, according to Kaiser Family Foundation. UnitedHealth Group also maintained its bullishness on MA during its earnings call last week.

Meanwhile, Humana’s CenterWell arm includes primary care, pharmacy and home health care. CenterWell Home Health is one of the largest providers of home health care in the country.

CenterWell Home Health is payer agnostic, but part of the Humana strategy is to put MA members under value-based models driven by its own provider assets.

“As we think about the CenterWell opportunity, there’s a literal incremental opportunity from just further penetrating our CenterWell capabilities by health plan members, which we continue to focus on,” Humana CFO Susan Diamond said on the call. “We do believe, over time, if we can create differentiated experiences for our members who use these services, that we can increase client satisfaction and increase engagement, which should ultimately lead to better star results, improved loyalty and retention, and overall improve total cost of care and health outcomes.”

Humana anticipates that it will grow its MA membership by about 150,000 in 2024, good for a 2.8% increase.

In the quarter, the company brought in $29.6 billion in total revenue, an over 10% year-over-year increase. CenterWell revenues totaled $4.8 billion, an about 7% year-over-year increase.

Other MA considerations

Even if Humana leaders have struck an optimistic tone, investors aren’t necessarily buying it. Year over year, Humana’s stock price is down over 40%.

The tumble it has taken on the public market has been relatively consistent over the last year and a half, and it has provoked the thought of renewed deal talks between Cigna Inc. (NYSE: CI) and Humana.

“The math now works for a CI+HUM fusion,” Jefferies Analyst David Windley wrote this week, suggesting that a deal for Humana at about $420 per share would be plausible. Humana’s stock price, as of midday Wednesday, was hovering around $314 per share.

Humana-Cigna combination talks picked up in late November, then stalled in mid-December.

It’s unclear whether Humana would be reengaging in talks at a low point, however. And, for now, its executives believe that the tide on MA will turn back around.

“The industry is experiencing a dynamic and challenging time we must navigate,” Broussard said. “And while the current environment will create disruption for the industry in the near term, I continue to believe in the strong fundamentals and growth outlook of the MA industry. Our ability to effectively compete in the MA market remains intact.”

Broussard specifically mentioned that he believed MA penetration would continue, and that about 60% of Medicare beneficiaries would be under MA plans over the next few years.

As of right now, just over 50% of beneficiaries are enrolled in MA.

“We feel the value proposition is going to continue to be strong as a result of not only the actuary value, but also the additional benefits,” Broussard said. “We continue to believe that that’s going to [lead to] more penetration of Medicare Advantage for Medicare beneficiaries overall.”

The post Despite Strong Medicare Advantage Headwinds, Humana Remains Bullish On Growth Opportunities appeared first on Home Health Care News.

Every home-based care provider wants to recruit and retain better this year than they did last year. But that’s easier said than done.

Companies are constantly tinkering with their approaches to attract and retain skilled professionals, and are doing so in 2024 yet again.

Between new recruiting processes, career advancement opportunities and more technology, there’s a lot to learn from some of the more forward-thinking organizations in home-based care.

“There’s lots of data that shows the importance of the purpose of an organization,” Amedisys Inc. (Nasdaq: AMED) Chief People Officer Adam Holton told Home Health Care News. “I’ve never worked in an organization before where people care this much about taking care of other people. Our leaders have that same mindset with our caregivers as our caregivers do with their patients. That cultural piece is something that we don’t take for granted.”

Investments made at Amedisys

Amedisys had one of its strongest years in 2023, when it comes to organic growth within its nurse hiring program.

At the same time, it has struggled to hold onto its nurses. When clinicians leave Amedisys, over 50% of the time it is in the first year.

“There are two big levers in this space,” Holton said. “You either bring in more clinicians at a faster rate or retain them at a better clip. Obviously it sounds simple, but it’s not.”

Based in Baton Rouge, Louisiana, Amedisys is one of the largest home health and hospice companies in the country. It has over 520 care centers and about 19,000 employees across 37 states and the District of Columbia.

In order to keep the momentum strong from 2023 to 2024, Holton and his team have doubled down on a number of initiatives that have worked incredibly well over the past 15 months. Those ventures include widening the aperture of where Amedisys looks for talent and implementing sourcing capabilities to its job posting program.

“Once upon a time in our industry, and in our company as well, we could get away with only hiring primarily — and almost exclusively — individuals who had past backgrounds and home health,” Holton said. Those days are over.”

Estimates vary, but the general consensus for how many home health nurses the industry is short ranges from 200,000 to 400,000. The nurse workforce contracted by 3.3% during the pandemic while the demand continues to rise every year between 5% and 7%, Holton said.

Because of that, home health providers have to get creative to find the right workers. Last year, Amedisys invested in a new applicant tracking system that has been a real needle mover, Holton said.

“That has been game changing for us as an organization,” Holton said. “Being able to take our great recruiters and focus less of their time on a lot of administrative, manual work and have them focus on the art and science of recruiting great clinicians to come into the organization has been hugely important.”

Another major investment Amedisys has made is in its preceptor program. Although expensive, Amedisys has dedicated nurses who are not operational in the field, but are solely there to train new hires.

“It’s not new to the industry, and we’ve done it in the past, but we’ve really started to see value from it,” Holton said. “It’s an investment where we have individuals now that have been hired to 100% work with new clinicians coming in to train them, answer all the questions, to follow up with them and to make sure that they’re comfortable and confident in what they’re going to be doing day in and day out.”

CenterWell’s investments

As is the case in all of health care, information is king.

Data can be used at every level of a business, particularly when hiring clinicians and attempting to maintain a highly qualified workforce.

“We take a multi-faceted approach to recruiting and retaining nurses and other clinicians that provide home-based care to our patients,” Jennifer Rose, CenterWell Home Health’s VP of Human Resources, told HHCN. “We have put systems and processes in place to continuously learn from our clinicians in the field. This daily information gathering provides a window into our clinicians’ mindset: their needs, pain points and what they’re asking for to enhance their experience.”

CenterWell Home Health — Humana’s (NYSE: HUM) home health provider arm — has over 350 locations, over 9,000 clinicians and serves more than 350,000 patients annually.

The simple process of actively listening to current clinicians about what they want out of their job has been a point of emphasis for CenterWell as staffing shortages persist.

Elevating the perception of the job and offering career paths for clinicians has proven to be a major boost in CenterWell’s retention efforts, Rose said.

“We’re helping grow the careers of our clinicians by investing in tuition reimbursement programs for college and university degree work, as well as RN to BSN advancement programs,” she said. “We also have programs in place for our clinicians to learn new skills and obtain technical certifications that allow them to care for patients with specialized needs.”

CenterWell has also made sure to work with its parent company when offering advancements and promotions throughout the company. The provider has made it easier for its employees to move from one part of the organization to another, in hopes that the flexibility offered to clinicians and nurses will be a boon to retention.

“For instance, moving from a care coordination role with our insurance business to home health or even our owned primary care centers,” Rose said. “This agile approach is a win-win for our clinicians as well as the business, providing additional flexibility.”

Investment in new technologies has also been an area of focus for CenterWell. Using AI and other capabilities to streamline scheduling and reduce on-call burden are just a couple of examples.

“We’re implementing advanced technologies like voice-to-text capability to simplify the task of documenting patient encounters,” Rose said. “That allows our clinicians to focus more of their time and energy on what they’re most passionate about – serving their patients.”

Amedisys has found success in its own newer investments in tech.

“We recently invested in a new listening platform,” Holton said. “There are lots of good listening platforms out there, but the one we’re now using collects all the feedback that we get from our clinicians and people in the field, and based off the science and the algorithms, it helps our leaders to pin down, ‘Here are the two action items you should take that are going to have the most impact on the caregiver experience.’”

The post How Amedisys, CenterWell Home Health Are Retaining Workers In 2024 appeared first on Home Health Care News.

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

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

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

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

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

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

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

Telling home health care’s story

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Each is their own beast.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

The post CenterWell President Sanjay Shetty: ‘It’s Time To Give Home Health Its Due’ appeared first on Home Health Care News.

Seniors have more options than ever when choosing MA plans. But a few of the top companies continue to gain market share.

Specifically, UnitedHealth Group (NYSE: UNH), Humana Inc. (NYSE: HUM) and CVS Health (NYSE: CVS) – through Aetna – continue to outpace competitors.

Last year, UnitedHealthcare owned 29% of the MA market with 8.9 million beneficiaries; Humana owned 18% of the market with 5.5 million beneficiaries; and CVS Health owned

11% of the market with 3.3 million beneficiaries, according to Kaiser Family Foundation.

Blue Cross Blue Shield plans owned a significant portion of the market, too, with 14% and 4.4 million beneficiaries.

Between 2023 and 2024, the largest plans continued to see growth. UnitedHealthcare gained 478,000 new members, Humana added 412,000 new members and CVS Health added 544,000 members, according to a Chartis analysis.

Meanwhile, Elevance Health’s (NYSE: ELV) beneficiary total dropped by 25,000. Centene (NYSE: CNC) had an even greater fall off, losing 212,000 members.

Cigna (NYSE: CI) also agreed to sell its MA business to Health Care Service Corporation for $3.7 billion.

Over 80% of the 1.7 million new MA beneficiaries went to for-profit plans – such as UnitedHealthcare, Humana and Aetna – according to Chartis.

What’s noteworthy about the biggest players in the MA space is their at-home care ambitions.

UnitedHealth Group is directly involved in home health care. It owns LHC Group and is in the process of acquiring Amedisys. Those are two of the largest home health entities in the country.

Humana owns CenterWell Home Health, also one of the largest home health entities in the country.

CVS Health does not directly own home health assets, but does own the at-home care enabler Signify Health.

Home health providers have generally had difficulty getting fair rates from MA plans for home health services, despite many of their parent companies going after home health assets.

Other trends to consider

For home care providers, these plans’ direction when it comes to supplemental benefits is worth paying attention to.

“Similar to plan options, the prevalence of supplemental benefit offerings (which have increased significantly in recent years) seems to be slowing and even declining for some benefits, suggesting that ‘more is not always better,’” authors of the Chartis analysis wrote. “The proliferation of both plan options and supplemental benefits is driving proposed regulations from the Centers for Medicare & Medicaid Services related to agent/broker compensation, D-SNP integration, and supplemental benefit reporting.”

Experts in the space still generally believe that supplemental benefit utilization – and particularly in-home support services, which home care providers help administer – will hold up. That’s because the plans that are believers in those benefits will continue to lean into them, even if others drop benefits to deal with rate cuts.

But CVS Health CFO Tom Cowhey did acknowledge this week that some supplemental benefits could be on the chopping block.

“What are some of the things that we’re going to need to look at?” Cowhey said at the 45th Annual Raymond James Institutional Investor Conference. “I think supplemental benefits have to be on that list. I think ourselves – and probably all the industry – are going to have to look at all the benefits across the board and decide where it is that we want to cut. But I know that supplemental benefits will be part of that conversation.”

The post UnitedHealthcare, Humana, Aetna Continue To Outgain Peers In Medicare Advantage appeared first on Home Health Care News.