Join us for a captivating discussion with Dr. Andrew (Andy) Agwunobi, President of Humana's Home Solutions division, as we explore Humana’s holistic approach to care and addressing social determinants of health (SDOH), proactive care benefits, and the need for unified healthcare providers. Dr. Agwunobi also discuss tackling the fragmentation of providers, enhancing delivery systems, technology platforms, and the future of home healthcare.
If you liked this episode and want to learn more about all things home-based care, you can explore all our episodes at alayacare.com/homehealth360.
Join us for a captivating discussion with Dr. Andrew (Andy) Agwunobi, President of Humana's Home Solutions division, as we explore Humana’s holistic approach to care and addressing social determinants of health (SDOH), proactive care benefits, and the need for unified healthcare providers. Dr. Agwunobi also discuss tackling the fragmentation of providers, enhancing delivery systems, technology platforms, and the future of home healthcare.
If you liked this episode and want to learn more about all things home-based care, you can explore all our episodes at alayacare.com/homehealth360.
Welcome to Home Health 360, a podcast presented by AlayaCare. I'm your host, jeff Howell, and this is the show about learning from the best in home health care from around the globe. Howdy listeners, welcome to another episode of Home Health 360. Today we have Dr. Andy Agwunobi, who joined Humana in February of 2022 as president of Home Solutions. In this role, he's responsible for leading Humana's home care capabilities, including Centerwell, home Health, One Home, mergers and Acquisitions, and the company's outcomes focused, value-based care model. He's been, among other things, the CEO of Grady Health System in Atlanta, providence Health Care in Spokane, and has an MBA from Stanford. Dr Agwunobi, it's a pleasure to meet you and thank you for being here today. It's a pleasure to be here. Thank you. So, as the largest provider of in-home health care in the United States, give us some background on how Centerwell actually got here.
Dr. Andrew (Andy) Agwunobi:Well, in 2021, humana acquired Kindred at Home, and that made Humana the nation's largest provider of in-home care. The plan at that time and continuing is that we want to significantly expand our home health offering. We believe that home is the next frontier of care and we want to be able to provide that with a focus on clinical innovation, improving patient outcomes, increasing satisfaction for patients and providers and, really, very importantly, reducing the total cost of care, which is, of course, what Medicare Advantage is all about.
Jeff Howell:And what's your story? How did you come to fit into this role?
Dr. Andrew (Andy) Agwunobi:Well, I am a pediatrician by training, so in my heart, I'm a clinician, a physician, and I believe in great care for patients and, in particular, I believe that everyone should have access to high quality, affordable care on their own terms, and that's why I came to Humana to help lead an innovative organization that was focused and leaning into this type of vision and understands the and understands the power of care in the home. And, as you mentioned before, I've spent a lot of my career in integrated delivery systems that include hospitals and include home health organizations and skilled nursing facilities and such, and I always felt very early on that a lot of the care that's delivered in clinics and delivered in hospitals could be delivered in the home, and so that's why I joined Humana.
Jeff Howell:So what's your vision for the future of home health care in the United States?
Dr. Andrew (Andy) Agwunobi:Christ. Simply, home is the next frontier in medical care. For many conditions, providing care in the home is the best way to ensure that care is delivered in a safe, more personalized way, and so that's our vision. Our vision really is to say, all the care that can be delivered in the home, safely and well, should be delivered in the home ultimately, because that's really where research has shown that patients want to get their care in the home. They want to have access to care in a seamless, safe manner. If you think about it being in your home, you can eat your own food, you can walk around your own house, you can have your loved ones with you, you can have your pets with you, it's less costly, you're not exposed to infections, you're not exposed to falls beyond what you might have in your own home. So just a lot of advantages to having care, access to care in the home, and so that's really what we're all about.
Jeff Howell:Yeah, every survey comparing long-term care to in-home care, it's 95% plus that people want to age in place, and one of the things that a lot of people don't even talk about is that they have all those things that you talked about, but they also have all their memories.
Dr. Andrew (Andy) Agwunobi:Oh, yes, of course. Yeah, that's what I mean by. On their own terms, hospitals are fantastic. Other inpatient facilities do a wonderful job for what they're good at, but going to a hospital and sitting in an emergency department for four hours and then having to go home again we can do better than that. And I also think that when you think about social determinants of health, we see so much in the home that you don't see any in the office or in the hospital. People have the impression that every home is a white picket fence and a beautiful house in a suburban area, but there's so much that our nurses see and our clinicians see when they go into the home. That is part of the patients and the members' lives. As you mentioned, memories, it's their lives, it's their real life. When healthcare, only 20% of outcomes are related to clinical care, 80% is related to social determinants of health.
Jeff Howell:There's so much there, but I agree with you completely Memories and life is just a big part of people's health and I feel, speaking of Medicare Advantage, that it was a tip of the cap to the personal care world, that if you think about someone's end of life or any deterioration of health, it's like a sales funnel, where it's like the most number of people that you can help are really at the top of the funnel, where you can proactively intervene, and things like loneliness and confidence and having your dignity these are the kinds of things that really, if all of those are in place and you're living at home and you live a happy, satisfied life, you're going to be much healthier.
Dr. Andrew (Andy) Agwunobi:Yeah, no doubt there's so many tentacles from what you're saying and even nutrition being able to get the right food. We need ambulations. So you're not lying in bed just waiting for a nurse to come in and give you your medication. You're at home and it's just a piece of all of that. I think sometimes we discount the effect that has on your health. So I couldn't agree with you more.
Jeff Howell:Even just sitting on your own front porch and seeing your neighbors and those feelings of familiarity. Well, you aren't going to avoid addressing workforce shortages on this podcast. So aging population is very predictable increase for demand. It's just a no-brainer that we can see that the silver tsunami and the accompanying demands for healthcare are going to rise dramatically. What's your plan to ensure that there's enough skilled professionals to meet the needs of patients?
Dr. Andrew (Andy) Agwunobi:Obviously it's a short-term and a long-term play. In the short term, we just have to do everything we can to make sure that our clinicians are feeling valued and that we're reducing the burden administrative burden Documentation is a big one Leveraging technology to ensure that clinicians can operate at the top of their license, they can do what they love to do, which is actually take care of patients and speak to them and make them feel like they're cared for. So that's one piece of it. Obviously, compensation and all the rest of it's important as well.
Dr. Andrew (Andy) Agwunobi:But longer term, I think it's really about developing a pipeline, and so in Central Well Home Health we've incorporated our expertise into the clinical rotations of student nurses at nearly 40 colleges and universities across the US. One notable partnership is with Atlanta's Emory University, where we created the Central Well Home Health Lab. It's a simulation lab for their nursing school, and we realized, in sort of collaboration with nurse leaders in the industry, that a lot of nurses in nursing school do not get exposed to home health. They get exposed to acute care, and so building a simulation lab with Emory where nurses in training can actually get a feel for what it's like to take care of patients in the home, and so that's something we're very proud of and hopefully will be able to inspire more nurses to pursue a career in home health. And so a lot of work we have to do, but we're very optimistic.
Jeff Howell:I love that. That is the really first grassroots story I've heard about a lab being put into a university like that, and certainly even within healthcare professionals. When people ask me what is the sliver that is, home health amongst the entire spectrum, I always said it's probably about 3% of the overall ecosystem, probably growing at the fastest rate of any segment and makes the most sense financially, as well as the demand for patients wanting to age in place. Love the idea that you're starting early and you're getting nurses turned onto the idea at a very early stage that they can deliver care multimodal and the home is one of those spots.
Dr. Andrew (Andy) Agwunobi:Well, it's interesting.
Dr. Andrew (Andy) Agwunobi:One thing is we found some nurses, of course, get into home health and they find it's not for them, that they prefer to work in a team environment that's much more colleagues around them all the time, but there are a lot of nurses that would never go back Once they do get into home health.
Dr. Andrew (Andy) Agwunobi:They're sort of like this is it Taking care of people holistically, every aspect of that person, knowing whether they have electricity, knowing whether they have food, understanding whether they have transport, understanding whether they know what meds to take and just all of the different pieces of it, and that sort of direct connection with the real life of a person. So there's a lot of people that just absolutely love it when they get into it. And I'm glad you said that only a small percentage of care is delivered in the home right now I think it's less than 6%. You mentioned 3%, which makes sense, but studies have shown that up to 25% of care that's delivered through Medicare and Medicare Advantage could probably be shifted to the home if you have the right support and the right technology et cetera. So there's a huge opportunity to give more people access to care in the home.
Jeff Howell:So home health care can be costly for patients, even those with insurance coverage. You talked about Medicare Advantage. How do you plan on making services more affordable and accessible to a wider range of individuals?
Dr. Andrew (Andy) Agwunobi:The nice thing about being part of Humana is that Humana is focused heavily focused on Medicare Advantage and, at its core, medicare Advantage is all about aligning incentives to deliver care as efficiently, as effectively and with great quality, because that's how Medicare Advantage works. You're taking responsibility for the full care of the patient and the cost of the patient, so what you want to do is make sure that you're giving the absolute best care. It's holistic care and the great thing about it is, if you're giving the best care and it's holistic, it's also more affordable. It's less costly. We were just talking about care in the home. Care in the home is safer, is more comfortable, is more customized all the things we talked about and it's also less costly.
Dr. Andrew (Andy) Agwunobi:We found that with working with dispatch, which is one of our partners that actually sends clinicians, physicians and other types of clinicians into the home, we found that about half of VR visits could be delivered in the home. So, really, by focusing on our vision and our vision is to go from fee-for-service to really sort of use our center well, home health as a chassis to move into the value-based world where it's not just about being paid for individual services as in fee-for-service. You come to my office. I get paid for an office visit. It's being paid for keeping the patient healthy in the most efficient way possible, and I think that's really the ultimate answer Along the way. Our goal is to drive as much efficiency as possible while keeping care and the quality of care also as high as possible. But what?
Jeff Howell:are things today that 20 years from now, people will look back and say wait, we used to do it this way, and I think about healthcare being so reactive and it's really a sick care right. You just wait until someone needs help and then they go to this assembly line that we call hospitals, and then you wait forever and it's very expensive. And being able to solve the problems proactively, especially with the advancements in technology, I think it's an exciting time, which brings me to my next question is how do you plan to leverage advancements in technology to improve patient outcomes?
Dr. Andrew (Andy) Agwunobi:With today's technology we're able to do much more in the home than we ever could before. Take, for example, mobile imaging, doing x-rays in the home, doing dialysis in the home, doing infusions in the home and even advanced expansion of services like hospital at home and primary care at home. Brigham and women has I think they did a study that showed that by doing hospitals in the home, higher acuity care in the home instead of doing it in the hospital, they could reduce costs by about 38%, and I think Johns Hopkins saw sort of a 32% reduction. So we know that it works and, by the way, everybody I think you mentioned this earlier everyone that goes through it, loves it. Now we do have to give more, give as much support as possible to the caregivers in the home. So patients love it, but we do also have to support the caregivers who are in the home with the patients most of the time.
Dr. Andrew (Andy) Agwunobi:But to get back to your question, there's a lot more technology that can be applied in the home and particularly telehealth can cut down on travel costs for patients, infection risks, et cetera. So you can imagine in a value-based model where it's not just paying for each transaction, you're being paid for the total care, the total quality and the total costs. A payer can then start saying well, maybe you don't need as many visits in person, you can substitute some for virtual. Or maybe you need more visits than you had before, but instead of doing them all in person, you can do some virtual. You can improve the quality of those visits through remote patient monitoring, et cetera. And then, of course, technology can also be used to ease the administrative burden for our clinicians, because this is a very expanding field and there's a shortage of labor that we talked about before. Logistics scheduling, decreasing what they call the windshield time for clinicians so they can spend more time in the home with the patients, is also a way we can use technology.
Dr. Andrew (Andy) Agwunobi:But, quite frankly, when you think about AI and all the rest of it, I think it's getting back to what you said, that sometimes you don't know what's possible. I think there's so much more that's possible that we don't even know about right now. I'd like to give the example of in the old days when women delivered babies in hospitals. Well, first of all, they always delivered in hospitals, or mostly, and secondly, they were told you had to have 10 days bed rest after a delivery. Well, now we know, you know, medicine has advanced and we know that people can be discharged within 24, 48 hours and it's actually better for the baby and the mother. And so there's just so much. We don't know, both in terms of care and in terms of technology, but it's moving and it's an exciting place to be in, to be a part of it.
Jeff Howell:Even the ability to predict. Oh, there's a client that has COPD in their at home and we know, with their ICD 10, these are the symptoms that might be precursors and they volunteered to test themselves daily and there can be a dashboard that warns an agency to say hey, we know what's going on here, we have to intervene and we don't need to have frequent visits, but this is a high priority visit based on what the data is predicting for us.
Dr. Andrew (Andy) Agwunobi:Yeah, well, and that's a great application for artificial intelligence to really pull all of those pieces together and give us predictive analysis, as you said. And there are also some let more basic technologies like speech to text. There's a technology called invoke speech to text where it helps our clinicians so they're not spending a lot of time typing into a computer natural language processing as well, so that when referrals are coming in from different areas, that you know the different organizations or facilities or community doctors, that the technology can organize all that material so that it's easy for the nurses or the therapist to be able to sort through it and get to a quality start of care. It's just a lot. The technology is becoming cost effective as well right now.
Dr. Andrew (Andy) Agwunobi:So this is the nexus going on where people have understood that the home is the next frontier of care there is. Technology is now there to be able to support all sorts of advances of care in the home and patients. This is consumerism. Patients have come to be more and caregivers be more expecting expect more, should I say, from health care, because they know what they get when they want streaming video. They know what they get when they go to the bank. They know what they get when they go to the airport, and so they expect health care to be able to provide more in their home, real time in a convenient, simple, integrated manner. Right.
Jeff Howell:Yeah, and I think what the pandemic did for every grandma's ability to figure out how to use Zoom. The introduction of chat GPT to the world has also allowed everyone to wrap their mind around what's possible with where we're at. This is probably the fastest growing technology we've ever seen, and there's so many exciting applications for it. The home health care does involve coordination with other health care providers and facilities. How do you plan to strengthen the communication and collaboration between Centrewell and other entities in the health care ecosystem?
Dr. Andrew (Andy) Agwunobi:Yeah, integration is a big theme for us and so it should be for everyone. If you think about it, home, as we've mentioned about home being the next frontier, but it's not the only location for care, right, we still need hospitals, we still need doctors, offices, etc. We believe in humana. That should all be within a value based ecosystem. So when you go to your primary care physician, it should be a senior, focused, value based care physician, and so same thing for home.
Dr. Andrew (Andy) Agwunobi:As I mentioned I think I may have mentioned our overarching vision is to integrate across Centrewell. So we have I mentioned we have the largest home health provider, but we also have the largest senior based primary care provider and we have a large pharmacy and all of those are under one umbrella we call Centrewell, which is our sort of version of an integrated delivery system, and so we're integrating across that so that you go to your primary care physician and that could be primary care in the home, but it could also be primary care in a doctor's office, again, value based focus, total cost of care focus. Then that's integrated with home. So if you need home care, you get it from us as well, and if you need pharmacy, you can, if you choose, should I say, and if you need pharmacy, mail order pharmacy, others, you can get that within the integrated system as well. So we think it's really important that it be seamless for our patients and they get all the care they need at the right time in the right place.
Jeff Howell:Yeah, I can't think of another industry that has more fragmentation of providers as well as disparate systems, where there's just so many old, archaic systems that don't talk to each other and there's incentives for that to remain in place as well.
Dr. Andrew (Andy) Agwunobi:But it's opportunity right, and we just think that integration and whether that's integration of the providers that I just described Are integration of the technology platforms, which is also part of it. But we have to get to a point where you know, like the banking industry and other industries, we work from the customer back what are the customers needs? Not the needs of the system, but what are the customers needs. And I think if we do that, if we have two themes value based care, so total care, everything integrated in your care. Total cost of care, everything integrated, and then we have integration of the delivery system and integration of the technology and the platforms, I think we start to approximate where we need to go for people's best care.
Jeff Howell:That's exciting to hear what's your approach to measuring and improving client outcomes.
Dr. Andrew (Andy) Agwunobi:Yeah, we measure patient satisfaction and health outcomes using a variety of methods including, for example, net promoter score as well as cms star ratings. In fact, we're very proud of the fact that center well home health 50% of our branches have a rating of 4.5 stars or above, and five is the highest, and so we're very excited about that, because it's obviously about, if you unpack that, it's about things like timeliness of care and are we getting people to ambulate sooner. So it's really about the real stuff that people care about, and so we're really happy about that. We also have data.
Dr. Andrew (Andy) Agwunobi:Getting back to your integration question, we have data showing that patients who use more than one of center well services so they use both the home, but they also use pharmacy, or they use pharmacy and they also use the primary care physician they use all three have better overall experiences and health outcomes than patients who use just one of them. So guess the integration. For example, those that use human health plan, center well pharmacy and center well senior primary care saw a 6.4 point increase in net promoter scores, which is huge. So that's another reason why we're intently focused on connecting our center well units and integrating to improve experience. Yeah, makes total sense.
Jeff Howell:Well, we're bumping up against our time here. I'll get you out of here on this. Give us a reason to be optimistic about the care in the place where patients call home.
Dr. Andrew (Andy) Agwunobi:When I sort of researched into this before I joined to you, manna, one of the things that struck me is there are very few locations where the patients want to be. In that location the care is as good from a quality perspective and better from a safety perspective and from a personalization perspective than the home. There are very few places that have that and that also is a lower cost of care. That is at a point where people have understood that's where care is evolving to. We've always known that care is evolving from the hospital to outpatient, but from out hospital and outpatient to home is sort of a new push. It's right, it feels right, it is right and that's why it's growing and so I'm very optimistic about it and I think we'll work through the issues like labor shortage issues and technology adoption and cultural change will work through those, because it is the right place for care to be.
Jeff Howell:I've written down so many. I love the data that you came here with today. I always try to come away from each episode with one or two big takeaways. Love the Emory University grassroots simulation lab I thought that was incredible when you mentioned that and it's inspiring to hear that about half of all our visits Could be in the home and the cost savings there could be put towards paying caregivers more money, and so there's just so much work to be done, so much optimism to be had. This has been super inspiring. So I thank you for coming on today, Dr Agwunobi, and I look forward to following you guys pretty closely and seeing the noble and great work that you guys continue to do. Well, thank you.
Dr. Andrew (Andy) Agwunobi:Jeff, it's been a pleasure.
Jeff Howell:Home Health 360 is presented by like here. First off, I want to thank our amazing guests and listeners. To get more episodes, you can go to that's spelled home health 360 or search home health 360 on any of your favorite podcasting platforms. The easiest way to stay up to date on our new shows is to subscribe on Apple podcasts, spotify or wherever you get your podcasts. We also have a newsletter you can sign up for on alayacare. com/homehealth360 to get alerts for new shows and content from a like here right into your inbox. Thanks for listening and we'll see you next time.