Humana Wants More Profit from Kindred at Home

Strange Tony,

Humana CEO Bruce Broussard informed Wall Street analysts of plans to build a longitudinal health record.

This year, we'll be bringing on all of Kindred in that relationship as a result of them completing their EMR install.

In the home, we advanced our transformational home health initiative with Kindred at Home and Curo through the implementation of a company-wide EMR and the extrapolation of best practices for our [indiscernible] over 20,000 home health episodes.

The next phase beginning in 2020 is to provide more care services in the home, including acute care and primary care in the home, so that we may begin to generate meaningful trend vendors for our health plans in the future while improving clinical outcomes for our seniors.

Homecare Homebase's cumbersome, complex software requires multiple workarounds.  It turned into "garbage in/garbage out" as nurses refuse to check any boxes that might take them on a clinical rabbit trail.  The narrative summary is the only place to find pertinent clinical information.  It resides nowhere else in HCHB's twisted bowels.

On measure after measure our hospice is far worse under Broussard's greedy leadership.  Humana implemented a littany of worst practices.  The system robs staff of fair pay for hours worked and miles driven. That is not a best practice. It's abusive.

Humana CFO Brian Kane mentioned Kindred at Home several times in the recent earnings call with Wall Street analysts.

For Healthcare Services, we had a strong year as we saw growth in our pharmacy business, solid performance of Kindred at Home and continued improvement in our Conviva operations, partially offset by the cost incurred to continue to expand our owned JV and Alliance senior-focused primary care centers.

Our home business is also anticipated to perform well led by Kindred at Home in which the conversion to Homecare Homebase across home health and hospice in 2019 weighed on results due to the significant required one-time investment, but will drive EBITDA in 2020.

Kindred at Home is also performing well. We hope to continue to see strong EBITDA growth, not withstanding the change in the payment model.

I'm not sure what else Brian Kane can do to drive EBITDA growth.  Humana and its financial rapscallion partners already depopulated our hospice staff.  Caring people quit or were targeted for elimination by the Mean Girl managers, local and regional.

Humana executives want higher earnings and Medicare Advantage cost savings from Kindred at Home.  Greedy executives rely on complex, unreliable technology while abusing actual caregivers.  Broussard and Kane want profit growth and they don't care who gets hurt in that pursuit.

Anonymous

Hospice Staff Should Prepare to be Leveraged

Strange Tony,

"Home Healthcare News" interviewed Humana at Home President Kirk Allen.  One question targeted Humana at Home's plans for Kindred at Home, a company 40% owned by Humana.

"We have learned that there is a real depth in the clinical relationship that exists between the hospice care providers and the hospice patient and the patient’s family, as well as how holistic the benefits of hospice are. There is a medical component. There is a spiritual component. There is bereavement care for the family following the patient’s death.'

'We are learning to take a look at those interactions and consider how we can leverage that time we spend with the [Humana] member in their homes, and how we can take full advantage of that moment of influence to really help serve that member."

That depth in clinical relationship resulted in a huge pay cut for our hospice's nurse practitioner. Evolution Health implemented a similar move just prior to Kirk Allen joining the company.

The company decided to cut NP pay for an entire group of NPs. This decision was announced by email. There was no warning, no meeting, no telephone call. There was just an email stating "we are reducing your pay per visit and IF you do not sign a new contract in one week we will quit assigning you patients". For me it was a 29% pay cut. I am not sure how much of a pay cut it was for the other NPs. Several NPs quit immediately because they did not have a contract that protected them.

Humana and its financial rapscallion partners continue shedding jobs at our hospice.  Every few months they eliminate a position and overload the few remaining office staff.  Our census is roughly the same as summer 2018 when we were sold down the river.  Homecare Homebase continues to be cumbersome and overly time consuming.  Staff continue to work hours and drive miles for which they are not paid.  What kind of leaders would do that to their people?  Snakes in Suits.

"Psychopaths manipulate others to accrue power, sometimes pitting them against each other in an attempt to divide and conquer. They are often attracted to bigger, dynamic corporations with very little structure or supervision. They generally don’t work well in teams because they don’t like to share information or skills and it brings them joy to watch others fail. They are addicted to power, status and money. Sound familiar?

The corporate world is set up to favor psychopathic traits such as fearlessness, dominant behavior and immunity to stress. Because of this, psychopaths often find themselves in these types of positions, and then have an easier time climbing the corporate ladder and obtaining positions of great power. This is where they can do real damage to society as we see it today."

Kindred at Home executives have skin in the game, i.e. an ownership stake in the company.  They will make a king's ransom when Humana buys the rest of the company from TPG Capital and Welsh, Carson, Anderson and Stowe.  They stand to make more by robbing the people who do the clinical and office support work.  Pathological, earthly leaders are widespread in healthcare as more and more companies come under the ownership of financial rapscallions.  Greed is omnipresent and it kills.

Anonymous

Humana Has Two New Executives from CMS

 Strange Tony,

"Yahoo Finance" reported on two new senior executives at Humana:

Humana Inc. has detailed how it will put two former federal government personnel that it hired recently to work.

Drs. Kate Goodrich and Mona Siddiqui will lead efforts to better integrate the company's clinical efforts, according to a statement from the Louisville-based health insurance company.

Earlier in the month, news broke that Humana (NYSE: HUM) had hired Goodrich and Siddiqui to unspecified senior vice president roles. Goodrich left the chief medical officer role at the Centers for Medicare & Medicaid Services. Siddiqui left the chief data officer position with the U.S. Health and Human Services Department.

Goodrich will take on the title of senior vice president of trend and analytics. Siddiqui will take the title of senior vice president of clinical strategy and quality, enterprise clinical management, the statement reads.

Specifically, Goodrich will be accountable for developing and implementing Humana's clinical trend strategy; leading the clinical business analytics needed to deliver the work of the ECOM strategy; work with various analytics units in Humana including the recently created digital health and analytics division.

Siddiqui will be accountable for Humana's integrated clinical strategy and establishing the direction for the company's clinical quality measures. 

Humana has two new executives to enrich as they continue robbing my hospice coworkers of fair pay for hours worked and miles driven.  Homecare Homebase continues to be a garbage in/garbage out system.  

The two new executives can advise CEO Bruce Broussard on ways to optimize payment under Medicare's complex extrinsic motivation schemes.  Broussard and his fellow executives will take any windfall while Kindred at Home employees struggle.  Crumbs rarely fall from the king's table.

Anonymous

Humana Enriches More Executives

Strange Tony,

Humana CEO Bruce Broussard sold company stock before Christmas as did thirteen other executives.  Broussard received $21.7 million for his shares.  Broussard's stock sale is 4.6 times more than the $4.7 million Kindred contributed to employee 401(k) retirement accounts in 2018.

Humana enriched former Homecare Homebase Chief Operating Officer Tom Maxwell when it announced it would buy specialty hospice pharmacy provider Enclara Healthcare.  Maxwell is an Enclara board member and owns healthcare consulting firm Maxwell Healthcare Associates.

Over a year ago Humana influenced the Kindred at Home board to go with Homecare Homebase.  Maxwell Health Associates assisted our hospice with its Homecare Homebase  go live.  Maxwell consultants ensured staff was not be paid fairly for hours worked or miles driven.

While valuable staff members were laid off Tom Maxwell made big money from Kindred at Home's conversion to Homecare Homebase.  He will make big money again when Humana closes the Enclara deal.

Two former Medicare Chiefs are directly involved with Humana/Kindred at Home or Enclara.  Obama Health Reformer Nancy Ann Deparle will profit handsomely in her role as founder of financial rapscallion Consonance Capital.  Bush II Medicare Chief Tom Scully owns a chunk of Kindred at Home via financial rapscallion Welsh, Carson, Anderson and Stowe.  He will make massive profits when Humana buys the rest of Kindred at Home from Humana at grossly inflated prices.  Broussard once worked for another Welsh Carson affiliate, U.S. Oncology and traded Concentra with WCAS as Humana's CEO.

Kindred Hospice workers toil under bad management and ineffective computer systems.  The spoils do not trickle down to the people doing the billable work.  Workers vote with their feet daily by leaving.  Executives have neither eyes to see or ears to hear.  They do have fingers to count their earthly gains which remain on this planet when they receive God's final judgement.

Anonymous

Toad Kicks Off "Gather Your Own Straw" Program

Strange Tony,

The day after Thanksgiving First Senior Regional Executive Vice President Toad introduced Kindred at Home's latest executive initiative to our hospice.  The mandatory meeting occurred on Black Friday.

FSREVP Toad:  "Our new program is based on a story from the Bible, one Kindred at Home executives and our investor dominated board discussed in a retreat.  As a group they asked 'How can we be more like that guy?'"

Employee #1: "Jesus?"

Toad: "Nope.  Think Old Testament.  Any guesses?

Employee #2:  "Moses?"

Toad:  "No."

Employee #2:  "David?"

Toad:  "Guys, it's the Pharaoh!  I'll read the verses that moved senior executives and our board of directors:"

Pharaoh gave this order to the slave drivers and overseers in charge of the people: ⁷ “You are no longer to supply the people with straw for making bricks; let them go and gather their own straw. ⁸ But require them to make the same number of bricks as before; don’t reduce the quota. They are lazy; that is why they are crying out, ‘Let us go and sacrifice to our God.’ ⁹ Make the work harder for the people so that they keep working and pay no attention to lies.”¹⁰ Then the slave drivers and the overseers went out and said to the people, “This is what Pharaoh says: ‘I will not give you any more straw. ¹¹ Go and get your own straw wherever you can find it, but your work will not be reduced at all.’” ¹² So the people scattered all over Egypt to gather stubble to use for straw. ¹³ The slave drivers kept pressing them, saying, “Complete the work required of you for each day, just as when you had straw.” ¹⁴ And Pharaoh’s slave drivers beat the Israelite overseers they had appointed, demanding, “Why haven’t you met your quota of bricks yesterday or today, as before?”

Employee #1:  "Since we don't use straw in caring for hospice patients what is it executives want from us?"

Toad:  "We want you to complete the work required of you each day.  We demand you meet productivity quotas established by top leadership.  Straw is symbolic of whatever barrier you face in getting your daily work completed."

Employee #2:  "How can you hold us to higher productivity standards after management eliminated key positions and gave us systems that hurt productivity?"

Toad:  "Straw!  You have to find your own.  It's your responsibility to figure it out.  The plan is to build institutional resilience from the ground up.  Employees are the bricks."

Employee #2:  "That makes no sense given the extra work management added.  We spend more time scheduling.  I have to wait for my work to be scheduled so I can actually do it.  I spend hours now entering my time and mileage in order to be paid correctly.  That usually doesn't happen so I spend hours figuring out how the company shorted me and how to resubmit time and mileage."

Toad:  "What you described is the work required of you every day.  Get 'er done."

Employee #3:  "There aren't enough hours in a day to do what the company expects."

Toad:  "Time is straw.  Straw is time.  Make your own."

Employee #4:  "Under Kindredlink it took me two hours to prepare for IDG.  Homecare Homebase increased that to a full eight hour day.  That's time eating, not time saving."

Toad:  "Homecare Homebase was a strategic decision made by our board of directors, the same people who admire and emulate Pharaoh.  Your personal inefficiency is very concerning.  I will make a note of it and ask your direct overseer (DO) to beat, (clears throat) verbally berate you."

Employee #4:  "Why did I open my mouth?"

Toad:  "Any more questions on this new exciting executive initiative?  Seeing none, I'd like to turn it over to the people in charge of ensuring this program is a success.  The Bible calls them slave drivers but executives call them Area VP's and DCO's."

Employee #1 (under their breath):  "We call them Mean Girls."

Mean Girl #1 (looking at Employee #1):  "Speak up if you have something to say..."

Employee #1 slinks down in their chair.

Mean Girl #1 (pause):  "Nothing?  Didn't think so.  (shifts gaze to whole group)  You guys must be so proud.  Your hospice is the first to pilot the "Gather Your Straw" program.  I am so honored FSREVP Toad selected one of my hospices to start this exciting effort.  Our fantastic Director of Clinical Operations is here to help you, so I will turn it over to her." 

Mean Girl #2 DCO:  "It's all about the employee experience which you now get to live 24 hours a day, seven days a week, although we only pay you for 40.  As of today all nurses are salaried and hourly employees are prohibited from submitting overtime.  If a employee submits overtime they will be disciplined for not using your time, straw, effectively.  That discipline could result in termination.  (Staff groan)

Toad:: "Gather Your Straw" puts you in charge of solving your own problems, so solve away."

Employee #3:  "Can we have our time here not count against our productivity measures?"

Toad:  "I'm afraid that's not possible.  Any meeting with an executive like myself is considered optimal use of your time by the company.  Remember the whole company is looking at this hospice.  You'd better perform.  Executives are counting on you."

Employee # 2 (spoken under their breath):  "for their giant paydays while we break our backs."

Toad:   "I would like to close with a prayer asking God's blessings for abundant admissions, census and margin.  Is a chaplain willing to do that?"

None volunteered so we exited the meeting room deflated and diminished.  It was the Blackest of Fridays.  We'll see how many more leave the toxic wasteland fouled by Humana/Curo.  The Bible says they will reap what they've sown  Lord, deliver us from evil.

Anonymous

Toad Returns to Head Up New Executive Initiative

Strange Tony,

I learned that former Vice President Toad has rejoined Kindred at Home to head up a new program.  He and the Mean Girls will be at our hospice site soon to kick it off.  I understand we are the pilot for this new executive program.

Toad left shortly after the buyout by Humana and two financial rapscallions.  At Mednax he helped trash a vibrant culture.  That makes him a perfect fit as Humana/Curo decimated our hospice over the last year.

I am curious what mendacity Toad and his Mean Girls will foist on our already stressed to the max site.  Lord, give us strength and peace in the coming maelstrom.

Anonymous

Humana CEO on Kindred at Home Q3 Earnings Call

Strange Tony,

Do you have any insights for me on what this guy is saying?  Humana CEO Bruce Broussard highlighted Kindred at Home in an Q3 earnings call on 11-17-19:

At the core of our strategy is interoperability, which facilitates our relationship with our provider partners, while simplifying the experience of our members. Recently Humana Pharmacy developed what we believe is the first clinical decision support fire integration in production between a payer and a provider via their clinical workflow. Our partner Signifyd Health is now using our OneMedList in connection with an in-home assessments, giving them the ability to confirm in real time member adherence to their medication and more proactively identify potential adverse drug interventions and drug disease conflicts.

During 2020 we will roll this same functionality to all Kindred at Home and other health care – health home health providers including integration with the new home care – home based system. The integration of technology like OneMedList with Kindred at Home is enabled by Humana's integration with the home care, home-based electronic medical record and practice management system. The integration allows the prescription drug information gathered by the Kindred at Home nurse to become part of the Humana record, ensuring a more comprehensive record and reducing the likelihood of medication errors.

This will accelerate our ability to proactively identify key clinical interventions while improving revenue capture and business and quality reporting.

The Kindred Hospice nurse has to re-enter the complete med list with every re-certification in Homecare Homebase.  As they are salaried and work 50-60 hour weeks the accuracy of the manually re-entered medlist may not be 100%.  That will be uploaded to Humana, who will begin to see the garbage in-garbage out nature of HCHB.  You can't have real time adherence to a medication the patient is no longer taking but remains in the system as a current medication.
 

...when we went into the Kindred investment, we went into it with the view that there would be reimbursement changes in there and those reimbursement changes would not only be rate impacted, but also just the way the business was going to the drivers of the business. And we are very excited about the changes of the reimbursement model, moving to a model that is going to reward more for nursing and reward more for chronic conditions as opposed to just therapy and be more oriented to less chronic conditions. 

So first just the structural changes there we find are very helpful for our member base and then advancing the downstream costs, such as admissions and readmissions in addition complications of particular conditions in total. The second thing is when we constructed the deal and did our forecast, we constructed the deal with knowing that there would be a transition both – that would require operational transition, and in addition, require us from a financial point of view. And so, when we did the deal on it and based on our valuations, we also assumed this particular transition there.

That is one of the reasons why you saw the organization invest in technology in 2019 to be able to prepare for these changes. And I think, if you were sitting in the board room of Kindred, you would also see a number of other changes both from competencies, clinical programs and so on and preparing for it. So I think – the both Kindred and Humana are very active in that evolution.

The third thing is on the just the financial side and I would say that it is incorporated in our outlook for 2020 and the years beyond that. But I do also want to highlight that in, when we were to exercise the put or call it is on the operating performance post that reimbursement change. So it does reflect in the other 60% that we purchased on. So, in summary, we're very excited about the changes as it structurally changes the economics to take on the conditions that we feel are most important for our members.

Secondarily, we have incorporated that in the transaction, both in the operating results that we see over the coming years. But then most importantly, as our – as we move to exercise in the put or call is, it will be reflected in the purchase price accordingly.

Humana will enrich Kindred at Home executives and two financial rapscallions when it buys the 60% of the company it does not own for a 10.5 to 11.5 multiple of EBITDA.  Kindred shareholders got a mere 8x multiple from Humana.

Broussard did not mention how Humana and the Kindred board keep ruining our once nationally recognized hospice.  Curo technology is a Trojan Horse.  Employees are under constant surveillance.  That's devolving.

Anonymous