Specialist background
- Experienced Managed Care Expert responsible for business development with an overview of total account management function with regional and national health plans, while serving as the central point of contact for internal and external operations
- Implemented ongoing management of health plan contracts and monitoring financial and quality performance, including lead payer contract negotiations, FFS and full-risk partnership agreements, expansion of services and delegation of additional responsibilities
- Assisted in payer strategy development, including growth and financial planning, regional and national expansion, data negotiations and operational improvement initiatives
Questions
1.
How broadly would you characterise Humana, the relationships with someone like an Oak Street, and how would you describe Humana to others, in terms of whether or not they were… actually, I'll (inaudible) very open-ended. How would you characterise Humana?
2.
How about just general Oak Street-Humana relationship? How did that look, relative to other payers, level of engagement, level of clinical engagement, level of personnel engagement, successfulness of the relationship, metric-wise, quantitative analysis, did they think more about that? All that kind of stuff, be curious to see how it compares.
3.
In terms of technical integration, like sharing records, sharing data, making sure that the care delivery is coordinated through data analysis, records and a really close integration, how did they compare against other payers?
4.
Can you give me some examples of that? Like, I don't know, the physician had a Humana app and was able to pull up the record on their phone or iPad in the room with the patient, or other payers didn't do that. Some examples of the data and integration, and then we'll move from there.
5.
How closely did a Humana work with you guys on customising that, or if something wasn't working as well as you guys thought and had a suggestion, how responsive were they to that vs some of their peers?
6.
A data feed is great but having the personal touch of the coordination of care, I think, is also quite important. How do you think about Humana working with an Oak Street there, to help manage that population or manage those lives better, from a personal perspective? Did they have folks who were on the ground, working with you guys all the time, and working with the care providers all the time, to make sure they were optimising things, or were they under-staffed on that? How do they compare to their peers there?
7.
How did Humana look on that? How was their approach on that vs others?
8.
Ultimately, what you'd like to see is, is Humana any better-positioned than anyone else to manage cost of care through an Oak Street relationship than others? We talked a little about the data, we talked a little about the people. Is there any other reason why Humana should be able to manage the relationship better or have a lower cost of overall care, just because of the way they interact with an Oak Street, if you will?
9.
In terms of capitating their MA lives (ph) within the primary care field, is Humana further ahead of anybody else, or not?
10.
Putting numbers into value-based arrangements, where they're getting better outcomes than others. For instance, if Humana had started partnering with payers five years ahead of everybody else, and started that integration ahead of everybody else, and has more capitated arrangements, and they actually are looking to be able to reduce costs and lower risk, you would think that Humana is in a better position to offer better benefits and offer a better package for their members, just because they've got a better downstream organisation.
11.
Does Humana have any better negotiating power with providers than anybody else?
12.
Can they get lower costs than anybody else, just because of scale or whatnot?
13.
Why is that a good thing? Does the provider make more money, or that's a good thing because it means there's better coordination of care or there's better willingness to transact? Is it a good thing from Humana's perspective?
14.
All else equal, it leads to a better patient experience, a better provider experience, which ultimately leads to better outcomes for Humana, is your point?
15.
What do you think the financial benefit to Humana from that is? I can think of some off the top of my head, I'm just curious what you would think.
16.
Basically, if you have a two-way partnership with someone like Oak Street, they're going to act as a bit of a channel to drive MA conversions to Humana first, over potentially some others, is your point?
17.
Is it correct that you think Humana is better-positioned to win that MA life, that MA conversion life, if they have a good relationship with Oak Street, rather than one that's a little bit more aggressive?
18.
How about Humana's CenterWell business, which is in particular to start their own primary care, their own PSPCO (ph)? Do you have any point of view on the success of that business, or how well it's integrated or how that's going for Humana, or whether they do a good job of managing those lives and they own the provider, or not?
19.
Why is it that you can do a better job when you own the provider than when you're partnered with the provider? I can theoretically understand that. I'm trying to ask what are the tangible reasons, the pay plans, the incentives, the communication? What are the specific reasons why, when you own the provider, it's a better-integrated process than when you partner, even if you partner as closely as Humana?
20.
How important is the ability to control coding, in terms of owning the provider, integrating with a partner like Oak Street, etc, or is that pretty standardised across the board?
21.
Is that as simple as moving the higher-profitability procedures and higher-profitability care provider services into your own vertically-integrated side, and moving everything else elsewhere? Is that what that means? It's not anything wrong with that, trying to manage that better on your own, but is that what you mean there?
22.
Just broadly, how strategic or how positive of a transaction or a vertical integration do you think that is for Humana? Is that something that you think was a smart move, a bad move, a great idea? How do you think about that?
23.
What about just broadly, talking about payers and home health as a part of value-based care, steering (ph), managing, coordinating care, managing patients, etc? Not Humana-specific, not Kindred, just broadly, does it even make sense for payers to be focused on home health? Is that an area you can…
24.
Does it make sense, from your perspective, for a payer to own home health providers?
25.
When Humana talks about their patient population, they talk about a percent that are in value-based care arrangements and a percent that are on their path to risk. If this is something you know about, happy if you can answer, if not, we can pass, but when they say path to risk, what does that mean, and how likely are they to get that person into a value-based care arrangement at some point?
26.
Is it working? As you move along that spectrum, do you really reduce total risk of care effectively?
27.
Of all the payers out there, just a broad question, what are your views on Humana, whether or not it will be successful in accomplishing its goals and be financially successful? How do you think Humana stacks up against the other guys, against United, against CVS Aetna, against Elavon, everybody else? I know it's not really your purview, but just if you have any thoughts.
28.
What do you think specifically is the benefit of dropping commercial? Maybe an example is you had 100 people selling commercial, that was just in your G&A or your overhead expenses, and now you can take that and put that into better marketing materials, make your own internal brokers, that kind of stuff. What are the specific benefits of exiting commercial, in your mind?
29.
How do you think of Humana's position in MA? What are their competitive advantages within MA vs other providers?
30.
How do you think, just broadly, Humana compares to its peers along some of these lines, like their ability to accomplish their financial goals and be successful? I know that's a very broad, open-ended question, but how do you think they rank?
