National health insurer Humana said Thursday that it will mail more than 1 million in-home colon cancer and diabetic management screening kits to Medicare Advantage and Medicaid members.
Humana said the screening kits will help expand access to preventative care that members may have put off during the COVID-19 pandemic. Providing in-home preventative care could also help Humana maintain its scores on certain quality and performance measures that are important to its bottom line and ability to attract seniors to its health plans. Colorectal cancer screening and diabetes care are two of those measures.
Following CMS guidelines and state orders, health systems, physician offices and other providers postponed non-urgent procedures and appointments over the past several months, though patient visits are beginning to rebound. Patients also canceled routine care for fear of contracting the novel coronavirus.
Health insurers and providers have voiced concerns that the postponed care could exacerbate patients' medical conditions.
"Because of the pandemic, many of our members—who are primarily seniors—have not been comfortable leaving their homes for routine healthcare," Humana Chief Medical Officer Dr. William Shrank said in a statement. "Now more than ever, proactive, preventive care can be lifesaving and life-changing for our members."
Humana said the in-home screenings can help members identify early any complications related to diabetes and colon cancer, which could help reduce costs and improve health outcomes. Between June and September, the kits are being provided to eligible Medicare Advantage members at no additional cost. Some Medicaid members will also receive kits to assess how they manage their diabetes.
The screening kits that Humana supplies include a stool sample test for colon cancer screening, a blood test to check diabetics' average blood glucose levels, and a urine test for diabetic kidney function, according to a spokesman. He said that Humana sent out about 364,000 of these screening kits to members in 2019.
Humana will follow up with members who receive unfavorable test kit results to encourage them to see a physician. Humana also communicates the test results to the member's doctor, he said. The insurer will also monitor claims data to determine if the member received follow up care and deploy nurses to reach out to those who don't.
Analysts at Evercore ISI said in a research note on Thursday that Humana is offering the in-home tests to maintain or improve its Medicare Advantage star ratings scores. Star ratings measure the quality of care and customer experience that enrollees in an Advantage plan receive. Humana said 92% of its Medicare Advantage members are in plans with a four-star or higher rating for 2020.
Richard Lieberman, chief data scientist at Mile High Healthcare Analytics, also said the star ratings program may be motivating Humana to supply the at-home tests. Star ratings are important to insurers because high scores drive higher enrollment in a health plan and come with a financial bonus. Insurers rated four stars or higher receive a 5% boost to monthly per-member payments from Medicare, while those with lower scores receive nothing extra.
Losing that 5% bonus is devastating, Lieberman said. He noted that insurers are likely panicking about keeping those star ratings. "All the places where seniors are concentrated are getting clobbered (by COVID-19) and there's no end in sight. So if I'm a health plan … you're just grappling looking for strategies because people aren't going to the doctor."
But Lieberman questioned whether Humana would be able to get members to actually take the colon screening and diabetes tests and then go to the doctor if needed. He also noted that some colon cancer screening tests aren't very accurate.
The COVID-19 crisis has thrown a wrench into health insurers' ability to collect data and meet reporting requirements for Medicare Advantage star ratings. Insurers must collect data by reviewing medical records or obtaining information from doctor's offices, and some data collection activities are done in person.
Noting that collecting the data could pose safety concerns and burden insurers and physician practices at a time when resources are strained, the CMS in March issued an interim final rule relaxing some star ratings reporting requirements for 2021 and 2022.
Humana CEO Bruce Broussard has acknowledged that the COVID-19 pandemic could cause problems for star ratings, particularly in 2023, which he said is based on service periods for 2020. During Humana's first quarter earnings call in late April, he said the company was devising plans to ensure that Humana would "close those gaps in care that drive stars results."