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Humana Steps Back To Seize the Future

MANAGED CARE July 2011. © MediMedia USA
Plan Watch

Humana Steps Back To Seize the Future

With the purchase of Concentra, a company that operates 300 clinics, the health insurer once again provides care
Frank Diamond
MANAGED CARE July 2011. ©MediMedia USA

With the purchase of Concentra, a company that operates 300 clinics, the health insurer once again provides care

Frank Diamond

When Humana recently purchased Concentra, a company that, among other things, operates 300 stand-alone clinics, the plan entered familiar terrain. Before becoming primarily a health insurance company in 1993, Humana was the nation’s largest for-profit hospital company.

Paul Kusserow, Humana’s chief strategy and corporate development officer, is responsible for the $790 million purchase of Concentra, finalized in March. “Strategically, the reason we did this is that we’re very comfortable in the provider space.”

Provider roots

“We were in the hospital business, obviously exited, and are now a health insurance plan, but we still have a lot of people with provider roots.” (Other large health insurance companies are also buying providers. See “What Can Be Done to Counteract Growing Power of Providers?”)

Kusserow predicts that medical directors at other health plans will take notice. “We are integrating our own providers and caregivers in our plans to provide access and high standards,” says Kusserow. “If I were a medical director at another plan, I would think, Wow! Humana really went all-in on this one. They actually have physicians, they understand the physician business, they’re setting up clinics for their members, they’re starting to engage in population health management.”

He doesn’t feel that he’s giving away trade secrets to the competition, either. “It would be difficult for competitors to follow this model because they originated as insurers, whereas our roots are in the health care provider space,” says Kusserow.

Humana’s medical directors, in the meantime, have been trying to gain a firm understanding of the capabilities of the new Concentra physicians. Something those medical directors must take into account: Concentra is considered a leader in workers compensation and occupational health benefits. “They are 14 percent of the market,” says Kusserow. “They do very well.”

Concentra employs about 1,100 providers, including 650 physicians. “They know how to recruit docs,” says Kusserow.

“They know how to manage and motivate doctors. They know how to manage caregivers as well. They know how to run the specific practices. They know how to drive standards of care that get people back to work.”

The clinics will help Humana, which has 10.9 million medical members and 7.2 million specialty members (dental, life, disability, critical illness) to expand and even to add diversity. Kusserow wants to see moms and children walk through those clinic doors, not just workers.

Since Humana is the second biggest supplier of Medicare plans after UnitedHealth Group, Kusserow sees the Concentra clinics catering more and more to that population. “That’s where we ultimately see this going,” says Kusserow. Humana has about 1.8 million Medicare beneficiaries in its Medicare Advantage plans.

Very applicable

The Affordable Care Act makes the purchase particularly timely, though Humana still would have made the move even without the current push for accountable care organizations. “At this point, ACOs are still nascent, from our perspective,” says Kusserow. “I still think there are some miles to go in terms of really assembling it and what it actually means. But in terms of the concept of what we’re looking to do and what ACOs are looking to do, we believe this business would be very applicable.”

“About 23 percent of Humana medical members live within seven miles of a Concentra Center,” says Paul Kusserow, the plan’s chief strategy and corporate development officer.

Meetings

HealthIMPACT Southeast Tampa, FL January 23, 2015