How CenterWell Can Showcase the Value of Home Health Care within Humana

Earlier this year, I had the opportunity to interview CenterWell President Sanjay Shetty onstage and offstage 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, 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, especially in Medicare Advantage (MA). As a provider, Humana’s CenterWell is also a powerhouse, with home health, pharmacy and primary care divisions.

While MA plans and home health organizations often disagree, Humana and UnitedHealth Group (NYSE: UNH ) are in a unique position. They are two of MA’s largest operators, and they also own two of the largest home health providers in the country, CenterWell Home Health and LHC Group, respectively.

While chatting with Shetty in February, he felt that CenterWell could raise the bar for the entire home health industry.

“I think, I hope that piece of evidence will help,” he told me. “Maybe we’re still in the early days, … but it’s been great because, again, we have a real patient laboratory, and a real opportunity to participate in this process. The bottom line is, we’re opening How is it possible for home health organizations to engage in a quality-based approach?”

Allen and I started a conversation that Shetty and I left off.

Humana’s goals in the home, and how they may impact the home health industry as a whole, are the subject of this week’s exclusive HHCN+ Feature.

To prove quality

Some home health providers are frustrated by high payers getting other top providers. But the best case for them would be CenterWell Home Health, LHC Group and Amedisys Inc. (Nasdaq: AMED) shines within Humana and UnitedHealth Group.

If they do, it may open the door for other home health providers to discuss MA plans at a higher level.

In addition, those payers will always need more home health services than their providers can provide.

Allen has been with Humana for seven years. He officially became president of home solutions at the company in January.

As Shetty said, CenterWell Home Health is still in the early stages of its mission to prove quality in home health care.

“My tendency is … I feel very confident that well-designed home care – with an eye towards results – will lead to higher results when it comes to quality, but also experience and results,” Shetty he said. “I feel very confident because these are highly skilled workers in the family, who really look at the whole person and interact with them in a different way than you would in a clinic.”

Allen explained that Humana has a near-term goal of treating 80,000 home health patients under a value-based model.

That model, though proprietary, could be a framework for future agreements between health plans and home health providers.

“Humana is in a unique position because of the investments it has made, measuring and proving impact,” Allen told me. “And to do it in a way that is representative of home health, MA and physician practices. I think that could have an impact on the industry, and that’s why we’re very excited about this value-based model and the fact that we’re committed to covering these 80,000 members. ”

The 80,000 number, Allen believes, is a sufficient sample size to prove the model. If all goes well, the goal is to treat more patients under a value-based model in the future.

“I think this could have an impact on payments in the industry as a whole,” Allen said.

How the model works

The value-based model remains Medicare-certified home health care. So, for example, OASIS is being compiled, and all the expectations that other providers follow based on the guidelines of the Centers for Medicare and Medicaid Services (CMS) will be followed by CenterWell Home Health.

But freedom – and promise, really – comes elsewhere. Under the model, the Low Utilization Payment Adjustment (LUPA) is not a concern, for example.

“In our value-based architecture between CenterWell Home Health, one home and our primary care organization (PCO), there is [an ability] focus on the patient and their needs at the center,” Allen said. “The PCO has those patients, from a doctor’s point of view. We’re a home health provider for those patients, so there’s not a lot of different people involved. The first thing that happens because of that is that they know exactly who to go to for home care, and we know exactly who to go to for prescriptions, right?

At the PCO end, there are physician “champions” who coordinate directly with home health care on the clinical side. That way, if the patient needs something, it is delivered immediately.

“The important thing is that both organizations are fully accountable,” Allen said. And it becomes what the patient needs. And that’s what you give. You don’t have a sales process that you’re running around. It’s a bigger connection to care and delivery of care than selling for care. ”

The value-based model was up and running last November, and early signs are that hospitals are slowing down, according to Allen. More information will be available later in the year, at every opportunity.

Humana has focused on home care for more than a decade. Its home health care experiment may be one of its biggest moves, so much so that the company has publicly protested earnings calls in the past.

If everything goes the right way, the new model will represent the big tail of Humana, CenterWell and especially CenterWell Home Health.

CenterWell Home Health could – as a payer agnostic organization – switch to other MA plans and demonstrate the true value of their services.

“We’re always focused on delivering value,” Allen said. “What we’re most excited about is proving our model based on the quality and care we provide below.”