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Humana
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Over the last several years, the majority of Humana's enrollees have been in state- or federal-government-sponsored programs. As seen in the top figure, historically, members of these programs have constituted some 50-55% of Humana's membership; ... that number has recently jumped to 70%. Humana currently offers four government-sponsored programs:
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Humana Inc., headquartered in Louisville, Kentucky, is one of the nation's largest publicly traded health benefits companies, with approximately 11.3 million medical members. Humana offers a diversified portfolio of health insurance products and related services - through traditional and consumer- choice plans - to employer groups, government-sponsored plans, and individuals.
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It is difficult to quantify just how much extra revenue Humana has forfeited by its slow bundling uptake. However, a comparison with bundled-insurance leader Aetna shows Humana with a relatively high MLR (84% in 2006), while Aetna's MLR is much stronger and lower (75% in 2006). While other differences between the two companies surely contribute to this 10% gap, it is safe to assume that bundling has a significant positive effect on lowering the ratio of medical costs to premiums paid.
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The plaintiff challenged managed care not on the basis of denial of care but because Humana failed to exercise ordinary care in performing its obligations in managing care. In this respect, plaintiffs presented evidence that Humana failed to follow its own Member Handbook, Physicians' Administration Manual, and internal guidelines, policies and procedures. The jury found that Humana did not apply case management to Joan Smelik as a process of identifying patients with "chronic or potentially catastrophic" diseases. Case management was ... supposed to deal with patients with complex diseases. Mrs. Joan Smelik was a complex patient who according to Humana never hit the "triggers" to qualify for case management. Humana's own computer records for Mrs. Smelik showed that Humana knew of her diseases even down to the size of each of her small kidneys, which were indicative of "chronic" kidney disease.
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Humana made two significant acquisitions in late 1997. In September the company acquired Physician Corporation of America (PCA) for $290 million in cash and the assumption of $121 million in debt. PCA had a total of 1.1 million members in its HMOs, with 324,000 in Florida alone where Humana already had 1.1 million members. Humana ... gained large plans in Texas and Puerto Rico. In October 1997 Humana bought ChoiceCare Corporation for about $250 million in cash. ChoiceCare managed the largest HMO in the Cincinnati area, which had about 250,000 members.
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Humana Inc. was founded in 1961 in Louisville, Kentucky as a nursing home company. At that point of time, Humana was known as Extendicare. The corporate name was changed to Humana Inc. in 1974. Today, Humana is a growing company driven by innovation.
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