Humana (NYSE: HUM) continues to bet on the home as a main site of care.
In addition to its multi-billion dollar purchase of Kindred at Home, the insurer has also formed partnerships with home-focused companies such as Heal, DispatchHealth and Papa, among others.
Dr. Amal Agarwal, the VP of home solutions for the Louisville, Kentucky-based Humana, already sees that bet paying off. And it’s not only in his work with Humana, but also on the ground during his time practicing medicine part time.
“I think there’s patient demand. Also, there’s just a natural fear now, especially over the last 12 months, of any sort of brick-and-mortar establishment,” Agarwal said recently at Home Health Care News’ FUTURE conference. “I’m seeing patients ask for home care, and that’s what’s really interesting. They’re saying, ‘Do I really need to stay in the hospital? Can this be done in the home?’ You have patients asking for it, you have physicians asking for it and payers wanting it. So I think the natural pendulum shift is [underway].”
Over the course of the public health emergency, that desire has been reflected in the statistics.
Skilled nursing facility (SNF) referrals plummeted, as did home health referrals for a period. But as some semblance of normalcy resurfaced, the numbers no longer looked like they did before.
“Pre-COVID, you saw an even split between referrals going to SNFs and home health,” Bill Miller, the CEO of Wellsky, said at FUTURE. “There were obviously big changes in volume during March, April and May of last year, and then it all started creeping back. But it creeped back in different ways. We saw SNF referrals drop, and they didn’t come back the same way. That 50-50 split is now settling, where SNFs are getting 35% to 40%, and the rest is going to home health.”
Overland Park, Kansas-based WellSky is a post-acute technology company that utilizes software and analytics to help providers across the continuum achieve better outcomes at lower costs.
The company works with 20,000 home health agencies, which gives it a unique perspective on health care system trends.
That exact split won’t necessarily be long-lasting, and Miller emphasized that there is still a prominent place in post-acute care for SNFs. But providers’ willingness to continue to explore home-based options is helping sustain what were once considered temporary, pandemic-related changes.
“We’re watching it being sustained today because some of the outcomes are starting to support that we can actually … take the higher acuity patients into the home, and so I don’t see that slowing down,” Miller said. “I don’t ever say normal, because I don’t think we’re going to get back to a ‘normal’ necessarily – but an adjusted, new normal instead – and that’s what we’ve seen happen across our networks.”
Humana’s integrated network
Agarwal says that 60% of the patients he currently sees in the emergency room do not need to be there. The issue often is that there is nowhere else for them to go.
In the future, however, that place could be in the home.
“My priority right now is to focus on how we get robust care in the home, and how we can keep people out of the ER inappropriately,” Agarwal said. “Some of that care could be done in the home. And so I want to make sure that we do that.”
The other priority for Agarwal is integrating Kindred into Humana completely, which will be known in the future as “CenterWell Home Health.” On top of integration, the goal is to turn the enterprise into a value-based home health model.
Between Humana’s endeavors as a payer and a provider, its ultimate goal is to be a single point of contact for patients.
“The goal is for the member or the patient to have one point of contact, one that takes care of everything you need,” Agarwal said. “Whether it’s pre-acute, post-acute, acute, advanced or specialty care. That’s the vision. … The goal is to have an integrated ecosystem.”
Because Humana can switch between its payer and provider hats, it’s constantly thinking about what is feasible in the home from a cost perspective.
Though hospital-at-home trends have been very promising, Agarwal said, the next step is making sure that there’s value in the programs, and that it’s not just low-acuity care that coincides with a higher-acuity, hospital-like charge.
“We have to be willing to take a little bit of risk, and we have to be willing to admit and care for high-acute or sick patients in the home,” he said. “We have to see what is possible. When I think about moving forward, I think about how we actually measure the value that’s taking place. So it’s about coming up with the right metrics that we can all align on with the hospitalists, the providers, the nurses, the patients and the payers to find what value-driven care in the home is.”
When it comes to caring for patients in the home, the toothpaste is out of the tube, which is a good thing for home-based players.
Now, the attention has been turned to how more home-based care can be both cost-effective and clinically feasible.
“You never hear people say that their loved ones [had a good experience with this process],” Miller said. “If there is one, I’d like to meet that person. It’s never been that way, unfortunately. And so as more volume gets pushed out into the home, there’s just a lot of work that we’re trying to do to make that transition easier and financially viable.”
