Health insurer Humana has acquired Your Home Advantage, a Deerfield Beach, Fla.-based company that sends nurse practitioners and other providers to assess and care for patients in their homes.
The company will become part of Humana At Home, Humana's home-based services division that was previously known as SeniorBridge Family Cos. Humana bought SeniorBridge in 2012.
Humana is one of the largest Medicare Advantage insurers in the country, covering more than 3 million people. In-home care has become a rising business priority for Humana and other insurers that treat large numbers of seniors because managing chronic conditions and coordinating care at home is cheaper and potentially safer than having patients stay in acute-care hospitals.
Humana employs about 10,000 nurses and actively helps people transition out of the hospital to their homes, CEO Bruce Broussard recently told Modern Healthcare.
“We actually spend a lot of time helping them coordinate care,” Broussard said. “And what we see is that we've been able to connect between the provider and what's happening at home through systems, through services and through individuals like nurses and social workers.”
Insurers are also using in-home visits to diagnose the health risks of their Medicare Advantage members. But that has drawn scrutiny from the CMS because those assessments have been seen as a way for insurers to fraudulently boost patient risk scores, which leads to higher Medicare payments.
The CMS was “concerned that in-home assessments were merely a strategy by MA plans to find and report more diagnosis codes to CMS, generating higher levels of coding and, therefore, payment than assumed under our risk-adjustment methodologies,” according to the 2016 Medicare Advantage rate notice released earlier this month. Humana has disclosed a a U.S. Justice Department probe related to its risk-adjustment practices.
The CMS also said there is little evidence that primary-care providers actually use the information gathered from home visits to improve members' care.
For 2014 and 2015, the CMS had proposed that risk assessments and home visits had to be confirmed by a visit to a physician's office, but those proposals eventually fell by the wayside. In-home assessments remain the same for 2016 health plans as well. Instead, the CMS encouraged health plans to adopt best practices for the in-home assessments they perform, such as reviewing a person's home for safety risks and creating a process to verify follow-up is provided. The CMS will also track care that is provided after in-home visits.
The CMS is likely to revisit the issue, saying earlier this month: “We remain concerned that in-home risk assessments may continue to be used as a tool to identify diagnoses primarily for reimbursement purposes.”
Terms of Humana's deal were not disclosed. Humana already was a major part of Your Home Advantage's business. Humana subsidiaries and joint ventures contributed 70% of the company's revenue.
