A central theme in Humana’s plan for boosting Medicare Advantage profitability in the future is a strategy its peers have relied on for over a decade: coaxing members in for their annual wellness visits.

The Medicare Advantage business has come under fire in recent months for its outsized impact on the federal budget, and the potentially billions of dollars that could come from limiting insurers’ tactics for maximizing their government payments. Against that backdrop, Humana leaders who spoke at the company’s investor day Monday made the case that there’s still money to be made on the private form of Medicare for older adults, and the answer lies in doubling down on time-tested strategies. 

“It’s been talked about quite a bit that these annual wellness visits may not be a good thing,” George Renaudin, the president of Humana’s insurance business, told the audience gathered in Louisville, Ky., where the company is headquartered. “That’s not true. Our annual wellness visits, the at-home visits, are loved by our seniors. They love the convenience of them. They love the personalized attention they get to be able to talk about their intimate health conditions in the comfort of their own homes.”

Medicare’s annual wellness visit, created by the Affordable Care Act, was envisioned as a way to allow doctors to take a broad inventory of their patients’ health conditions. The reality, in many cases, is insurers use the visit as a way to tack on lucrative diagnosis codes, since patients who appear sicker on paper draw higher government payments. STAT wrote last year about how the country’s largest Medicare Advantage insurer, UnitedHealth Group, used bonuses and peer pressure to convince doctors to perform annual wellness visits on their patients. Some patients got $75 gift cards for completing the visits. 

In Humana’s case, meeting the company’s goal of increasing annual wellness visits will entail a “new, innovative” partnership with the company’s primary care subsidiary and “embedding clinical insights” into providers’ workflow system, Lisa Stephens, the chief operating officer of Humana’s insurance division, said at the investor day. The approach will be comprehensive. If a member dials into a call center to ask about their benefits, workers will be instructed to ask whether they’ve had their annual wellness visits. 

“We recognize that life gets busy and we’ll schedule the visit right while we have you on the phone,” Stephens said.

UnitedHealth took a similar approach in its first quarter earnings call in April, in which then-CEO Andrew Witty pledged to double down on “engagement,” which refers to adding more diagnostic codes to patients in visits at their homes or clinics. Witty stepped down the following month. 

One concern with annual wellness visits is that they lead to higher payments for insurers but no additional care for their members. A federal watchdog last year found that insurers collected an estimated $7.5 billion in 2023 from diagnoses added during health risk assessments — a part of the annual wellness visit — and chart reviews, that didn’t have any other record of treatment. Humana received the second-highest amount after UnitedHealth. 

Jim Rechtin, Humana’s CEO, urged the investor day audience to view the company not just as a health insurer, but as a senior services business. Not only is Humana the second largest Medicare Advantage insurer, but it also runs a large senior primary care business under its CenterWell brand. 

The focus now, Rechtin said, is returning the company’s Medicare margin to a sustainable level. Historically, the company has done that by beefing up its benefits to attract more members — a plan that backfired last year when members used their benefits more than the company expected. 

Going forward, Rechtin said the emphasis will be on ensuring that members get “accurate” diagnoses, follow-up care, and improved clinical outcomes, which ultimately will lower the company’s expenses. 

“Benefits tend to attract new members, service tends to keep them,” he said, “and better economics for this business comes from managing growth with retention first. Retaining a customer across multiple years where you can have a bigger impact on their care … that is really what drives the business.”