Specialist background
- Experienced corporate strategy and risk management expert with over 20 years’ experience in the healthcare space
- Well-placed to discuss industry trends and competitive landscape, including compliance, risk management and quality assessment
- Well-versed with running a programme to ensure value-based providers were maximising reimbursements and bonus monies
Questions
1.
We'd love to get your thoughts just generically on the leadership team at Humana and thinking particularly whether or not this is a team you would want to put your money and invest your money behind as well. Just thoughts there, and I'll leave it to you to say how deep you want to go on that. We'd love to go deep because it really helps inform our decision-making, one way or the other.
2.
Do you think about these things, these moves as negative overall, or positive? How do you think about this? Sometimes people moving in and out can be negative, sometimes it can be positive, I'm just curious what your thoughts are there.
3.
How about culture? How would you describe the culture at Humana?
4.
Let's talk about, generically, Humana's business in MA. What do you think are Humana's advantages or their competitive advantages vs any of their large peers?
5.
How much better at doing this is Humana than any of their large peers, or are they on par?
6.
Can you give me some examples of whether or not, if you were a Humana patient in MA, or if you were a Centene or a United Health or one of the blues within MA, what were some examples of where Humana managed the life better, or more touchpoints, or did better to lower long-term costs?
7.
Do you think that they were doing more outreach or had more value-based relationships than any of their peers? Is there a way you can quantify that for me?
8.
Other MA payers weren't doing that to the extent Humana was?
9.
Why do you think Humana can do a better job of this than others? It is quite expensive, I'd imagine, to have folk visiting all the high-acuity members, so why can Humana do this any better than anyone else?
10.
Is there a way to quantify how far ahead of any of their peers they are in doing this?
11.
You mentioned a little bit of the economies of scale in MA, so they are one of the largest providers in MA, number two behind United. What are the benefits of scale in MA? How does it help you to have more lives within MA vs (talking over each other)?
12.
Who do they contract with that drives the majority of that benefit? Is it the DMEs? Is it hospitals? Is it value-based primary care? Where is the contracting secret sauce enacted?
13.
Because of some of these efforts, if Humana has, let's call it five million MA members today vs United a little bigger and most other guys smaller, does Humana have, like-for-like, meaning diabetic for diabetic, non-diabetic for non-diabetic, high acuity for high acuity, do they have a healthier population than others because of the cumulative impact of some of these efforts? If they have a member from six years ago when they were doing this, who's well-managed but yet has diabetes, is in one of these chronic condition management programmes, do they have a better-managed existing population than anyone else in MA?
14.
What is the churn rate? If I start a year for Humana with 100 members, the following year after we get through an enrolment period, of those existing 100, how many are still there and how many left to go to another population vs how many passed away, just voluntary, involuntary and whatnot?
15.
How many of them were voluntary exits of the 30? Is it 15 or is it 20 or five?
16.
Is there any reason why it would go up or down from here, in your mind?
17.
How would the benefits playing field look today vs five years ago? Is it more even today vs historically Humana had an advantage, or is it the same? How has that playing field from a benefits perspective changed?
18.
How do you think Humana's churn rate looks vs its peers?
19.
How do we quantify that? The stars help quantify, I can see CVS, I'll just make an example up, is, call it two-and-a-half stars here on average and Humana is four-and-a-half everywhere, I can see that, so I know the service. How do I think about the churn? If Humana is 30% churn, does that mean CVS is 35%, is CVS 50%, is CVS 31%? What do you think that means?
20.
The service people get, is it mostly the call centre, is it mostly somehow the relationship with the physician? How is that service delivered? Is it in the one-on-one relationship for some of the high-acuity folks? Is it all of the above? What's the touchpoint for that service?
21.
Explain this a little bit to me. What you're trying to say is Centene is not as close to understanding who their lives are and what the patient population is as Humana?
22.
I guess maybe they just don't have the systems or people or something like that? Is that what your point is, they're not as close to the population as a Humana (talking over each other)?
23.
I'm trying to understand the financial impact or maybe the degree of difference here between what you're saying that a Centene would have and what you're trying to, I guess, point out Humana has? Is it night and day, or is it, I don't know, most people don't understand their population and Humana is just a little better?
24.
Do you think other payers, other managed care organisations are similar to Centene in this closeness, or lack of closeness with their members, or do you think they're closer to Humana?
25.
If you had to quantify that, scale of 1-10, Humana is an eight out of 10 at just generally managing the life. United, you've seen, maybe you've talked to some folks there, they're a 10 out of 10. Centene, it sounds like is a zero out of 10. Is there a way to just generically quantify that in terms of, in particular, the financial outcome?
26.
We talked a little bit about the churn rate. If Humana is at 30%, where do you think United is and where do you think Centene is, and maybe a CVS also? If Centene is a 50%, I don't know, I'm just curious there on the churn rates.
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