Humana Touts Impact of Senior-Focused Primary Care as MA Market Exits Loom

Senior-focused primary care organizations can enhance access to care for Medicare Advantage members, particularly among historically underserved groups, according to a new study of Humana plans that was conducted by the insurer’s research arm. The research, which was published in Health Affairs and co-authored with Harvard researcher J. Michael McWilliams, M.D., Ph.D., highlights the potential of population-based payment models to drive equity in health care delivery. Additionally, this research comes as Humana and other large insurers plan strategic exits from the MA market after experiencing sustained medical cost pressure in public sector insurance. The study analyzed data from six senior-focused primary care organizations covering more than 421,000 patients enrolled in Humana MA plans in 2021. The selected groups included Humana’s CenterWell Senior Primary Care and Conviva Care, in addition to Amazon’s Iora Health, CVS Health Corp.’s Oak Street Health, ChenMed Primary Care Centers and ChenMed’s JenCare Senior Medical Center. Researchers found that these specialized primary care organizations, which operate predominantly under full-risk capitation payment arrangements, serve a higher proportion of Black and dually eligible beneficiaries compared to other primary care providers. Compared to users who sought care from those other providers, beneficiaries using the senior-focused organizations experienced a 17% higher incidence of primary care visits, 6% fewer hospitalizations, 11% fewer emergency department visits, and a 10% lower likelihood of 30-day inpatient readmissions. Patients utilizing this care model also saw better outcomes on multiple quality measures, including cancer screenings, medication adherence and controlled blood pressure. “Senior-focused primary care organizations are uniquely positioned to address the needs of underserved populations,” the study authors observed. “Their focus on comprehensive primary care, data analytics, and supportive services enables better disease management and improved health outcomes.” The findings suggest that population-based payments in MA can advance health equity by incentivizing providers to enter underserved communities and offer enhanced care. Black beneficiaries and those eligible for low-income subsidies experienced significant benefits. For example, Black beneficiaries served by senior-focused primary care organizations had 39% more primary care visits and 12% fewer hospitalizations compared to their counterparts in other primary care settings. Similarly, dual-eligible beneficiaries had 21% more primary care visits and 30% fewer 30-day readmissions. “This study bears out what we see day-to-day in our approximately 300 centers, many of them located in underserved areas,” Reneé Buckingham, president of Humana’s CenterWell Senior Primary Care & Conviva Care Solutions, said in a Sept. 4 press release. “Focusing on seniors in a value-based, team-oriented care model means that we can spend more time with patients, understanding the many social and other factors that play a role in overall health.” While Humana’s findings are promising, the authors caution that further research is needed to confirm these results in other populations and settings. “As these organizations increasingly serve traditional Medicare beneficiaries, it will be important to see if these benefits extend beyond the MA population,” the authors concluded. Also on Sept. 4, Humana presented at the Wells Fargo Healthcare Conference. Chief Financial Officer Susan Diamond unveiled 13 MA county exits, along with strategic product changes. Combined, that reshuffling will impact an estimated 560,000 members. Diamond said she expects about half of those members will be retained through enrollment in other Humana plans, but losses will likely reach “a few hundred thousand.” “The exit itself is positive in the sense that those plans were not contributing,” she said. “And so just exiting, even if we don’t retain the members, is positive. 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.” Humana is maintaining its full-year guidance of approximately $16.00 adjusted earnings per share (EPS), still a far cry from Wall Street’s original 2024 prediction of $29.14 EPS. And some firms suggest that an enrollment slowdown could impact CenterWell’s bottom line. When asked if Humana will meet its $16 EPS target, 67% of readers who responded to a Sept. 10 poll in AIS Health Daily said yes. “Humana’s financial model is highly levered to the Medicare Advantage program as it represents ~88% of its insurance revenue, while the CenterWell segment also has significant exposure through its primary care and home health businesses,” a Raymond James analyst wrote in an Aug. 1 research note. “If enrollment growth in the program were to slow, or program changes were implemented that adversely impacted the health plans economics, this could significantly impact HUM’s profitability and earnings growth potential.” Wells Fargo, in a Sept. 4 comment on takeaways from its health care conference, noted that any shrinking in the MA book would be a downside risk, as CenterWell’s growth would slow. CenterWell’s year-over-year primary care revenue increase of 22.3% was 7.5% above Wells Fargo’s estimate for 2Q.