[{"innerBlocks":[],"name":"core\/freeform","postId":2287,"blockType":{"name":"core\/freeform","keywords":[],"attributes":{"content":{"type":"string","source":"raw"},"lock":{"type":"object"}},"providesContext":[],"usesContext":[],"selectors":[],"supports":{"className":false,"customClassName":false,"reusable":false},"styles":[],"variations":[],"apiVersion":3,"title":"Classic","description":"Use the classic WordPress editor.","category":"text"},"originalContent":"Walmart\u2019s potential interest in buying Humana is the latest buzz around the emerging symbiotic relationship between retail and health insurance. It\u2019s a combination that aligns well from a consumer perspective\u2014with both companies serving a growing population of seniors\u2014and from a technology perspective, according to industry analysts.

Both companies possess IT prowess and data that could help facilitate efforts to provide consumers, particularly senior citizens and Medicare beneficiaries, with improved services.

\u201cThe majority of the business certainly that Humana has is senior business,\u201d says Ashraf Shehata, a principal in KPMG\u2019s healthcare life sciences advisory practice and in its Global Healthcare Center of Excellence. \u201cWalmart and other retail organizations are very interested in expanding that footprint of clinics and operating capabilities as well as the pharmacy business in the retail environment. It\u2019s really a nice combination of seniors and their propensity to use pharmaceuticals.\u201d

Walmart\u2019s interest in Humana no doubt stems from the fact that it has the second-largest Medicare Advantage presence of any insurer as well as a highly effective pharmacy benefits management business, contends Shehata. Walmart, he notes, is the nation\u2019s fourth largest provider of prescription drugs.

Also See<\/b>: How a Walmart-Humana deal could reshape healthcare<\/a>

Humana\u2019s main focus has been selling private insurance under Medicare, the federal health insurance program for people who are 65 or older and use a lot of prescription drugs. According to Humana, as of the end of 2017, it has 14 million medical members\u2014with a Medicare membership of 8.6 million, of which 3.3 million are Medicare Advantage members.

In particular, growing enrollments in Humana\u2019s Medicare Advantage plans are seen as being attractive to Walmart. Similarly, CVS last year agreed to buy Aetna, the third largest Medicare Advantage insurer, for the same reasons.

\u201cWe\u2019ve seen the strength of the Medicare Advantage market for really the last four years, and it\u2019s going to continue to get better,\u201d says Shehata, who adds that the Centers for Medicare and Medicaid Services announced on Monday that it would increase payments to insurers running private Medicare Advantage plans by nearly twice as much as previously projected.

A KPMG research report<\/a> released in January concluded that the Medicare Advantage plans are \u201cproviding a service worthy of their current government support, in part because of ongoing confidence in the commercial market\u2019s ability to reduce costs through care management tools\u201d and the fact that consumers \u201cgenerally favor MA plans, given their predictability, added benefits and reduced estimated costs.\u201d

From Humana\u2019s perspective, an alignment in the supply chain is where Walmart\u2019s retail side could streamline partnerships for pharmacy and common medical supplies for which payers like Humana are responsible, says Bryan Komornik, a director in the healthcare practice at consultancy West Monroe.

\u201cWalmart\u2019s expertise in tracking and distribution of those items is a strong plus for Humana,\u201d says Komornik. \u201cWalmart\u2019s footprint could provide a large network of sites to place clinics and other customer interaction points. This would compete with a potential CVS-Aetna deal.\u201d

Komornik observes that Walmart\u2019s per-store sales have been on a steady decline, similar to other retailers. And, as Amazon looks to build an online pharmacy presence, he sees Humana\u2019s membership as providing Walmart with a more direct link to consumers.

\u201cThere\u2019s also some offense here\u2014in recognizing their common consumer base, Walmart and Humana are developing a bulwark in rural America with an ability to address inadequate access and medical services,\u201d adds Komornik. \u201cAnd, one more\u2014this offers Walmart an easier way to manage its own employee population. After all, it is the largest employer in the United States by far with 2.3 million employees, equivalent to 7 percent of the nation\u2019s population.\u201d

When it comes to technology, Shehata points out that Humana has been a pioneer and innovator in the use of data and analytics to empower consumers.

Humana operates a Digital Center of Excellence, which focuses on creating \u201csimple, connected and personalized digital experiences that empower its members to achieve their best health,\u201d the company\u2019s information says. Humana\u2019s goal is to improve the healthcare in the communities it serves by 20 percent by 2020, with seniors as a major target for these efforts.

\u201cThe team is focused on the end-to-end experiences that we create for the consumers,\u201d says Nick Walter, director of pharmacy digital strategy in Humana\u2019s Digital Center of Excellence.

In late 2017, Humana released a new tool to enable its members to more easily maintain an up-to-date list of their medications in one place to improve medication management, safety and clinical outcomes. Members access the RxMentor tool via the MyHumana.com website or by downloading the app for iPhone and Android devices. The app pulls from claims data in addition to medication and allergy information that members report themselves.

\u201cWe have access to up to three years of their claims data that we\u2019ll pull in, but we start with claims within the past 180 days,\u201d adds Walter.

According to Walter, the RxMentor tool serves as a \u201csingle source of truth\u201d for Humana members when it comes to their medications, which is shared with their care team\u2014including pharmacists and physicians\u2014to ensure better prescription management. Members receive a prompt to update their medication list when there is new claims data; for members with multiple conditions who might be on several medications, the tool prompts them to schedule a complimentary one-on-one consultation with a Humana pharmacist to conduct a medication review.

Because nearly three out of four Americans do not take their medications as directed, it results in nearly $300 billion a year in additional doctor and emergency department visits as well as hospitalizations. Walter contends that Humana\u2019s RxMentor tool is a way to help its members stay organized by keeping prescription medications, vitamins and supplements, other over-the-counter items and personal allergy information in one convenient and easy-to-access place. In addition, users of the tool can make notes in the app about a medication\u2014such as how to take it, when to take it, and any reactions.

Data is also being used by Humana to help its members manage the costs of medications through transparency, notes Walter. \u201cWe\u2019ll take that list of medications and forecast out for the whole plan year how much they\u2019re going to spend,\u201d he says, providing members with \u201csavings opportunities they may not be aware of,\u201d such as alternative generic drugs and moving their prescriptions from a retail pharmacy to a mail order pharmacy.

Last year, Humana also launched a new Medicare enrollment tool called Rx Calculator to help members and non-members determine annual drug and premium costs to ensure the medications they are taking are covered by their Medicare Advantage or Part D plan. The tool can be used by members and the public online, as well as by Humana licensed sales representatives and by licensed sales agents through Humana\u2019s agent portal, giving them the ability to guide prospective members through the Medicare enrollment process and to determine what plans best meet their needs.

\u201cWe have a pretty robust self-service pricing tool,\u201d concludes Walter, who says users can enter the drug name, dose, quantity and frequency to see if medications are covered. \u201cThere are a lot of innovation-type projects like that that we\u2019re working through\u2014test and learn to identify the right experience to go to market at scale.\u201d","saveContent":"Walmart\u2019s potential interest in buying Humana is the latest buzz around the emerging symbiotic relationship between retail and health insurance. It\u2019s a combination that aligns well from a consumer perspective\u2014with both companies serving a growing population of seniors\u2014and from a technology perspective, according to industry analysts.

Both companies possess IT prowess and data that could help facilitate efforts to provide consumers, particularly senior citizens and Medicare beneficiaries, with improved services.

\u201cThe majority of the business certainly that Humana has is senior business,\u201d says Ashraf Shehata, a principal in KPMG\u2019s healthcare life sciences advisory practice and in its Global Healthcare Center of Excellence. \u201cWalmart and other retail organizations are very interested in expanding that footprint of clinics and operating capabilities as well as the pharmacy business in the retail environment. It\u2019s really a nice combination of seniors and their propensity to use pharmaceuticals.\u201d

Walmart\u2019s interest in Humana no doubt stems from the fact that it has the second-largest Medicare Advantage presence of any insurer as well as a highly effective pharmacy benefits management business, contends Shehata. Walmart, he notes, is the nation\u2019s fourth largest provider of prescription drugs.

Also See<\/b>: How a Walmart-Humana deal could reshape healthcare<\/a>

Humana\u2019s main focus has been selling private insurance under Medicare, the federal health insurance program for people who are 65 or older and use a lot of prescription drugs. According to Humana, as of the end of 2017, it has 14 million medical members\u2014with a Medicare membership of 8.6 million, of which 3.3 million are Medicare Advantage members.

In particular, growing enrollments in Humana\u2019s Medicare Advantage plans are seen as being attractive to Walmart. Similarly, CVS last year agreed to buy Aetna, the third largest Medicare Advantage insurer, for the same reasons.

\u201cWe\u2019ve seen the strength of the Medicare Advantage market for really the last four years, and it\u2019s going to continue to get better,\u201d says Shehata, who adds that the Centers for Medicare and Medicaid Services announced on Monday that it would increase payments to insurers running private Medicare Advantage plans by nearly twice as much as previously projected.

A KPMG research report<\/a> released in January concluded that the Medicare Advantage plans are \u201cproviding a service worthy of their current government support, in part because of ongoing confidence in the commercial market\u2019s ability to reduce costs through care management tools\u201d and the fact that consumers \u201cgenerally favor MA plans, given their predictability, added benefits and reduced estimated costs.\u201d

From Humana\u2019s perspective, an alignment in the supply chain is where Walmart\u2019s retail side could streamline partnerships for pharmacy and common medical supplies for which payers like Humana are responsible, says Bryan Komornik, a director in the healthcare practice at consultancy West Monroe.

\u201cWalmart\u2019s expertise in tracking and distribution of those items is a strong plus for Humana,\u201d says Komornik. \u201cWalmart\u2019s footprint could provide a large network of sites to place clinics and other customer interaction points. This would compete with a potential CVS-Aetna deal.\u201d

Komornik observes that Walmart\u2019s per-store sales have been on a steady decline, similar to other retailers. And, as Amazon looks to build an online pharmacy presence, he sees Humana\u2019s membership as providing Walmart with a more direct link to consumers.

\u201cThere\u2019s also some offense here\u2014in recognizing their common consumer base, Walmart and Humana are developing a bulwark in rural America with an ability to address inadequate access and medical services,\u201d adds Komornik. \u201cAnd, one more\u2014this offers Walmart an easier way to manage its own employee population. After all, it is the largest employer in the United States by far with 2.3 million employees, equivalent to 7 percent of the nation\u2019s population.\u201d

When it comes to technology, Shehata points out that Humana has been a pioneer and innovator in the use of data and analytics to empower consumers.

Humana operates a Digital Center of Excellence, which focuses on creating \u201csimple, connected and personalized digital experiences that empower its members to achieve their best health,\u201d the company\u2019s information says. Humana\u2019s goal is to improve the healthcare in the communities it serves by 20 percent by 2020, with seniors as a major target for these efforts.

\u201cThe team is focused on the end-to-end experiences that we create for the consumers,\u201d says Nick Walter, director of pharmacy digital strategy in Humana\u2019s Digital Center of Excellence.

In late 2017, Humana released a new tool to enable its members to more easily maintain an up-to-date list of their medications in one place to improve medication management, safety and clinical outcomes. Members access the RxMentor tool via the MyHumana.com website or by downloading the app for iPhone and Android devices. The app pulls from claims data in addition to medication and allergy information that members report themselves.

\u201cWe have access to up to three years of their claims data that we\u2019ll pull in, but we start with claims within the past 180 days,\u201d adds Walter.

According to Walter, the RxMentor tool serves as a \u201csingle source of truth\u201d for Humana members when it comes to their medications, which is shared with their care team\u2014including pharmacists and physicians\u2014to ensure better prescription management. Members receive a prompt to update their medication list when there is new claims data; for members with multiple conditions who might be on several medications, the tool prompts them to schedule a complimentary one-on-one consultation with a Humana pharmacist to conduct a medication review.

Because nearly three out of four Americans do not take their medications as directed, it results in nearly $300 billion a year in additional doctor and emergency department visits as well as hospitalizations. Walter contends that Humana\u2019s RxMentor tool is a way to help its members stay organized by keeping prescription medications, vitamins and supplements, other over-the-counter items and personal allergy information in one convenient and easy-to-access place. In addition, users of the tool can make notes in the app about a medication\u2014such as how to take it, when to take it, and any reactions.

Data is also being used by Humana to help its members manage the costs of medications through transparency, notes Walter. \u201cWe\u2019ll take that list of medications and forecast out for the whole plan year how much they\u2019re going to spend,\u201d he says, providing members with \u201csavings opportunities they may not be aware of,\u201d such as alternative generic drugs and moving their prescriptions from a retail pharmacy to a mail order pharmacy.

Last year, Humana also launched a new Medicare enrollment tool called Rx Calculator to help members and non-members determine annual drug and premium costs to ensure the medications they are taking are covered by their Medicare Advantage or Part D plan. The tool can be used by members and the public online, as well as by Humana licensed sales representatives and by licensed sales agents through Humana\u2019s agent portal, giving them the ability to guide prospective members through the Medicare enrollment process and to determine what plans best meet their needs.

\u201cWe have a pretty robust self-service pricing tool,\u201d concludes Walter, who says users can enter the drug name, dose, quantity and frequency to see if medications are covered. \u201cThere are a lot of innovation-type projects like that that we\u2019re working through\u2014test and learn to identify the right experience to go to market at scale.\u201d","order":0,"get_parent":{},"attributes":[],"attributesType":{"content":{"type":"string","source":"raw"},"lock":{"type":"object"}},"dynamicContent":""}]

Pairing of Humana, Walmart tech could boost health services

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