Sunday, August 5, 2018

Broussard Talks Hospice in Humana's Q2 Earnings Call


Strange Tony,

Humana owns 40% of our hospice alongside two financial rapscallions.  CEO Bruce Broussard spoke of Humana's interest in caring for patients with terminal illness in the recent earnings call.

Over the last year, we've continued to make significant advances in our enterprise strategy, particularly in the past few months as demonstrated by our recent investments in both Kindred at Home and Curo Health Services. With a continued focus on helping seniors achieves their best health, we are striving to reshape healthcare by expanding access to high-quality, value-based care in both primary care and home health. 

Humana's CFO said the company used approximately $1.1 billion in parent cash to buy the 40% stake in Kindred at Home and Curo.  Parent cash could've bought 100% of Kindred at Home and had two divisions to spin off, LTAC hospitals and RebabCare.  Humana would've had $280 million leftover to invest in Curo.  Instead Humana did a squirrely deal with Welsh, Carson, Anderson and Stowe (WCAS) and TPG Capital, the employer of a Kindred board member.

In the call Humana's CFO added "we expect reasonable adjusted EBITDA growth in our healthcare services segment, as the Kindred results are annualized and our other businesses in the segment, particularly our own clinics, improve."

Broussard stated in his prepared remarks.

Turning to home, we recently announced the completion of the acquisition of a 40% interest in each of Kindred at Home and Curo Health Services, collectively the largest home health and hospice operator in the nation. As we previously indicated, we are striving to do something that has never been done before in home health -- transform the payment model into one that is value-based, encouraging a transition for maximizing volume to focusing on managing health and chronic conditions, such as COPD, congestive heart failure, and diabetes to prevent or slow disease progression. This movement to value-based care and aware from a predominantly therapy-based methodology, is aligned with the recent CMS proposal for changes to the home health payment methodology, which was anticipated when we entered into the transaction.
Broussard partnered with leveraged buyout firm WCAS, which employs ex-Medicare Chief Tom Scully.  WCAS is also Broussard's former employer and sponsor of his first fortune.

In that regard, we appreciate the model proposed by CMS and welcome change that aligns home health with pay-per-value and improved clinical outcomes, reducing preventable events. While the ultimate transformation will take many years, upon closing of the transaction, we immediately launched test-and-learn pilots aimed at both operational and clinical improvements in four markets: Richmond, Virginia; Charlotte, North Carolina; Virginia Beach, Virginia; and Dallas, Texas. These pilots incorporate a pay-per-value mechanism in addition to the traditional fee-for-service payment based on four quality measures: hospital admissions, hospital readmissions within 30 days, emergency room visits without hospitalization, and timely initiation of home care specifically within 48 hours of referral or an M.D. order.

In addition, in order to create differentiated home health model, we had the opportunity to weave the richness of Humana at Home telephonic and in-home engagements, as well as Humana pharmacy resources, into the skilled nursing provided by Kindred at Home clinicians. Over the next year, we plan to leverage Humana predictive modeling to identify additional clinical interventions, integrate Humana pharmacy resources to conduct comprehensive medication reviews, and extend our care management best practices from Humana at Home into the Kindred at Home homecare environment.

We will also reduce friction in the authorization process to ensure Kindred professionals are in the home within 48 hours of a referral or supplement the ordering physician through telehealth with a virtual M.D. to expedite the delivery of care. We expect the changes we are making in the home health space will not only benefit our Medicare Advantage members, but also our Medicaid members over time.

The continued development of our in-home capabilities, together with our demonstrated clinical capabilities in Medicare Advantage uniquely position us to serve the Medicaid population, giving us confidence that we'll be successful in growing our Medicare platform through procurements. Under our recent statewide award in Florida, we expect to serve an additional 141,000 members, an increase of 44% from our existing Medicaid membership.

The Florida contract was awarded based upon the ability of plans to achieve the Medicaid agency's goals. These goals included creating enhanced provider and member experience, the ability to reduce preventable inpatient and outpatient events, high-quality scores, innovative and effective methods to deliver integrated care, and integration with the community and support of Medicaid beneficiaries.

We've been successful in achieving strong results across these areas by leveraging the capabilities that have positioned us as a top Medicare Advantage plan, including our capabilities in chronic condition management, integrated care delivery, value-based provider relationships, and community programs designed to address social determinants of health, such as food and security, and social isolation. While we are confident in our capabilities and expect to be successful in the procurement process, consistent with our previous remarks, we will continue to assess length of time to scale and potential barriers to entry at the state level, while considering potential M&A opportunities in the Medicaid space. In that regard, we appreciate the model proposed by CMS and welcome change that aligns home health with pay-per-value and improved clinical outcomes, reducing preventable events.

Broussard's excitement over home health is clear in his remarks.  What about hospice?


David Windley -- Jefferies -- Analyst
Good morning. Thanks for taking my question. Going back to Kindred and Curo, and understood those are investments not full acquisitions. Integration is maybe not the right word, but how do you think about optimizing or harmonizing your workflow between those entities and your internal home health initiatives to drive more cost savings for the member base? I'm thinking about what could manifest as a trend-bender as we think into 2019 and what has to happen to make that a reality?

Bruce D. Broussard -- President and Chief Executive Officer 
At the time of close and pre-close, we had a lot of planning of what would be our top priorities in engaging with Kindred. I'll wrap around a few things. First is we're going to test and learn in a number of markets and be able to really focus more on just not about bringing our home health business over to Kindred, but more importantly, bringing the ability to prevent preventable events from happening. We have a number of things going on that are focused more on nursing-oriented patients that have chronic conditions that can be managed in the home.

First, we're just rerouting more effort nursing area as opposed to the therapy area. That's the first thing. As you mentioned, the trend-bender out of this is reduced admissions, readmission, our rates going down, ER visits going down. That's our measurement of success there, by focusing on these chronic conditions.

Part of that test will also be how we bring telehealth into the home. The telehealth platform will not only allow us to be more convenient in bringing care into the home, but the second thing is it also will help us with our star scores and other preventative measurements that that we can get into the home quicker, both in being able to do it more convenient as a result of not having to get people transported there and, in addition, working through the appointment schedule. So, we see two combinations here in our test-and-learn. One is around how do we reduce the preventable events from happening and then secondarily, how do we continue to increase our performance on our quality measurements.

David Windley -- Jefferies -- Analyst
Thank you. 

The following interchange showed CEO Bruce Broussard soft pedaling Humana's vision of being the largest hospice operator in the U.S.  Humana paid a huge premium for Curo relative to Kindred deal pricing.

Frank Morgan -- RBC Capital Markets -- Analyst
My second question, obviously with the Curo acquisition, you must like the hospice business. So, my question is, with hospice being carved out of the MA benefit today, what's your short term and your longer term view there and also just any thoughts in the context of the future for value-based purposing for hospice? Thanks.

Bruce D. Broussard -- President and Chief Executive Officer
Hospice for us is really, we look at that as a service we are participating in and providing to the healthcare community, and we leave it ultimately up to the caregiver, the family, and the physician to decide where is the proper place for an individual.

But once that decide that it moves from a restorative to pain management kind of treatment, then we are there to serve them and integrate that into offerings we have. In regard to is it in or outside of Medicare Advantage, we really look at it more is it the right thing to do for the family member and then ultimately be able to help them with the transition of quality of life.

We do believe, over time, that hospice and palliative care will continue to be more and more important parts of the care model as we see the need for it. We see people living longer and at the same time, treatment options at end of life become more intense or there are fewer of them and people make this choice that is probably one of the less used area of healthcare today that probably have a large, positive impact on people's life as they think about where they are in their stage of life.

 For us, we are more a recipient of it. We are believer it's the right thing to do and we are a believer that we will provide that service to our members if they choose to.\
The payment model is less of an issue for us and insignificant in our decision making.

Frank Morgan -- RBC Capital Markets -- Analyst
Thank you.

 
Broussard provided mixed messages to hospices in his call.  It's an important service for families and the payment model isn't important.  However, as people have less treatment options hospice has a role to play.  What if insurance denials result in more insureds having few to no treatment options?  In that case hospice would be a cost saving measure for Humana.

If payment were insignificant why would Humana's CFO talk about Kindred's contribution to reasonable EBDITA growth for the second half of 2018?  He went past EBDITA as a measure saying the company would only report adjusted EBDITA for Kindred at Home/Curo.  Adjusted EBDITA is a financial rapscallion measure

Cost control measures have already begun at our hospice.  WCAS, TPG and Humana have set clear financial performance expectations.  The only window into these is Humana's SEC filings.  Financial rapscallions don't disclose.  

Anonymous (from KAHtivacare Hospice managed by Curo Executives)

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