Healthcare Insider Podcast: How Humana is optimizing home care delivery

As medicine continues advancing and patient expectations evolve, the home is increasingly viewed as an optimal care setting. The many benefits of care in the home include that it increases convenience, minimizes access barriers, strengthens patient relationships, enables greater visibility into social determinants of health, and reduces the cost of care.

In this episode, Dr. Andrew Agwunobi, President of Humana’s Home Solutions Business, discusses strategies for integrating home care into more seamless care delivery for patients. Dr. Agwunobi covers how the nursing shortage has impacted staffing for these services as well as what he envisions for the future of home health.

Listen to the full episode below.

Camille Baxter: Hello, and welcome to Healthcare Insider, a sponsored content podcast series from Modern Healthcare Custom Media. I'm your host, Camille Baxter, and today I'm excited to be joined by Dr. Andrew Agwunobi, president of Humana's Home Solutions business. In this role, he is responsible for leading Humana's Home Health in home nursing and assessment operations. Dr. Agwunobi is also a member of the management team, which sets Humana's strategic direction.

In this conversation with Dr. Agwunobi, we will be discussing how home care can be integrated into a more seamless care delivery for patients, as well as how the nursing shortage has impacted staffing for these solutions. Before we dive in, I'd like to thank Humana for their sponsorship of this podcast. Humana's Home Solution segment provides patients with a variety of home-based care services to choose from, depending on needs and eligibility, ranging from in-home primary care to advanced in-home care and acute care at home. Dr. Agwunobi, Andy, thank you so much for being here today.

Dr. Andrew Agwunobi: Thank you, Camille. It's great to have this opportunity to talk about a subject that's very close to our hearts here at Humana.

Camille Baxter: Well, great. I'm delighted that we're able to have this important and timely conversation. But before we jump into that, can you share with us a little about what you've learned along the path of your career journey?

Dr. Andrew Agwunobi: Yes. Well, one thing I've learned is that none of us have as much access to healthcare as we think we have. And so it's a wonderful thing to be in home solutions at Humana where we can begin to make a difference in that.

Camille Baxter: Wow, that's really amazing work that you're doing. I'm excited to learn more about it. So can you talk about how Humana's Home Solutions business has grown and the type of care that it offers?

Dr. Andrew Agwunobi: Well, thanks for that question, Camille. I would say it started with our two main convictions, and one of them you just mentioned, and that is that many conditions currently treated in facilities like emergency departments, hospitals, skilled nursing facilities, there are many conditions that can actually be treated in the home safely and with great quality for our members and our patients. And this spans the continuum of care. I'm not just talking about hospital type care, but primary care, emergency department type care, and as I mentioned, skilled nursing facility care across the whole continuum, acute, post-acute primary care, et cetera. The second conviction that we have is that value-based care is the way of the future. And people have asked me, well, what do you mean by value-based care? And I really just mean care that takes the whole person into account, and that happens at the right time in the right place with the right providers at the right affordability. It's more holistic and is better for patients than fee for service care.

In short, to get to your question about how we've grown, the types of care that we offer, the two convictions I mentioned drove us to assemble a number of assets and partnerships that span that continuum of care that I mentioned. For example, a big one is CenterWell Home Health, formerly known as Kindred at Home. CenterWell Home Health, we've acquired that company. It's the nation's largest home health provider. It has 352 locations, 9,000 clinicians, it does more than 350,000 home health visits or patients should I say, that it serves per year and great satisfaction ratings, et cetera. And we also partner with physicians, other facilities to deliver this care. So I would say that's maybe the centerpiece of the provider part of what we do.

We also, however, own a company called One Home, which does things that we call, for example, we call it post-acute MSO or Management Services Organization. But basically, in simple terms, what it does is it does utilization management, make sure that all of the care we provide is clinically appropriate, does network management, make sure that all of the providers we use, because we use other home health providers as well for our members, and making sure that those providers are the highest quality and very efficient. But it also does durable medical equipment. Think of things like oxygen canisters, as well as wheelchairs, infusion services, medications that can be given at the home.

So you begin to see that we've pulled together a group of capabilities that can serve patients. And then we have partnerships with a company called Heal, which does primary care in the home. Imagine not having to go to your doctor's office, actually getting your doctor to come to you. And we have a partnership with Dispatch, a company that provides urgent care and even emergency care level care in the home. And we plan to do a lot more. And the last thing I'll mention here is that we own 40% of a company called Gentiva, which is a hospice company for end of life care. And so if you take all of these capabilities and integrate them together, you begin to see how we are positioning the home as the center of care and building it around the patients.

Camille Baxter: And because most people are more comfortable in their own home than they are in a healthcare environment or institution, I'm sure that's got to contribute to just the healing and even the comfort at end of life care.

Dr. Andrew Agwunobi: No, absolutely. I mean, statistics have shown that most seniors really want to age in place. They'd rather be in their home, and even non seniors. If you think about it, being able to stay in your home, be with your loved ones, be with your pets, eat your own food, walk around, there's something about that. Putting the control in the hands of people themselves is something very, very powerful.

Camille Baxter: Yeah, absolutely. Can you talk a little bit more about home care and how you integrate that into a more seamless care delivery experience for the patient?

Dr. Andrew Agwunobi: Integration is a key word here. That's a great question. First, I would say that fortunately at Humana, we don't just have the largest home health provider, which is important because having the ability to touch as many of our members and as many of the patients out there as possible is important. But we also have the nation's largest senior based primary care organization. So that is clinics with doctors that do primary care for seniors, but they do it in a value based care model, as I discussed before. And in addition to having the largest home health provider and the largest senior based primary care organization, we also have a very large pharmacy organization. So these three organizations together are what we call CenterWell. They're call branded, they have the same brand, and they're well positioned to provide an integrated experience.

And the only other point I'll make is that in general, when we talk about integration, home is a wonderful site of care for integrating the care delivery experience for patients. For example, if a member lacks a primary care provider and the home health organization is in the home, the nurse, we can connect that member or that patient with a local primary care option, a value-based care primary care option, including our own primary care organizations, but not necessarily, we can also use others. CenterWell Home Health can also act as an extension of a primary care doctor's office into the home. So you go into a doctor's office, the doctor needs something done in the home, then we are there to do that in the home so it works both ways. If a member would benefit from, say, home delivery of medications, then CenterWell Home Health can help that member to set up a mail order delivery. So that comes by mail through our CenterWell pharmacy. So you start to see all of the ways that these different capabilities can work together to improve a member experience, improve the health outcomes, and I think it can be very powerful for our members.

Camille Baxter: Yeah, I can really see that growing, like you said, as more of the population is aging and more people want to receive their care from home. Now, there's been a lot of talk about the nursing shortage and difficulty that organizations have had with having enough nurses. Has the nursing shortage affected you, affected Humana in how you hire and retain talent? And what's been your approach to recruiting?

Dr. Andrew Agwunobi: The nursing shortage is affecting pretty much all healthcare providers. But at Humana, we feel good about the value proposition that we offer nurses and about the efforts we are making to recruit and retain them. The first thing I would say is that we're ensuring that we are the best place for nurses to work. Now, that goes beyond the usual steps of making sure we're competitive in compensation and benefits. It means ensuring that the work environment is also everything it should be for nurses who are just amazing, they do amazing work every day. So for example, we want to make sure that nurses have a voice in decision making, and Humana has what we call our nurse advisory council under our chief nursing officer that enables that. It sort of takes those opinions from all of our nurses and makes sure that we're listening to them as we make decisions.

We also are offering flexible schedules. We're investing in nurse education and orientation. And actually one of the interesting things is I talked about value-based care, and I believe that as we move more into value-based care, that will also help with recruitment and retention because it will enable nurses to more holistically address patients' needs, which is why a lot of nurses got into the profession in the first place.

Secondly, we're leveraging technology. This is a great time to be in healthcare, so much technology out there. And so we're leveraging that to improve the clinician experience, enhance efficiency, and part of that is decreasing the amount of documentation. I'm sure you've heard that one of the burdens on nurses is the amount of documentation they have to do in electronic medical records. So being able to help to have less clicks, should I say, but also optimizing scheduling, routing so there's less windscreen time for nurses as they're going out to homes, et cetera.

And then lastly, we're focusing on training programs and developing career pathways. So an example, one of these we've spoken about is that in June CenterWell Home Health and our chief nursing officer announced a collaboration with Emory University's Nursing School, the Nell Hodgson Woodruff School of Nursing, to create a lab that will simulate care in the home so that when nurses go into nursing school, they can go into this lab and see what it's like not just to treat patients in hospitals, but to take care of patients in the home. And we think that's important.

Camille Baxter: Yeah, it's really evolving not only from when they get into the role, but as they're learning and being educated in getting a broad range of experience. With the challenges that healthcare providers are facing today, what are the biggest issues Humana's home business is facing?

Dr. Andrew Agwunobi: Well, I think the nursing shortage in my mind is a temporary headwind. I actually believe that the opportunities outnumber the challenges. This is a time of great change in healthcare, and the home is on the frontier of that. I think it's all about growing the existing home health organization while sort of introducing, as I said, a new value-based model. And we're excited about the journey. Camille Baxter: I'd like you to put your physician hat on for a moment. So you're a physician. What do you see as the future of home health? You've talked a little bit about that, but can you expand on that?

Dr. Andrew Agwunobi: I see a future, and I've always believed this, where the home is the center point of care and that everyone has access to high quality, affordable care on the patient's terms. And I think this will come from a combination of holistic care, so including the social determinants of health. When you're in the home, you can see whether a patient has electricity. You can see whether or not they have transport. You can see whether they're eating well. These things are so important, but along with sort of timely access to care and availability of the necessary information so that people don't view emergency departments as their only avenue to receive care, particularly in off hours periods.

Camille Baxter: Yeah, the healthcare landscape is changing so much, and it's been so helpful to learn more about home healthcare and not only what's going on now, but the direction that it's headed. Dr. Agwunobi, Andy, thank you so much for this conversation and for taking the time to discuss strategies for success in home care Delivery.

Dr. Andrew Agwunobi: Camille, thank you so much. And thank you for showcasing some of the important topics in healthcare today.

Camille Baxter: This has been a sponsored episode of Healthcare Insider, created in collaboration with Humana. To our audience, thank you for tuning in today. To listen to more episodes of Healthcare Insider, go to the multimedia section on modernhealthcare.com or subscribe at your preferred pod catcher. I'm your host, Camille Baxter. Thanks for listening.