Humana, Kelsey-Seybold team to expand Humana's Medicare Advantage provider network
The insurer expects the move will expand access to care to include members of its Medicare Advantage HMO plans.
Photo: Raymond Gehman/Getty Images
Major insurer Humana has partnered with multi-specialty group practice Kelsey-Seybold Clinic, signing an in-network agreement that Humana hopes will allow expanded access to value-based care through a broadening of its Medicare Advantage provider network in the Houston area.
The insurer expects the move will expand access to care to include members of its Medicare Advantage HMO plans.
Under this agreement, which becomes effective Jan. 1, 2022, Houston-area members of Humana Medicare Advantage HMO plans will have in-network access to care at more than 26 convenient Kelsey-Seybold Clinic locations, as well as access to more than 500 providers in 55 medical specialties across the Houston-Galveston region.
WHAT'S THE IMPACT
Members of the MA HMO plans will have access to Kelsey-Seybold's coordinated health services, with multiple specialties enhanced by advanced technologies, including electronic medical record systems, which strive to eliminate duplicate medical testing.
Humana has stressed that the new relationship will emphasize the insurer's focus on value-based care, which includes more personal time with health professionals and personalized care, as well as access to proactive health screenings and programs focused on preventing illness.
The insurer has also promised to leverage technologies such as data analytics to connect physicians and facilitate coordination of care. And it has pledged reimbursement to physicians that is linked to health outcomes, rather than the fee-for-service model of reimbursement based on quantity of services.
Humana has also said it expects improved care for people living with chronic conditions.
THE LARGER TREND
The year has been a busy one for Humana in terms of pursuing partnerships with various organizations. In June, the insurer signaled its intent to acquire One Homecare Solutions, or onehome, in an effort to grow its presence in the value-based home healthcare space. Financial terms of the deal were not disclosed, though the insurer expects it will not have a significant impact on its financials for the year.
In July, Humana and Signify Health began working together with the Alamo Area Community Network to support Humana Medicare Advantage members in San Antonio through AACN's community resources and by connecting those in need with health-related social services such as food, transportation, housing and financial assistance. It marked the latest effort in Humana's six-year Bold Goal campaign to address health-related social needs.
Also in July, Anthem, Humana and SS&C Technologies entered into a joint venture named DomaniRx to develop a claims adjudication and pharmacy benefits manager cloud platform, according to documents filed by SS&C Technologies with the Securities and Exchange Commission. SS&C Technologies holds an 80.2% interest, and Humana and Anthem each hold a minority interest, according to the agreement filed with the SEC on July 15.
Humana logged a net income of $588 million during the second quarter. And while that's considerably less than the $1.8 billion posted a year ago at this time, when patients were deferring care, it still beat expectations thanks in large part to falling COVID-19 treatment costs for its members.
Humana also said that "solid fundamentals" across its business lines have played a part, especially as the company continues to navigate the impacts of the coronavirus pandemic.
ON THE RECORD
"Kelsey-Seybold Clinic, both well-known and respected in the Greater Houston area, has a longtime history of providing quality and coordinated healthcare to patients," said Bill White, Texas Medicare president at Humana. "This is a major development for Humana in Houston, and we are grateful to be able to offer our Humana Medicare Advantage HMO members an additional high quality healthcare option as we continually work to help make it easier for our members to achieve and maintain their best health."
"Providing high quality, coordinated care for those living in the Houston-Galveston region is what Kelsey-Seybold Clinic is known for, and what we are most proud of," said Kenneth Janis, chief operating officer at Kelsey-Seybold Clinic. "Expanding access to care for Medicare eligible patients in this region is an important step in improving the health and wellness of all Houston and surrounding area residents and we look forward to welcoming their members at our clinics."
Twitter: @JELagasse
Email the writer: jeff.lagasse@himssmedia.com
