In March, Humana Inc. (NYSE: HUM) announced a new brand that would combine its “Partners in Primary Care” and “Family Physicians Group” into one.
These two sects of Humana, independent from the payers and focused on the elderly, became “CenterWell Senior Primary Care”. The newly appointed elderly care organization is now venturing into the original health insurance through direct contracts with the federal government.
“Everything about CenterWell was designed with the elderly in mind,” Matt Eirich, Humana’s director of growth, told Home Health Care News in an email. “We combine this with a value-based reimbursement model that allows us to invest in proactive care, to see our patients regularly, not just when they are sick, and to invest time in helping them manage their conditions. “
CenterWell and Conviva de Humana Care Centers together form the “Humana Care Delivery Organization”. “CenterWell Care Solutions” was created as an entity to work with Center for Medicare & Medicaid Innovation (CMMI) on its global and direct contract model, while Conviva participates in the model through the “Humana Direct Contracting Entity” tag.
Both are senior-focused primary care organizations that take holistic approaches to care.
Together, they operate more than 160 centers across the United States and serve more than 200,000 patients.
Direct contracts generally allow approved entities to enter into risk-sharing agreements for traditional health insurance. The goal is to save money and provide better patient care.
Humana is optimistic about its potential success as a Direct Contracting Entity (DCE) and believes its model fits perfectly with what the payments system is trying to accomplish
“We invest significantly more in our primary care practices than the average practice, but our model prevents avoidable hospitalizations, creating better outcomes for our patients and savings for the broader healthcare system,” said Eirich.
As with all DCEs, CenterWell’s reimbursement will be tied to its performance and based on the quality of care its new Medicare patients receive. He will share financial responsibility with the Centers for Medicare & Medicaid Services (CMS) during the direct contracting period.
Direct contracts expand the already large pool of patients CenterWell can provide care to.
“By participating in direct contracts, we can serve more patients,” Eirich said. “About 65% of all Medicare beneficiaries are in original Medicare. [Additionally], CMS will share data, enabling more patient-friendly care and services based on patient needs, and provide a reimbursement model that will allow us to invest in preventive and proactive care.
Humana is in the process of purchasing the remaining 60% of Kindred at Home for an enterprise value of $ 8.1 billion. Kindred, which is one of the largest home care providers in the country, will eventually become “CenterWell Home Health”.
Kindred at Home, on the other hand, has offices in 40 states, providing home health, hospice, and community services to more than 550,000 patients per year.
CenterWell Senior Primary Care’s mission and direct outsourcing efforts also mesh well with what Humana is trying to do at home.
“As primary care providers, we strongly believe in the power of the home as the setting of care preferred by our patients,” said Eirich. “We have designed our model of care to maximize the time our patients spend at home and out of hospital and other institutional settings. We also coordinate care with other members of the home ecosystem, including Kindred at Home.
Because direct contracts encourage more comprehensive care for Medicare beneficiaries, Humana will be able to leverage its in-home capabilities for the new patients it takes on.