Image source: Humana

The Rise of Humana and What to Expect from Its Tech Race?

Start out as a nursing home in the 1960s, Humana now is the nation’s largest healthcare company and as an oldie in the field, it never seems to lose pace with its rivals. What is the lesson to be learned?
By Ally Nguyen | 8 min read
on September 25, 2020
Image source: Humana

Humana started out in the 1960s as a nursing home company, and quickly grew to be the largest in the United States, letting go of its hospital division and start focusing entirely on its managed healthcare plans. As a health and well-being company, Humana’s segments include Retail, Group and Specialty, Healthcare Services and Individual Commercial.

The Retail segment consists of Medicare benefits, including dental, vision, and other supplemental health and financial protection products. The Healthcare Services segment includes services offered to its health plan members, as well as to third parties, including pharmacy solutions, provider services, home-based services and clinical programs, as well as services and capabilities to manage population health. The Individual Commercial segment includes Individual Commercial products marketed under the HumanaOne brand.

To this day, Humana is a Fortune 500 company based in Kentucky and one of the largest health insurance companies in the US nation. Let’s take an insight tour of this story!

Humana Story: Devil For-profit Healthcare or A Proud “Taxpaying Hospital”?

Founded by its ex CEO David A. Jones who borrowed $1,000 to found what became the nation’s largest nursing home chain, then transformed it into the world’s largest hospital company and finally a health insurance statue worth more than $37 billion.

At its peak, Humana owned more than 100 hospitals in the U.S., Canada, Mexico, Spain, and Switzerland, and employed more than 45,000 people. Unlike some competitors, it remained highly centralized, achieving huge efficiencies by operating all patient billing and data collection out of its home office in Louisville.

Scandalous view at Humana’s For-profit “Great Business”

To mention Insurance business, scandal is a must. Defended by its founder David Jones, Humana is a “taxpaying hospital” and “who is not paying taxes on profits has the moral issue, not those of us who are paying taxes” as he mocking nonprofit healthcare organizations as self-righteous snobs.

Once sued by a widow who claimed her husband had died because Humana delayed approval for coverage of a liver transplant. Being asked by her attorney whether there was a conflict between caring for the sick and stockholders who demand profits, the company’s spokeman replied “You don’t build great businesses by satisfying customers. You build great businesses by meeting their needs.” Now we know Humana’s secret on doing “great business”.

Proud “Taxpaying Hospital” And A Few Of Its Good Moves

#1: “Triage Nurses”

The year 1979 is the first time Humana topped $1 billion and broke into the ranks of the Fortune 500 as one America’s largest companies. Thanks to its market research which showed what people most wanted in a hospital was a dependable emergency room. Borrowing an idea from the military, the company decided to assign “triage nurses” to see patients within 60 seconds of when they walked in the door. “Our volume went up and others went down," said David Jones its Chairman.

 #2: Brilliant marketing move

Humana also decided to slap its name on the front of every one of its hospitals – Audubon Hospital became Humana Audubon Hospital, for example – something no other chain did.

Then, when Humana wrested control of the artificial heart experiment from the University of Utah – and implanted the world’s second Jarvik 7 into the chest of Bill Schroeder at Audubon – overnight the company's name spread around the world. Three hundred print journalists and 37 news trucks descended on Louisville

Humana and Cost-related Issues: How Do They Face Covid-19 As A Health House?

Does Humana benefit from the Covid-19 outbreak? Around April, reported a 17.6% rise in first-quarter revenue on 27th April as it benefited from strong demand for its government-backed Medicare plans. Total revenue rose to $18.94 billion from $16.11 billion and the company said the impact of the COVID-19 outbreak was not material during the quarter. As a giant in the business with millions of members. What tactics are Humana planning to face off this pandemic era?

The First One to Make Moves Toward This Health Crisis?

Staff at COVID site
Image source: Humana

Leading health and well-being company Humana announced a pilot home-testing program today that will enable at-home COVID-19 test collection for members, making Humana the first insurer to offer LabCorp’s at-home test-collection kits. Humana also announced an innovative new collaboration with Walmart and Quest Diagnostics to help members more easily get tested – becoming the first health care company to offer its members drive-thru testing at hundreds of Walmart Neighborhood Market drive-thru pharmacy locations across the country. Humana will continue to waive member costs related to COVID-19 diagnostic tests.

“Our members continue to be worried about COVID-19 – including the anxiety about possibly having it and not knowing it,” said Mona Siddiqui, Humana Senior Vice President of Clinical Strategy and Quality. “We want to help alleviate that stress. This is an additional step we can take to help address their concerns – whether testing from the safety of their own home or using the drive-thru option.”

Why is Medical Cost Waived Despite the Virtue Role of Healthcare?

Even though healthcare is playing an important role at the meantime, Humana has announced it is waiving consumer costs for treatment related to COVID-19-covered services. The company previously announced that it would cover out-of-pocket costs related to coronavirus testing. Now, costs related to subsequent treatment for COVID-19—including inpatient hospital admissions— will be waived for enrollees of Medicare Advantage plans, fully insured commercial members, Medicare Supplement and Medicaid.

The payer’s approach has two directions: it covered behavioral healthcare and primary care visits and it provided safety kits for members delivered directly to their homes. The main goal is to ease cost burden for Medicare Advantage members as the coronavirus restrictions lift.

The waiver applies to all medical costs related to the treatment of COVID-19 as well as FDA-approved medications or vaccines when they become available. There is no current end date. Humana will reassess as circumstances change.

Besides, to create a seamless experience for members, Humana has developed a coronavirus risk-assessment tool. The tool is based on CDC guidelines. Members who have symptoms consistent with COVID-19 infection, or those without symptoms who may be been exposed to the virus qualify for testing – and will be given the option to request an in-home test or drive-thru testing. This is part of Humana’s ongoing effort to meet members where they are and ensure that they have a wide range of options and choices for COVID-19 diagnostic testing.

Nonstop Racing for the Top of This Health Technology Trend

Enough with the pandemic stories, what else is going on inside its house? To be one of the top-tiers, Humana is never late in the tech-driven game. Let’s check out many of its up-to-date setups.

Featuring with Salesforce Health Cloud in A Brand-New Platform

a frontdesk at Humana studio h
Image source: Humana

Around September, Health insurer Humana has selected Salesforce to deliver a more connected, personalized healthcare experience for its members, using the Healthcare Innovation Lab, based in Humana’s Studio_H in Boston.

Through a new multi-year agreement, Humana will capitalize on infrastructure and capabilities offered by Salesforce Health Cloud to create an integrated health experience for its members.

Health insurer Humana has inked a new multi-year agreement with Salesforce to deploy Salesforce Health Cloud to help power its Enterprise Clinical Operating Model (ECOM), a new care management technology platform that will facilitate integrated care coordination between its members, care teams, and provider communities.

So, what’s this Care Coordination platform all about?

a young lady designed UI for Humana app
Image source: Humana

Healthcare is delivered beyond doctors’ offices — people now receive healthcare via telemedicine, primary care clinics, and home health. Because of this, Humana is building a care coordination platform that its trusted multidisciplinary care team can access to stay aligned on its members’ needs to receive care and stay healthy.

This implementation with Salesforce and API-led connectivity using MuleSoft will provide Humana’s care teams with the ability to easily collaborate by offering a single, central view of each member’s complete clinical history and insight into social, environmental, and lifestyle factors impacting that same member’s health.

In addition, Humana and Salesforce will collaborate on the development of transformative healthcare solutions through a joint Healthcare Innovation Lab, based in Humana’s Boston Studio_H, where the companies will co-create and co-innovate with the goal of solving today’s healthcare challenges. “By improving team collaboration and helping to coordinate the care of our members, we can allow them to focus on their health, instead of updating each doctor and clinician they see.” said William Fleming, President of Clinical and Pharmacy Solutions at Humana.

“Workforce of the Future” helps in Streamlines Services

With 45,000 associates serving over 14 million members, health insurer Humana uses artificial intelligence and robotic processes to help the daily routine of their associates making healthcare easier for clients to access. 

At the call center, Humana’s members call for many reasons, mostly health related issue or placing medicine orders. And to answer these questions the company uses artificial intelligence and intelligent automation for the best call experience.  “Whether a member calls about their medication or claim, we have a bot, or what we call ‘digital  worker’ actively helping the associate serve the member during the call,” said Alexis Paul, director of intelligent and robotic process automation.

In this project, Humana claims it also looks at how one process like claims combine with many business functions and systems can be turned into one experience for Humana's associates. The result being that anyone who handles the claim process can handle many parts of the member’s request without having to transfer a call.

At the same time, the company is also testing how digital workers can scan and highlight information from a medical report when the system hears certain keywords in the conversation between members and associates.

Thanks to that, its members now could experience a real-time and better access. Without being passing around between phonelines, they are a call away from the answer.

The Bottom Lines

Cover quite a wide range of healthcare services Humana is heavy-weighted insurer and it is doing a lot to reach out to their members, especially in the middle of this 2020 health crisis. Facing off Covid-19 with a well-prepared cost skimming tactic and new telehealth technologies, plus the strategic Artificial Intelligence application which is about to leverage the whole regime of Humana- It is not only winning but also leading the healthcare business.

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