Great. Good afternoon, everyone. My name is Lisa Gill, and I'm the Healthcare Services analyst with J.P. Morgan. It is with great pleasure this afternoon that I have with me Humana. For Humana, we have this afternoon CFO Susan Diamond. Susan, thank you so much for joining me today.
Yes. No, thank you for inviting us.
Susan's gonna start with a few opening comments, and then we're gonna go into a fireside chat.
Perfect.
Okay.
So again, thank you for inviting us. We're really pleased to be with you today, especially on the back of the strong AEP membership growth that we released this morning, and I'll comment on it a little bit later. I would say broadly, just to open it up, you know, the organization really is very focused on delivering against the strategy that we laid out at our Investor Day in September. That strategy was certainly underpinned by the objective of getting back to industry-leading MA growth very quickly, so that we can maintain the leading position in, you know, really the fastest growing sector of healthcare. You know, as we shared during our Investor Day, you know, the strategy, you know, is dependent on delivering 10% annual earnings growth.
You know, we certainly believe that we're in a position to do that by continuing to deliver strong Medicare Advantage growth while also continuing to invest for the long term, particularly in our growing CenterWell capabilities on the care delivery side of the organization. At the same time, we also shared a commitment to delivering improved operating leverage on a sustainable basis going forward while continuing to efficiently and creatively deploy capital. Certainly we view the industry as having very strong fundamentals and secular growth trends behind it, and we believe that we continue to have differentiated capabilities that will allow us to sustainably deliver strong top and bottom line growth within that industry. Certainly, the investments we made in 2023, which were designed to get us back to an industry-leading position, proved to be very successful.
You know, we had commented a number of times about some question about whether we could do that in one year or it might take a little bit longer. Really pleased to report our updated guidance this morning of at least 625,000 growth in MA, which represents about a 13.6% year-over-year growth rate. We think the industry's likely to grow in the high single digits, we're as anxious as probably all of you to see actual industry growth, hopefully later this week when CMS releases the first information broadly for the industry. We certainly would expect based on what we've seen that we will see some share gains broadly given the strength of our results.
As I said, we continue to invest for the long term, particularly within our primary care and home businesses. In addition to the strong MA growth that we saw, where we saw that growth occur broadly across the country, we did see that our primary care assets benefited from that strong growth as well, and are pleased to see that they will likely grow about two times the rate of what they did in 2022 AEP. Should grow about 8,000-10,000 patient lives compared to 4,000-5,000 that they grew last year. We view that very positively as well. Our home business continues to expand. As we said previously, they did meet the expectation of expanding to about 365,000 additional members in the fourth quarter, and through January 1.
That brings the total members covered under our value-based home health model to about 700,000, which is about 14% penetration, and we think we remain on track to achieve about 50% over the next couple of years. The same time, as we said, we are continuing to focus on delivering durable and sustainable productivity gains. We are very pleased to see that we achieved our billion-dollar value creation goal. We actually slightly exceeded that for 2023, and now the enterprise is very focused on ensuring that we have a pipeline of initiatives, particularly in the technology and digital deployment space, workflow enablement that allow us to sustainably deliver ongoing operating leverage that allow for earnings appreciation, but also reinvesting some of those gains back into the business, whether that's product, distribution or other long-term strategies.
We'll also continue to be efficient and creative with our deployment of capital, minimally through share repurchase, also look for opportunistic M&A opportunities that can allow us to deliver 1%-2% of additional EPS accretion through capital deployment. When you take all of that together as our midterm target of $37 by 2025 contemplates, we do expect about 14% EPS growth in the midterm, and there's no reason to think based on the strength of our Medicare book and then the growing CenterWell capabilities, that won't continue to deliver those strong EPS growth rates even beyond 2025.
In addition to the MA growth, guidance update we provided this morning, we were pleased to reaffirm both our 2022 guidance as well as our 2023 commentary as we respect EPS progression, and certainly we'll share more on our fourth quarter call in a couple of weeks. The last thing I would just say, we did announce earlier this year that we would be re-segmenting in 2023, where we will go to one insurance segment and then our CenterWell segment, which will have our care delivery capabilities. We do intend to report our fourth quarter results in the new segment structure for you, while also providing in our supplemental schedules the 2022 presentation in the old segment format.
You will have both, so that you can close out 2022, but then also have, those results as we go into 2023 as we will issue our 2023 guidance in the new segment structure as well.
Well, first off, Susan, welcome. I think this is your first time presenting at JPMorgan.
It is, I think. I don't know if I did last year at all with the virtual.
Well, you know, it's the first.
Live.
First live.
In-person. Yes.
Tonight too is standing room only.
Yes.
Thanks so much for being with us. Let's start with where you started things, and that is how things turned out for membership this year. 625,000, you had started out in, I think it was, what, early December, raised it to 500,000, and now it's 625,000. Can you maybe just talk about, you know, some of the areas where Humana benefited more from a competitive offering perspective versus your peers when we think about most likely taking market share? I know we're not gonna see the CMS data till later this week or next week, but it does feel like you took market share.
We are very pleased with the results. As we came out with our initial guidance, you know, on our third quarter call, you anticipated that we would grow slightly under the industry rate, was our estimate then. Even though we recognized our product positioning was strong, there were still some questions about sort of the channel performance in light of some of the changes we saw with the call centers. As we came out with our revised guidance in December, you know, we acknowledged at that time what we stepped up to was the increased sales activity that we saw through that timeframe. We acknowledged that while we were seeing some modestly improved retention, that data is less complete, and so wanted to see more time to see that develop before we fully included that.
As the AEP finally concluded, with our update this morning as we raised it to $625,000 you can think of that as fully considering our AEP performance, which we're very pleased to see continued strong performance in sales, and I'll comment a little bit more about sort of some of the drivers of that in a moment. Also we're really pleased to see that we did continue to see improved retention. We commented previously that we were expecting a 100 basis point improvement in retention year-over-year, and we're really pleased to see that ultimately we saw for the AEP a little over 200 basis point improvement in retention. Really strong response to our product designs on the new sales side as well as retention.
As we approached our 2023 plan designs and had, you know, created the capacity to make that significant investment that we've talked about, you know, we certainly want to maintain our leading position in the dual space, through the D-SNP product offering. We have been strong in the duals for a number of years, but in 2022, we didn't grow quite as much as we expected, and United did a nice job implementing some creativity and flexibility features. That was certainly a priority for us in 2023. We were able to introduce some of those same features while also creating some new innovative benefits around rollover, benefit designs for those benefits, and also expanding the service categories against which beneficiaries could use those Healthy Options card. That has resonated really well with consumers and brokers.
We were happy to see we will grow our D-SNPs about 50% more in 2023 AEP than 2022 AEP. We are anxious to see industry data, but certainly looks like we should take some gains in share there. At the same time, and frankly more importantly, we were focused on the non D-SNP space. It's, you know, from an absolute basis, much larger obviously than the D-SNPs, and so for a number of years, we actually have not been able to achieve industry growth in the non-dual space . That was an important priority for us as well. We really looked at our $0 HMO and PPO offerings. We made broad investments in our dental benefits as well as reduced pharmacy cost share.
We introduced some new Part B give back plans. Certainly in this inflationary environment, new sort of cash equivalent benefits we expect to be highly valued. That's what we saw in terms of those products really resonate. We also expanded our $0 LPPO to cover about a third more beneficiaries than we had in 2022, so that was also positive. So I would say in the non-dual space as we looked at our results, we should grow about 400,000 lives in AEP, so well above what we think will be the industry rate. That really was really outstanding to be able to do that in one year. Then as I said before, the retention broadly was improved about a little over 200 basis points.
We mentioned that the driver of the variance we experienced in 2022 was largely driven by attrition, so it was really important to us to be able to take ground there. You might remember that we commented on the call center channel in particular. We did expect that channel to pull back on some of the marketing this year. That's exactly what we saw, which we view as positive, recognizing, and they recognized, that they had probably sort of induced some additional shopping and churn and low quality leads, in their strategy in 2022. We were happy to see that pull back. On an absolute basis, that channel grew comparably year over year, but given our outsized growth this year, the share has declined pretty meaningfully from about 45% in 2022 AEP to about 37% in 2023, which is great.
A lot of that volume did shift to the independent agent channel, which has very strong results for us. They perform much more like our proprietary channels. Those tend to be face-to-face enrollments. They spend a lot of time with their beneficiaries, develop relationships, and we tend to see more comparable retention and plan satisfaction and lifetime value from that channel. We view that as positive. One final comment or two comments I'd make. On retention, you might recall the call centers we acknowledged saw about a 400 basis point deterioration in attrition or retention last year. Overall, we saw that slightly above 200 basis point improvement. In the call center channel, they improved about 330 basis points for us.
They did get back some of the additional deterioration they saw last year, which is really reflective of the strength of the product, but also a number of initiatives that they implemented over the course of the year to address some of the challenges. You know, improved agent recruiting and retention, training, as well as incentive compensation to make sure they were focused on quality sales and retention. The last thing I would say is we also look closely at the number of members that switched from other MA plans versus are new to Medicare as a source of growth. For 2022 AEP, switchers represented about 30% of our new enrollment. This year it was 50%, which is meaningfully higher than we've seen historically and also very positive.
Those numbers tend to come more fully documented, and so they will perform better for us than someone new to Medicare. We also view that as positive relative to what we had initially expected.
For those that don't follow the space as closely in this room, when we think about those people that are switching, would they have a tendency to be better profitability-wise for Humana, if you think about that, versus kind of a new member that may have not been doing all they need to do in the healthcare system, et cetera?
Yes. How we typically describe new members is sort of neutral to contribution. Not negative, but also typically in the first year won't contribute positively. What you see underneath there is, though, people that are new to either Medicare or new to Medicare Advantage will be less well-documented. If they're new to Medicare in general, they're just demographically rated. They don't have any risk adjustments. That discrete population tends to perform the worst in the first year. If they're new to Medicare Advantage, they just tend to not be well managed. They don't have the benefit of care coordination and care management and tend to be less well accurately documented. We do see when they switch from another MA plan, they're not as profitable as our retained members necessarily and our concurrent, but certainly better than someone new.
Given the favorable mix, that would be viewed as a net positive tailwind for 2023.
Right. You know, another net positive is 2024 stars. You know, clearly Humana standing out from the rest of the pack, when we think about 96% will be four-plus stars for 2024. Can you talk about, you know, what's really been differentiated for Humana? I think you and I have talked in the past around your relationship with value-based care providers and the difference that that's made, but maybe just talk in general around stars and what really is differentiated for Humana.
We were extraordinarily pleased with our results this year. You know, most of you probably remember that there were some adjustments made by CMS in 2023, recognizing the impacts of COVID. Some of our competitors had disproportionate benefit from that. We had acknowledged that we had very little benefit, only about 200 basis points as a result of that. We didn't face any particular headwinds going into 2024. At the same time, given the way that the program is structured, you know, there's always inherent risk. It's graded on a curve. It's not member-weighted, there's just inherent risk in the way the program operates. You know, we had a challenge back in 2015 that was more related to an audit outcome, and at the time, some implications of that.
At that time and what we went through then, the organization really pivoted from what we would have described as sort of a department that was responsible for Stars to an enterprise focus on Stars. We significantly invested in analytics at that time and resources so that we could deeply understand at a sort of metric and contract level, sort of whatever our performance was. We can watch that in real time and understand gap closures and make sure that we're very focused on contracts that may be at risk of falling below sort of the targeted four-Star threshold.
We have the ability to redirect resources, understand at a measure level where we might be seeing pressure, compare our performance to other peers and see if others are having more success in a particular measure, try to understand what they're doing and figure out if we can replicate that, and ensure that things that we're doing that are working, that we maintain a leading position. I would say just the discipline and infrastructure that we put in place as a result of the challenge we had in 2015 have served us well and have, you know, supported the strong results we've really seen since then and the consistent results. As you said, the other big factor, and we think that's more durable and differentiating is our focus on value-based primary care providers in particular. They consistently outperform on stars, and they consistently deliver high-quality results.
As we continue to work to have more of our patients and members supported by high-quality primary care, we see beneficial impact in terms of the stars results. That's certainly harder to replicate quickly, by some of our peers that are seeing some pressure. Again, we'll continue to focus on that, which we do think creates a differentiated advantage.
I think, again, Susan, I think you talked in the past that it's like a third, a third, a third. Third fully capitated, right?
Mm-hmm.
A third in some type of value-based care.
Mm-hmm
... mechanism, and then a third that are not today, but are utilizing some of the tools and technology that you provide to them as a health insurer.
We continue to work with all of our providers to work them through the sort of continuum of risk and value-based models. Certainly the larger, more sophisticated practices typically are best positioned, and they have the technology and infrastructure and operating model to do that. While we've seen fairly consistently the last couple of years, about a third in full value-based, like you said, and another third in some form of value-based arrangement. The percentages have stayed relatively similar, just the sheer growth that we've seen in MA membership has resulted in significantly more members being served by those models over that time.
While we have a third that are technically not in value-based models and a third that are in some form that doesn't include downside risk, we continue to work with those providers to move them across the continuum. As they see success in, say, a rewards program or upside only, they tend to get more comfortable with full risk, and we'll continue to support them. As you said, even those that operate in a traditional fee-for-service model, we would still provide them through, you know, interoperability information so that the point of care, they can understand the gaps that are open, try to get those addressed in real time so that they can still, you know, continue to perform well for us and address those needed gaps in care.
You know, as we think about utilization, you know, a couple topics I really wanted to touch on here. You and I had a great conversation post Q3 where we talked about flu, we talked about respiratory illnesses and, you know, your anticipation that we would see it at some point over Q4 and into Q1. I think many of you know that we've been following flu weekly and trying to really understand how this is all gonna play out, and it seems like it may have peaked.
Mm-hmm
... in the second week of December, so maybe a little more in the December quarter. You and I had a conversation earlier that we've never seen, a double flu season.
Correct.
I'm not sure that we won't have a double virus season after we're all back together, 8,000 of us together here. maybe just talk about how to, one, think about flu, and then I have some other questions around how to think about some other utilization trends.
Sure. The last commentary we provided was on our third quarter call and shortly after, where at that time anyway, we were still seeing lower flu volumes and COVID than we had anticipated. We have been clear that really throughout COVID, we've seen historically low levels of flu, and there was this question about would they ever return to pre-COVID levels, and if so, would it be a snap back, or would it progress over time? As we thought about our 2022 estimates going into the year, we did assume some incrementally higher flu for 2022 than 2021. We did not see that in the first quarter. In fact, we saw lower flu than we anticipated. Initially, we're expecting still low results in 4Q, although we did anticipate some uptick relative to what we saw in Q1.
Through, you know, really Thanksgiving, I would say, we continue to see lower levels than anticipated. You did start to hear some of the case rates uptick. Right as Thanksgiving hit, we unfortunately did see an uptick in hospitalizations for, frankly, both flu and COVID. You've heard us comment for the last two years on how every time we see a COVID spike, we would see an offset in non-COVID utilization. I would say right around Thanksgiving, we didn't see quite the full offset, so we did see higher overall admissions than we would have expected. Our view of that, though, is largely that during that timeframe, you usually see about a 20% reduction in admissions just because of the holidays and fewer scheduled procedures. There was some capacity you could inherently tap into.
While we didn't see increasing APT trends, it was higher than we had initially expected because of flu and COVID, because they could take advantage of that. We have, though, as you said, seen flu come down starting in December, it does appear that the U.S. is following what we saw in Australia, which is an earlier start to the flu season, an earlier peak, and then hopefully a continued decline. As you said, we have studied the data, we have never had a double flu peak, so hopefully that will not happen for the first time this year, and assuming that's not the case, we actually should have some positivity in the first quarter of 2023 relative to what we would have originally expected because the peak has occurred in December, and we were anticipating that it wouldn't occur until January.
We hope to continue to see that flu decline. COVID has plateaued, which is good as well, and we'll have to see sort of what that does. That has plateaued and we, back in December, have started to see some of that offset that has been so consistent for us.
You reiterated 2022 guidance today.
Mm-hmm.
As we think about inpatient/outpatient utilization levels compared to your initial expectations, can we just talk about how things came out for 2022? Are you looking for any pent-up demand as we start to think about 2023?
For 2022, one thing that's important to note is that looking at 2022 and heading into the year, you had to fully assess and account for the impact of mortality as a result of COVID on claims trend and the resulting morbidity of the population. We really think we were probably ahead of some others in fully analyzing that. Deceased rates were up about 25% as a result of COVID. While that doesn't maybe sound like a lot on an absolute sort of number basis, it's quite significant when you think about the impact to both risk scores and revenue yield and claims trend, because the individuals who are more susceptible to pass away due to COVID tended to have multiple chronic comorbidities, much higher than average risk scores, and much higher than average claims.
All of that we assessed and built into our expectations for trend in 2022, that resulted in some negative premium yield discretely and negative claims trend. As we saw claims develop over the course of the year up until the fourth quarter, which I'll comment on separately, we continue to see even better medical cost trend than we had anticipated. As we analyze the source of that, what we found is our estimates around morbidity and mortality were actually spot on. Like, we got that right. The source of the favorability was largely improved performance from our utilization management programs, and better than expected results, continued inpatient to outpatient movement. Our initial expectations were that it would be relatively flat because CMS had reinstated the inpatient-only list, and we thought provider behavior would shift procedures back to the inpatient setting more broadly.
We were very pleased to see that we continued to see movement of particularly orthopedic and musculoskeletal to the outpatient setting, and then flu in the first quarter, as I said. That was really consistent throughout the first three quarters of the year. As we got into the fourth quarter, again, we were seeing that until Thanksgiving. We did then see the uptick with flu and COVID, as I said, that did result in overall higher admissions than we had expected. We also had to deal with, some of you may have seen CMS changed the reimbursement for 340B.
Yeah.
It was effective as of September 28th. That's not small. That's discretely impacting the fourth quarter. It does not carry into 2023 but will impact us discretely in the fourth quarter. Previously we've shared that we thought the consensus on MLR for retail and consolidated was in line with our expectations. We now think that we will probably come in slightly above consensus for the fourth quarter because of those dynamics and because of the fact that we wanna maintain the reserve strengthening that we've commented on, in the third quarter and earlier this year.
We don't wanna compromise that just for the sake of, you know, fourth quarter MLR when these are discrete things in the quarter that do not have any carryover impact into 2023, and that's why you saw us reiterate our guidance this morning for 2023, because these items are just discretely one-time items that we'll deal with in the fourth quarter. Your question about pent-up demand, I would say where we've seen some of that has historically been where you've seen really high spikes in COVID throughout the pandemic. After that, we would see within discrete service categories, typically, you know, elective surgeries as well as chemotherapy. We would see some what we'd call above baseline utilization, but then it would typically, in a reasonable period of time, come back down.
We haven't had any of those major surges of COVID in a while. Our view would be that there really isn't pent-up demand that we have to be concerned about. What we are more concerned about is the rebound in healthcare capacity. You know, we all know that there's some level of constraint within staffing that's having an impact on utilization. We have anticipated some return of that capacity and resulting utilization in 2023. Although we do think it'll take a number of years before it fully restores to pre-COVID levels, but we are anticipating incremental healthcare capacity returns in 2023.
What about acuity levels? Like we've heard other managed care companies talk about that perhaps if you put off a surgery last year, now that you need some. You're not gonna get a second surgery, right?
Mm-hmm.
Maybe it's going to be a higher level acuity surgery. Are you anticipating that going into 2023?
We haven't seen anything that we would call an outlier.
Okay.
Anything of significant concern. I mean, it really is interesting the impact of mortality. The morbidity of the population is much lower than it used to be, and it will take a number of years for that to, frankly, even get back on par with where it was pre-COVID. You know, again, the pent-up demand, we feel like, you know, has worked its way throughout the pandemic. We and our primarily our values providers worked really hard to make sure members were getting the care that they need. They were staying medication adherent.
Mm-hmm.
We were making sure they had access to food and other things, you know, getting their vaccines and screenings and everything else once the system opened back up. So far, we haven't seen anything. There have been some reports that, you know, suggest that if you had COVID, you might be more susceptible of, you know, mortality or heart attacks, in particular cardiac events subsequent to that. We have analyzed that. So far at least, we haven't seen that within our population. We'll certainly continue to monitor it. I would say, you know, anything, you know, in terms of the trends that we've anticipated for 2023, we feel really good about.
You know, a couple topics out of D.C. You know, first would be just MA rates.
Mm-hmm.
for 2024. We'll hear about the preliminary rate in the first part of the year and then the final rate. I've heard you talk in the past that you believe that this is gonna move more towards normalization than what we've seen in the last few years. Maybe just explain your line of thinking of what you think the rates could potentially look like for 2024.
Yeah. In general, I would say our view, which we said this last year, so take that for what it's worth, because we got it wrong last year. What our view is that, you know, we've benefited from some favorable rate notices the last couple of years. We didn't necessarily anticipate that that would be as strong in 2023, and that proved to be wrong, and it was quite strong. We continue to maintain that we don't anticipate that that sort of 4% plus rate environment will necessarily continue long term. At the same time, there continues to be bipartisan support for the program. You know, nearly 50% of all Medicare beneficiaries have chosen Medicare Advantage. There's, you know, a strong desire to maintain stability in the program. We certainly think it'll be more modest.
You know, we would say something in the 0% to 2% range, would not be unreasonable to expect. In that environment, we think that we can continue to deliver and maintain the strong value proposition and industry-leading growth that we've seen this year. However, as you think about 2024, there is some complexity that we anticipate will come through the rate notice. You know, what I just described on mortality and morbidity, I'm not convinced that that was fully factored into the 2023 rate notice, that came forward. So if there is some sort of negative restatements that come through this year's rate notice, the thing that should offset that, based on our analysis, is the normalization factor, and that factor is designed to return the risk score to a 1.0 average.
The last couple of years, that has been a negative adjustment as the risk scores creeped up, as the demographic population ages and risk scores progress. They've had to bring it back down to a 1.0. With COVID, as I mentioned, because of the individuals who passed away had a much higher than typical risk score, it's now dropped below 1.0. In theory, you need a positive normalization factor to bring it back. What you saw on the 23 rate notice is for the first time, they did not bring in 2021 data into the normalization factor. They explicitly said they didn't do that because of the impact of COVID and noise they believed was in there. That's all true. It just doesn't go away. It's still there.
When they do that adjustment this year and bring that data in, if we do see some negative impact in terms of restatements to trend, we would expect then that you would see mitigation through the normalization factor, which should also acknowledge the impact. And there's other complexity of how do they think about the cost of COVID treatment, you know, Paxlovid and vaccines and things where at least initially we're hearing that they may be priced higher than, you know, what they've been charging the government. Those are all things we'll need to understand how CMS has considered in the rate book, as well as just the inflationary environment. What do they assume for provider reimbursement changes, which, as we all know, unfortunately don't get set till after the bid.
It's something we'll need to be thoughtful about as we develop our pricing for 2024.
Great. you know, the other big topic in D.C. is February first, RADV the ruling is supposed to come. I think probably a lot of people in this room know and understand this, but how is Humana thinking about it, and what are gonna be the key variables for us to watch when that announcement comes?
Sure. Lots of interesting questions. We have the same interesting questions as all of you. Unfortunately, you know, CMS has not really engaged with the industry since the comment period has closed. We don't really have any visibility into how they're thinking about it. When the proposed rule came out, I think Humana and everyone across the industry was fairly consistent in our feedback to CMS. Our issue with the proposed rule fundamentally was related to whether or not they acknowledge the need for a fee-for-service adjuster in the RADV program. We absolutely think a fee-for-service adjuster is needed. The proposed rule suggested that one was not. That's really where the commentary focused.
What we'll be, you know, they did send something to OMB for scoring, so it does appear that they've have something that hopefully they're prepared to release prior to the 2/1 deadline that they've set. What we'll be looking for is hopefully an acknowledgement that a fee-for-service adjuster is necessary to recognize the inherent error rate that's in sort of all claims datasets within Medicare. Assuming that they do acknowledge that, then the question will be, okay, how is it calculated, how is it defined, and we, do we view it as sufficient based on sort of our own analysis? That'll be complex and require, you know, assessment of exactly how they defined it. You know, is it retrospective, is it prospective? How are they going to run the audit programs going forward? How will they extrapolate the results?
There's a lot of complexity that we'll have to work through, but primarily we'll be looking for an acknowledgement of the need for an adjuster and then hopefully, you know, able to assess the fact of whether it's reasonable or not. If they take a position that an adjuster is not necessary like they did in the proposed rule, then I think as we and others have said, the industry is likely to resolve to litigation as a way to ultimately resolve it, which will tie us all up in litigation probably for a number of years.
I think, you know, the question we've gotten around that, and I think you've heard this question as well, does that put a stay on this? Like, what would happen if you were to litigate as an industry?
It's a great question. I mean, there's no way to know. We'll have to evaluate from a just legal perspective, what the options are and the likelihood of that prevailing. I would say there'd also probably be a very strong public policy response to it. If it was something terribly onerous that was going to impact 2024 pricing for beneficiaries, I think you'd see a very strong sort of public policy reaction to that and say, "Look, is this really what you intend to do?" Try to seek some relief there as well. It's complicated because so far, CMS has only audited through 2014. This is all sort of well in the past. The question is, whatever they decide to do, are they gonna now go back and audit 2015 through current?
You know, arguably, that's all about whether or not there's any obligation that we would have retrospectively, and is there a liability associated with that we'll have to deal with. In terms of 2024, who knows when they might audit 2024, and that's what you would arguably bake into pricing. I think what you can expect from us is if it's an onerous position by CMS, I think what we would say is, look, we're not going to, you know, have a really negative impact to pricing that we're gonna prefer if there's real uncertainty about what's gonna happen. I think we'll let it play out. If they come out and acknowledge the need for a fee-for-service adjuster, and it's reasonable, then this is an administrative burden, but a non-issue.
From all the work we've done, there's no reason to think that the error rate within MA is any higher than fee-for-service, and frankly, it should be lower based on all the things we do to ensure accurate coding and documentation. If they come out and say they acknowledge the need for an adjuster, but we think it's insufficient, that's where it's a little bit grayer. If it was sort of reasonably close to what we thought was necessary, maybe the industry just says, "Look, we'll just price for it and move on to just get this past us." If it's viewed as materially insignificant, I think we're back in the square of, okay, you know, we're gonna have to reduce the litigation.
I would say we're not going to do anything highly disruptive, you could probably expect for something that is highly uncertain in terms of the ultimate resolution.
You know, one other thing that's come up when we think about 2024 pricing is that, Eli Lilly's Alzheimer's drug.
Mm-hmm.
is projected to get approval. There could be pricing from CMS. How do we think about big drugs like that and the timeline of that and how you'll absorb that as a health plan?
Right now, all of these drugs are covered by the NDC that's been issued for the class. There are some significant limitations in terms of how to access those drugs as a result of that. It has to be part of a randomized controlled trial. You have to have certain sort of tests, you know, tests run to sort of validate the presence of certain things. Based on all of the limitations in place currently, our belief is that you will see very low uptake and utilization. It's really not a material item. We do think some of these manufacturers may look for, you know, go back and ask them to reevaluate the NDC. That tends to be a longer process, probably 6 or more months. We'll have to evaluate if that would occur.
You know, it opens up in terms of the utilization, it goes back to, okay, well, let's trigger the significant cost policy, which does provide some insulation for us until we can get it into pricing. You know, longer term, as these drugs go through trials, if they do prove to be effective, that's something that obviously the industry would look to price into its products, going forward.
You know, you started the conversation today talking about CenterWell, right?
Mm-hmm.
Talking about some of those businesses. You have many irons in the fire today as it pertains to primary care with investments in Cano Health, Oak Street Health. You're building out the CenterWell clinics de novo and through your JV relationship, building centers both inorganically. When we think about your current strategy, and we think about opening large primary care deals or continuing this de novo, like is there one preference that you have versus another? Do you see M&A opportunity in the marketplace?
Yeah. I think as we laid out at Investor Day, you know, we continue to support the continued de novo expansion, which we feel really good about. As I mentioned on the MA side, you know, we saw strong growth in the health plan side, and some of that benefits our CenterWell assets as well. We grew in areas where they have a strong presence as well. As I think I mentioned, you know, we expect to see sort of two times the growth this AEP versus last.
We feel really good about sort of their continued ability to demonstrate that they can deliver against that J-curve that we shared with you at Investor Day, which in the early stages for de novo is all about sort of patient panel growth and then getting engagement with those members and then sort of building risk for progression and health outcomes over time. We feel really good about that. They intend to open, call it, roughly 30 centers a year, and we think just given sort of all that, as you said, that they're managing, that that's sort of the right level of ambition for them to make sure that we can sort of do that well and continue to deliver against expectations. The same time, though, they do intend to continue to focus on probably more smaller to mid-size tuck-in M&A.
We've described before that we had some creative contracting provisions sort of early on, particularly in Florida and Texas, that give us the right of first refusal around a lot of these primary care assets. If they have come to market, you know, it's provided a really nice pipeline, and attractive economics for us to integrate those assets into our existing portfolio. You'll see us continue to do that. I would say we'll continue to look at other platforms and if larger ones, you know, come to market. You know, we've had a lot of questions about this previously, and certainly valuations at one time were somewhat prohibitive. You know, they'd be highly dilutive, typically, particularly those that are growing. That would be a challenge for us. Obviously, valuations in some cases have come way down.
We'll certainly always look at those. We would be looking for, you know, can it strategically advance, you know, our capabilities. Can it address sort of a geographic area of interest? You know, certainly look at it from a defensive position if we had any concerns. I would say, generally speaking, you know, we're less interested in the larger scale opportunities. We just feel really confident about what we've been able to do organically, and as we've demonstrated historically, you know, continue to be efficient with our deployment of capital, creative in how we thought about partnerships there. I think you'd continue to see us look for ways to do that, but probably continue to focus on smaller to midsize tuck-ins.
You touched on Home Health earlier. I think you said 750,000, 14% penetration, getting to 50% over time on the Home Health side. At your Analyst Day in September, you talked about the three healthcare services, CenterWell, Home Health, and Pharmacy could drive two to four times higher margins. You noted that at that time, there were very few that utilized all three.
Mm-hmm.
Right? Can you give us an idea of, like, the timeline to get more of your population onto that platform, to be able to achieve that margin improvement?
Sure. We laid out some of our ambition here at Investor Day, too, and recognize it's sort of early innings in this work. We do have now dedicated leadership and staff that's focused on this. I would say, historically, we've approached it more sort of discreetly. Each line of business sort of did its own thing to try to drive, you know, penetration and whatnot, but not in as coordinated a way as we could, and certainly not thinking through how we can truly sort of improve the experience and data sharing and interoperability and many other things that could actually accelerate some of that adoption. We now have that infrastructure in place. The pharmacy asset is certainly the most mature. We've had that for, you know, quite a long time, and so we have industry-leading penetration.
We demonstrated that when we're focused on it, we can drive that utilization. In terms of CenterWell Primary Care, that's been more of an issue of just expanding the footprint, which we continue to be focused on. As I mentioned, you know, we're really pleased with some of the strong growth that they'll report this year. As the number of members in our primary care assets continues to grow, that really is, I would say, our greatest opportunity to drive then that integrated sort of experience that we're looking for. If you can get primary care, they sort of hold the string. Like, they can control so many other things. They can refer into CenterWell Pharmacy, they can refer into CenterWell Home Health, you know, based on the benefits they know will be received through that.
We do have our primary care assets very focused on for the patients that they're managing. You know, CenterWell Home Health is one example. We'll roll out the value-based model, and that will inherently get more people in the model. What we really wanna see is the CenterWell primary care physicians then work with our home health assets to say, "Okay, why when you were serving my patients, why are they seeing a readmission? What is it that's needed? And if you brought us in, you know, the primary care physician, could we offer another alternative that would keep them at home and avoid that readmission?" That's what we're hoping to accelerate, is really deeply understanding the drivers of some of those adverse outcomes and see what intervention's required and do those assets give us the ability to offer an alternate intervention.
While, you know, we don't have a lot to share yet, we do think over the next couple of years, as we have more patients using multiple of those services and we increase our learning, that we'll be able to share with you what are the outcomes that we can demonstrate, both in terms of reducing total cost of care and admissions, but also just deeper engagement, which should lead to better Star Scores, which should lead to better revenue yield, and then hopefully retention and other positive benefits both for the health plan and healthcare services over time.
Susan, as we sit here today, you're in a great position, right? You know, you just came out with membership numbers that were far better than we expected. When you think of the lineup of those members, better than, you know, kind of bringing on new members. You talk about this whole healthcare strategy that you have. What do you think investors don't understand today that you'd like them to understand better over the next 12 months about Humana?
I do think Investor Day went a long way to sort of better educating everyone on the breadth of the capabilities that we have. I think prior to Investor Day, you know, understandably, a lot of the focus was on the Medicare Advantage health plan, which it should be. It will continue to be the largest driver of earnings and EPS progression. We hadn't shared a lot of detail on our primary care capabilities in particular. Certainly as other, you know, assets came to market and the industry and investors better understood the value of those assets, then we said, "Well, gosh, we've got the biggest one and the most mature one," and people sort of scratched their heads and said, "Well, gosh, you don't get any value for that." We agreed.
That was really the goal of Investor Day is to make sure everyone understood the breadth and depth of those assets, what the current sort of expectations were for those assets, and why you didn't see more earnings contribution, but yet, you know.
Right.
demonstrate the value of those assets and then show what our expectations are much longer term and the contribution you can expect more sort of post 2025. I think what we will continue to try to do is demonstrate proof points and demonstrate that we are on the trajectory we laid out, so that you can have confidence and continue to build your confidence that that value is coming. So long as we're gonna be measured and valued based on earnings sort of contribution...
Yeah.
We need to get past that 2025 date when those assets will really start more materially contributing to our earnings progression. I think for now, there's still probably some skepticism about, okay, well, is that really coming and when?
Right.
I think we'll continue to look through our disclosures to show additional proof points that demonstrate we're on the trajectory we told you about and are able to create the long-term value.
Well, I'm looking forward to it. Thank you very much for joining us today.
Yep. Absolutely.
Thank you. It was great. Thanks so much, Susan.