Humana Inc. (NYSE: HUM) has cemented its position as a home-based care powerhouse.

The company has largely accomplished this through buying and building Centerwell Home Health, along with a number of other efforts in the home, including strategic partnerships.

Now, Humana is focused on accelerating value-based care and integrating all of its services that fall under the larger CenterWell brand, which includes home-based care, Primary care and pharmacy services.

Enter Dr. Andrew Agwunobi, the president of Humana’s home solutions business. He first joined the company last year, and he’s a top executive who believes that the home is a key site for integrating the care delivery experience for patients and members.

Home Health Care News caught up with Agwunobi for its latest episode of Disrupt. During the conversation, he talked about Humana’s plans for home-based care, the advantages of being a payer and a provider – and more.

The conversation is below, edited for length and clarity. Subscribe to Disrupt to be notified when new episodes are released. Listen today on Apple Podcasts or SoundCloud.

HHCN: Humana’s at-home business obviously includes CenterWell Home Health, which has one of the largest home health footprints in the country. Outside of that business, what else is Humana focusing on in the home, and what else are you specifically focusing on in the home?

Agwunobi: We’re very proud of CenterWell Home Health, formerly Kindred at Home. As you said, it’s the nation’s largest home health provider. It has 352 locations, over 9,000 clinicians and more than 350,000 home health patients that we serve every year.

In addition to that organization, we have what we call our post-acute management services organization, or One Home. It’s an organization that helps us manage a network of providers, along the lines of utilization management, network management, coordinating durable medical equipment, like oxygen and wheelchairs, and things like that, as well as in-home infusions. That’s a big part of what we do as well.

We also focus on clinical innovation, and the idea is to reduce the total cost of care. So not just about going in and providing care in the home, but trying to reduce hospitalizations and emergency department visits that might occur either during or after a home visit.

We also have partnerships with organizations like DispatchHealth, which is an organization that sends in EMTs and other providers into the home, including physicians, to be able to provide urgent care, emergency department care and even hospital-at-home services. We have partnered with organizations like Heal, which provides primary care at home. We also own 40% of Gentiva, which is a hospice company.

The idea here is we’re really about making home the center of care. And to do that, you have to have all of the different services along the continuum of care, to be able to serve those patients.

CenterWell is the centerpiece of a strategy to embrace the full potential of care in the home.

What have been some of the high points of what Humana has been able to accomplish in the home?

We talked about the size and scale of CenterWell Home Health, and that’s important because we want to be able to serve a lot of people. But what’s most important to us is the quality and the satisfaction, and the seamlessness of the care that we provide to our members and patients.

We maintain a patient satisfaction survey star rating of 4, and we have provider partnerships with 21,000 hospitals and 43,000 physicians. That’s an important piece for us. It’s really about just the delivery of care in the home, serving the providers, meeting the needs of the hospitals – all just really important.

The expansion of our post-acute MSO model is also important. I talked about utilization management, network management, DME, etc., expanding that to as many of the Humana members as possible. That is really important to us as well.

You made the point that the medical community is re-discovering the fact that providing care in the home is often the best way to ensure high-quality outcomes. Are there any metrics around outcomes related to home-based care at Humana that you can share?

Our statistics, for example, show that 40% to 60% of emergency room visits are treatable in the home. If we could find alternatives to that, we can treat other clinical capabilities that can be treated in the home.

We also know that Medicare Advantage members who are affiliated with value-based physicians, who are also receiving home health services, had a 60% lower risk of readmission to a hospital within 30 days of discharge. They had a 45% lower readmission risk within 60 days, compared to those members who have fee-for-service based physicians. In addition, care of those members resulted in an 11% lower total 90-day health care costs.

Being in the home allows you to see what we call social determinants of health. Clinical care accounts for only 20% of health outcomes, with 80% of outcomes attributable to social determinants of health. When you’re in the home, you see what’s going on – and you’re able to intervene.

As listeners know, CenterWell isn’t just home health. It also includes primary care, among other things. One of the things we’ve written about at HHCN is the ways home-based care and primary care can be allies. With having both under CenterWell, has there been some cross-over in an effort to serve seniors?

CenterWell Senior Primary Care, along with Conviva Care Center, is the largest senior focused value-based primary care platform in the U.S.

It’s really nice to have the largest home health provider and also have the largest senior focused value-based primary care platform. We now operate about 249 primary care centers serving 266,000 patients, which is pretty impressive.

What’s most important is that those are patients who are getting value-based care.

Our vision is to integrate across primary care, pharmacy and home. Home is a wonderful site of care for integrating the care delivery experience for patients. For example, if the member lacks a primary care provider, CenterWell Home Health can connect the member with value-based local primary care options, including CenterWell Senior Primary Care, but also others.

CenterWell Home Health can also act as an extension of primary care. If someone goes to the primary care office and needs care in the home, then we can serve as an extension. If a member would benefit from home delivery of medications, then CenterWell Home Health can help the member set up a mail order delivery to our CenterWell Pharmacy. All of these services build on each other, to be able to provide the full visibility to a patient’s care.

It’s not just when you come into the clinic; it’s what’s happening to you at home.

How do you continue to operate a successful fee-for-service home health business while also keeping an eye on the future, which will include alternate payment forms, such as MA, of course, but also more value-based care?

It’s not an easy thing to do. What we believe is you focus on both. You focus on creating a strong core business, a home health business, while at the same time creating a transition to clinical innovation.

Part of doing this is not losing sight of the big picture. The big picture for home health is that original Medicare episodes overall are declining, whereas Medicare Advantage is increasing penetration. Over time, more people are choosing Medicare Advantage.

We have to always step back and say, “Yes, it’s hard, but that’s where the future is.” We have to figure out the solutions there.

There’s a lot of statistics that have shown that value-based care, from an outcomes perspective, drives better results than fee-for-service. We also also have to keep that in mind. I think it’s important to just always work from the customer-back. What are the needs of the customer? How do we create those clinical capabilities that will fill those needs?

What advantages does Humana have, being both payer and provider?

Because we’re both on the payer side and the provider side, you can start to think together about how to not have a zero sum game, where one part of the organization’s gain is another part of the organization’s loss.

The other thing I’ll say is, it helps with having a large organization that has a lot of data, to be able to innovate to find ways to deliver clinical capabilities that again, drive value-based care.

In your position, what are some goals you have in place for the organization for the next few years?

Growth – mergers and acquisition growth, organic growth. Plus innovation to serve value-based care.

Integration across our different organizations. Additionally, just essentially meeting the customers needs. Anything that falls under that umbrella is a goal of mine, and a goal for the team that works with us here.

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