Literature Review

Cigna considers Humana acquisition – What it means for the stocks MarketBeat; by Jea Yu; 10/29/24 There has been speculation of a massive merger in the medical sector between two massive health insurers. Specifically, the rumor is The Cigna Group NYSE: CI is interested in acquiring Humana Inc. NYSE: HUM. The conjecture caused both stocks to react, as Cigna stock fell 10% as the rumored surfaced on Oct. 18, 2024, and Humana stock remained relatively flat. Based on the reactions, the market doesn't see this as a favorable merger, and for good reason. While there are many potential synergies in a merger, assuming it passes the regulatory antitrust sniff test (which is a big "if"), there is also a major sticking point that sinks any possibility of it coming to fruition called Medicare Advantage (MA). 

Researchers raise concerns about the financial sector's rising role in US illness care Medical Xpress; by Mary Ann Liebert, Inc; 10/16/24 The authors of a new article in Journal of Palliative Medicine state that the "growing role of the financial sector in home health and hospice, a reflection of larger trends in U.S. health care, is concerning and has major implications for care quality unless reforms are undertaken." Co-authors Lauren Hunt, Ph.D., RN, FN, with the University of California, San Francisco, and R. Sean Morrison, MD, with the Icahn School of Medicine at Mount Sinai in New York, observe that home health and hospice began as nonprofit organizations with close ties to their communities. However, the overwhelming majority are now for-profit entities, many of which have become targets for private equity buyouts. The authors note that "big business's emphasis on maximizing profit can be at odds with patient welfare. Indeed, a substantial body of evidence now demonstrates that care quality is consistently worse in for-profits as compared to nonprofits," they state. The authors further express concern that "pressure to achieve high returns on very short-term time horizons may conflict with the need for longer-term investments in quality, training, and staffing, thus reducing care quality.

2 years after its rebrand, CenterWell Home Health is set on tackling big goals Home Health Care News; by Andrew Donlan; 9/24/24 Kirk Allen, the president of home solutions at Humana Inc., is living a home health veteran’s dream. Right now, he is heads down on helping create a value-based home health model within CenterWell, Humana’s provider services arm. Home health leaders have always touted the extraordinary health and monetary value that can be derived from their services. Not many have had the opportunity to prove that out, however. Allen does. Humana owns CenterWell Home Health, which is one of the largest providers in the country. CenterWell also includes CenterWell Pharmacy and CenterWell Primary Care. Eventually, CenterWell Home Health wants to have 80,000 home health patients under its value-based model. ... After Humana fully acquired Kindred at Home, it divested the home care and hospice assets. With the large and remaining home health footprint, Humana created CenterWell Home Health.

Here's what for-profit systems are watching as 2025 approaches Modern Healthcare; by Caroline Hudson; 9/9/24 ... Executives from HCA Healthcare, Tenet Healthcare, Community Health Systems and Universal Health Services joined insurers, pharmaceutical companies and others in the spotlight this week at the annual Wells Fargo Healthcare Conference in Boston.  Discussions ranged from upcoming capital projects to supplemental payment programs. Here are five takeaways from the for-profits' discussions.

Antitrust lessons for healthcare roll-ups – and everyone else Competition Policy International - CPI Columns US & Canada; by Lauren F. Dayton & Swara Saraiya; 9/12/24 ... The practice described in the U.S. Anesthesia Partners suit, known as a “roll-up,” is a common strategy employed by private equity firms through which smaller businesses in adjacent markets are acquired and consolidated. Large healthcare networks acquire smaller practices for similar reasons. That consolidation enables companies to build a greater presence, operate more efficiently, and can allow them to attract better talent. But that same consolidation can also create the risk of anticompetitive effects. The FTC’s suit is noteworthy because federal competition regulators have historically focused on the companies themselves, not their financial sponsors. The case is in step with statements by competition regulators about increased scrutiny of the healthcare industry, and of acquisitions by private equity firms, in particular. ...

25 fastest-growing healthcare companies of 2024 Becker's Hospital Review; by Giles Bruce; 8/13/24 The Inc. 5000 list of the fastest-growing private companies in 2024, released Aug. 13, includes 320 that focus on health services. The magazine ranks the companies by percentage revenue growth over the last three years. Here are the top 25 health services firms that made the list this year (and where they rank): [Click on this title's link to continue reading]

Risky business: Home sweet home or nursing home? American Nurse - Perspectives; by Christopher Hirschler, PhD, MCHES; 7/18/24 In 2018, “Nursing homes: Good intentions, sad realities” chronicled Rita Hirschler’s experience in a nursing home after decades of being a private care nurse. In response to the ideas espoused in the article, namely that a person has a right to live and die in their home and risks are unavoidable whether one lives at home or in a nursing home, a commentator asked, “What is the solution?” ... According to the Center for Medicare Advocacy and Lu and Lu, ownership and sponsorship type have been shown to significantly impact the quality of care in nursing homes, with for-profits generally having lower staffing levels and poorer patient outcomes. The Centers for Disease Control and Prevention, Meyer, and KFF Health News say for-profit nursing homes now account for approximately 72% of the more than 15,000 U.S. nursing homes, and they provide varying levels of care to 1.3 million residents. 

Apply now for AHA’s 2025 Circle of Life Award recognizing end-of-life and hospice care providersAmerican Hospital Association press release; 5/30/24Applications are open through July 24 for AHA’s 2025 Circle of Life Award, which recognizes hospitals and health systems that advance end-of-life and hospice care that is safe, timely, efficient, effective and equitable. There will be up to three recipients of the award, and Citations of Honor may also be presented to other noteworthy programs.

Silverstone Health expands care continuum beyond hospice, sees skyrocketing census growth Hospice News; by Jim Parker; 6/19/24 Dallas-based Silverstone Health has expanded its continuum of home-based services while growing its total daily census from 17 patients to 2,000. Silverstone came on the scene in 2020 as a standalone hospice after CEO Alfonso Montiel’s purchase and rebranding of Comfort Care Hospice in the Dallas-Fort Worth region. Since then, the company has built a palliative care service and is developing a personal care business. In the interim, Silverstone also acquired two small home health agencies for undisclosed amounts, as well as a physician group, according to Montiel. 

Stepped palliative care for patients with advanced lung cancer: A randomized clinical trialJAMA; by Jennifer S. Temel, MD, Vicki A. Jackson, MPH, MD, Areej El-Jawahri, MD, Simone P. Rinaldi, MSN, ANP-BC, ACHPN, Laura A. Petrillo, MD, Pallavi Kumar, MD, Kathryn A. McGrath, MD, Thomas W. LeBlanc, MD, Arif H. Kamal, MD, Christopher A. Jones, MD, Dustin J. Rabideau, PhD, Nora Horick, MS, Kedie Pintro, MS, Emily R. Gallagher Medeiros, RN, Kathryn E. Post, PhD, RN, ANP-BC, Joseph A. Greer, PhD; 6/24A stepped-care model, with palliative care visits occurring only at key points in patients’ cancer trajectories and using a decrement in QOL to trigger more intensive palliative care exposure, resulted in fewer palliative care visits without diminishing the benefits for patients’ QOL. While stepped palliative care was associated with fewer days in hospice, it is a more scalable way to deliver early palliative care to enhance patient-reported outcomes.Publisher's note: This article was reference earlier this week in Palliative care for cancer patients is found to be as effective given virtually as in person.

Transformative peer connections: Early experiences from the ASCO Palliative Care Community of Practice American Society of Clinical Oncology; by Mazie Tsang, Cristiane Bergerot, Natasha Dhawan, Rushil Patel, Darcy Burbage, Tingting Zhang, Jafar Al-Mondhiry, Joseph McCollom, Ramy Sedhom; 5/22/24 online ahead of print in June 2024  ... there are barriers to implementing palliative oncology at many institutions for myriad reasons. ... In this article, we discuss an innovative strategy that ASCO implemented called the Communities of Practice (CoP). We share our experiences as the Palliative Care CoP and how our group seeks to develop processes and structures to collectively promote systemic change and enhance palliative care delivery for people with cancer. Our Palliative Care CoP engages with senior leaders, administrators, and those in power to achieve a shared vision of delivering holistic health care for people with serious illness. ... [We address] eight main domains:

Aveanna is looking to grow in its ‘rightsized’ home health segment again Home Health Care News; by Andrew Donlan; 5/14/24 Aveanna Healthcare Holdings leaders believe the company is back at a place where it can bank on near-term growth in its Medicare-certified home health business. It first entered into a business “transformation” in January 2023, and that transformation is already paying dividends, according to CEO Jeff Shaner. But much of the turnaround has been led by the private-duty services segment. Now, Shaner sees a path for the company to begin accelerating its home health and hospice lines. 

Addus HomeCare expects 2024 acquisitions Hospice News; by Jim Parker; 5/7/24Addus HomeCare Corp. is poised for further acquisitions, potentially including some hospice deals. The company is seeking to pair its clinical services with its personal business in its existing markets. This is a cornerstone of its acquisition strategy. But Addus Chairman and CEO Dirk Allison does not rule out the possibility of moving into new markets if circumstances are right. ... When examining new markets, Addus focuses on regions where they can quickly become the largest or second-largest provider by market share, according to CFO Brian Poff. ... Addus’ roughly 33,000 employees provide hospice, home health and private duty nursing services across more than 200 locations in 22 states.