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Humana Inc. (NYSE:HUM)

June 12, 2013 2:20 pm ET

Executives

Steven E. McCulley - Principal Accounting Officer, Vice President and Controller

Regina Nethery - Vice President of Investor Relations

James H. Bloem - Chief Financial Officer, Senior Vice President and Treasurer

Analysts

Matthew Borsch - Goldman Sachs Group Inc., Research Division

Matthew Borsch - Goldman Sachs Group Inc., Research Division

Okay. All right, we're ready to get started here in day 2 of the Goldman Sachs healthcare research conference. We are delighted to, again, welcome Humana. Humana's been here for many, many years at our healthcare conference. And we have representing the company today Regina Nethery, Head of Investor Relations, who many of you know; Jim Bloem, Chief Financial Officer; and Steve McCulley, the Treasurer -- treasurer?

Steven E. McCulley

Chief Accounting Officer.

Matthew Borsch - Goldman Sachs Group Inc., Research Division

Chief Accounting Officer. I'm sorry. Close...

Regina Nethery

Jim's the treasurer.

Matthew Borsch - Goldman Sachs Group Inc., Research Division

Jim's the treasurer, right, okay. All right, with that as a clarification, with -- I have to read a disclosure. We're required to make certain disclosures in public appearances about Goldman Sachs' relationships with companies that we discuss. The disclosures relate to investment banking relationships, compensation received or 1% or more ownership. I'm prepared to read disclosures for any issuer now or at the end of this session if anyone would like me to. However, these disclosures are available in our most recent reports available to you as clients on our firm portals. In addition, updates to those disclosures are available by ticker on the firm's public website at gs.com. In addition, disclosures applicable to research with respect to issuers, if any, mentioned herein are available through your investment representative. And finally, as always, views of non-Goldman Sachs personnel may not represent the company views.

Well, with that, let me -- we can talk about 2014. But before we get into that, maybe I can just turn it over to you for a little bit of an update of how you think things are going this year.

James H. Bloem

Okay, thanks. And Steve and Regina and I are very pleased to be here, Matt. And we appreciate that we get the invitation and the opportunity every year.

This year has been a good year. We're off to a good start. As you saw in our first quarter, we exceeded our own guidance and we gave a lot of reasons for that, but the principal reasons were operating reasons. We did have some specials that we carved out and called out. So again, we're very pleased. We think that, that does help 2014 in terms of giving us even more confidence that we have with respect to that based on where we end up will be where we start off.

So anyway, go ahead. If you have a specific question we'd be very happy to answer about '13, otherwise, probably you should just go on.

Question-and-Answer Session

Matthew Borsch - Goldman Sachs Group Inc., Research Division

Sure, sure. No -- so let's get into where we were debating at our breakfast meeting this morning, and that's really about the outlook for 2014 and '15. And I'll just make one thing to be clear, which is I'm certainly not taking a position that is negative towards the long term or even near term that the Medicare Advantage is a great program and that Humana has done a truly tremendous job growing and managing that population. Really, this narrows down to a question about the stock and the fundamentals over the next couple of years as we go through a transition period on reimbursement. And the question is, how rough is that going to be, or not, from an earnings standpoint? So with the process that you are no longer thinking about or talking publicly about targeting a 5% pretax profit margin, how do investors think at this point about the degree of margin sacrifice that may or may not be needed in 2014 and then, again, in '15? Because things don't get easier in '15.

James H. Bloem

Again, I think that those are all very valid questions in terms of we are having the onset of the major provisions of the Affordable Care Act next year, and those do present some headwinds. However, I would come back to say that we have a number of levers that we can go and we can use, and these are the types of things that we've used many years in the past. We've got some new ones this year, but if you look at it, we -- there are 7 quick ways that we could quickly talk about, trend vendors being the first one; MRA documentation and reduced cycle time to get MRA data. The -- so better accuracy and shorter amount of time. We talked about that a lot last year in the second half. And we've reduced that time, that cycle time, to -- from maybe 9 to 12 -- to 9 to 12 months from maybe 18 to 24 months. The other thing is we did very well on the Star ratings, the Star quality ratings, this year for '14. And again, we're -- we have a lot of people working everyday in every market to make sure that we continue to give the customer satisfaction in customer experience, better outcomes, lower cost for that. We pay Medicare rates. So our providers share with us in these cuts in a negotiated way, not in a way that it's just pushed through and down but in a way that talks collaboratively about what the premiums and benefits ought to be. We've made a lot of progress in operating expenses or administrative expense reduction. We would point to the first quarter, I mentioned before that we showed very well our Retail SG&A ratio, which is where the lion's share of our Medicare Advantage and Medicare PDP businesses are, dropped 150 basis points year-over-year. We also showed that same -- a little bit less, probably about 110 or 100, in the Employer Group section, which includes the predominance of which is the Medicare Advantage for group. So we continue to work on that as a -- that's a -- that administrative cost reduction is a product of both effort. There's a big organization aligned, redoubling of efforts. We're always about the business of making sure we get operating leverage but also the scale that we have, the continued ability to enroll more members. And that comes back to your margin. When we said, well, we're going to -- we may or may not relax the 5%, what that really is saying is that -- based on last year's result, the '12 results where we enrolled twice as many as our initial guidance of members, that we saw what that does to the organization's ability to handle those members and get a quick handle on what they're chronic conditions are and their propensities to develop chronic conditions, and to get the MRA documentation going. So we have those. And then so that -- this sort of gets exactly done through these first 5. Now we're up to, well, benefits and premiums. And when we look at benefits and premiums, we look at a situation where we know that we have to continue to offer a superior value proposition to original Medicare, plus a Part D, plus a supplement. And we -- and that will continue to be there because when you think about it, if you have the combination of those 3 things, you're really in an unmanaged situation. You don't have care coordination, you don't have utilization management, you don't have wellness. And so again, we think that. And those things continue to go up sort of in an indemnity-like fashion. So we think that the Medicare Advantage against the original Medicare and those other two, that continues to be a very solid value proposition. So then it comes down to, well, what does Humana do versus the other people who do what Humana does? And again, because of the fact that we're blessed and we've worked hard to earn a second position in market share and a very good position in the major markets where the product has been successful over a long number of years, we think -- and the demographics of people coming in, we think that we've got a very good ability to continue to offer that value proposition, still being the thing where we're better against our competitors because of Stars, for example, and still again continue to have the superior value proposition. So we understand and we've watched very carefully and analyzed closely what you've written since March. And believe me, when it first came out, we were like everybody else, we're surprised by the preliminary rate book. But again, I always want to stress with our owners and with our potential owners that we still get to apply all of those tools to whatever it is that is eventually proposed and accepted by the -- by CMS. And while the -- while that can present challenges, like it does this year and like it did in 2010, but if you look at the amount of the cut that we're working with, the payment reductions that we're working with, 2010 and 2014 look a lot alike. They got that the -- what cost it is very different, but the magnitude and the extent of it are the same. So if we think about it in that -- from that standpoint, we feel that -- again I know a long answer, but we feel that it's not going to all come down to benefits and premiums and headroom. And then of course, the last thing that we have is we have the potential to exit markets that we don't think, over a long period of time, over our new view -- and this is the other reason why we talked about margin and relaxing the 5% because we learned last year that if we enroll a lot of members, the more we can interact and the quicker we can interact over the 7-year average life of a member, the better that member has in terms of outcomes and experience, and the better our results.

Matthew Borsch - Goldman Sachs Group Inc., Research Division

The -- fantastic. And the -- you made a number of points that I'd like to come back to you. But before that, if I could ask you about the -- how we think about the quantity of the value proposition of Medicare Advantage relative to the alternatives. And as you know, we've tended to try to focus on the rebate expenditures given the ready availability of that data across the industry, recognizing that when we look at an industry-average aggregate figure, which today is $71 per capita according to the Medicare Trustees' data that -- that is an average and that it's highly variable across different markets. I noticed that you've added that data yourselves to your website presentation that's available to investors now. Is a rebate the right way to think about the value proposition, or not, I guess, is the question I'm trying to ask.

James H. Bloem

Yes, I look at it and say it is, but it's only one of the factors. And the reason we put it in there is that it's new information. It's the trustees have just published their report. The headline of the press release from CMS was there's cost reduction and there's a lengthening of the life of the trust fund. But we look at it and, again, looking at it from more of a long term that you were referring to before and that I was talking about looking at the lifetime membership, we look at it as the paragraphs in there where the trustees themselves say that, in the short term, they're concerned about the financial adequacy of Medicare and, in the long term, the actuarial soundness. And we subscribe to that and we think that we're very much part of the solution of that. And we think that, given what's happened with the rate book this year and given what's happened with our ability to continue to have success in the Star quality ratings, that we are delivering better outcomes, they are reaching more people, those people are speaking with their members of congress, and we see a message [ph] out to get to more and more consensus in the country around the fact that what we do is very important to the trust fund. And so again, I think you'll see over time there's a melding of this. It's always messy, as your notes have pointed out. It's always very messy. And -- but a -- the other thing about the markets that you mentioned is very important too, that we do all of these things, these tools I mentioned, to offset all of that, whether it's the rebate, whether whatever it is. It's all done on a market-by-market basis. And that really is where I think you can -- you make a value judgment on management and the company's organization ability to do that and to which we say that we've had a fair amount of success, that I would modestly try to say that. But certainly, you would argue we have not -- we're not inexperienced in it given the time we've been in it.

Matthew Borsch - Goldman Sachs Group Inc., Research Division

No, I certainly wouldn't make any of those points. Although, I would dispute that my notes are messy. I...

James H. Bloem

No, I said the situation is messy.

Steven E. McCulley

The only thing I would add there, Matt, is that the numbers themselves, as you pointed out, are just industry averages. And if you've followed us for the last 3 to 5 years, you've heard us talking about the clinical investment we've made in the buildout and the 15% solution. And in terms of the funding, sure, we've got more headwinds in '14, but we've been going down a -- in terms of the funding journey, we've been on a -- on this journey for quite a while now in terms of where we were originally funded back in 2006. So it's not like that we're at the beginning of that journey, we're probably well down that path. And the investments we've made so far, we feel really good about. So we feel like we're better than average in terms of being able to deliver good outcomes. So whatever that number might be in average, certainly, for us and from our perspective, we expect that number to be better than average for us.

Matthew Borsch - Goldman Sachs Group Inc., Research Division

So that's a fair point and certainly a good place to acknowledge that your improvement in Star ratings was quite a bit above the others in the industry and, frankly, notably compared to your largest competitor. Just this is a little bit of a softball question, but can you give us a little bit more detail on what drives that improvement differentially for you guys? Do you think it was a particular thing you focused on in the last season? And are we going to see that again going into the Star scores that are unveiled in October?

James H. Bloem

Yes, I don't want to say anything about any other company because I don't really know how they do it, but I know how we do it, and that is, and I alluded to it before, we have a lot of organizational focus around what the 30-plus criteria are, how do we do against those criteria in each of the markets and what can we do to do better. And so I would say that this is the first year, 2014 is the first year, where in advance, we sort of knew what the criteria were and what we'll -- what was trying to be accomplished with them. In the past, I always sort of made it that when it -- when this program was introduced, they went back a couple of -- they went back 2 years from the year that the payments were going to be made based on the results. And it's sort of like you took a test but you didn't realize you were taking it, and then -- but now that everybody -- and the other thing is that the criteria changes, and we think it's made a change toward more substantive readmissions and drug therapy adherence and things like that in terms of what the criteria are. And while it's still important to answer the phone on time and to pay your claims adequately and to handle your appears -- appeals in a timely manner, there is -- continues to move, as we have as a company for many years, to really work on things that give better outcomes for "lower costs, lower the trend." And so it's the -- again, we continue to speak directly with the agency. But I would say the main thing is that we spend a lot of time with people because we think that if, we do well in those criteria, that's indicative of the fact that we have a competitive product that's very responsive to what people want, right?

Matthew Borsch - Goldman Sachs Group Inc., Research Division

That makes sense. So as you think about going into 2015, and one of the things that's going to change or, at least under current law, it's going to change; that these current regulations that the Star demonstration expansion is going to end going into 2015. It -- we ran some numbers looking at the potential improvement in Star scores. And you'll be better positioned in your -- than your competitors, assuming some further improvement. But you still have maybe even less than 1/2, but maybe 1/2 of your plans where you're getting bonuses today and you won't get bonuses in 2015. And so that's a major headwind, again, probably more for the industry in aggregate but certainly for you guys as well. And then we have the industry fee going up by more than 40% in 2015, the flow-through of the remaining 25% of the risk model recalibration and then, finally, the last major year of the benchmark phase-in. It would seem like it's a package where it would make sense to go back to CMS in congress and say, "This is too much on top of a program that's already been cut. " And frankly -- I mean, I think you can run a range of numbers and says this brings you below parity with Medicare. That's what we think. Do you think that that's an argument that you're going to be having? Maybe you're having it even now. And do you think it'll successful?

James H. Bloem

Well, we do have ongoing discussions, very vigorous discussions, around -- these are the things we think could improve the program. And these are the things that will make -- will give beneficiaries what they need at a lower cost and lengthen the life of the trust fund, if you will. And certainly, those are -- the 3 that you mentioned are things that we talk about often. Now we don't talk publicly about what we talk about, but you're right, we spend a lot of time saying about what are the intended and unintended consequences of what's on the books today. And the intended consequences, we generally would all acknowledge, are good, so we focus with the unintended consequences and make sure that the agency and, increasingly, the public, understands what that is. And so I think that's probably the best that can be said here. But that would be ongoing. And again, I think that Star, the Star quality bonuses, and those types of things at war [ph] are now getting traction as proxies for good plan-comparative value performance.

Matthew Borsch - Goldman Sachs Group Inc., Research Division

Okay, okay. And I realized you can't address any of the product changes that you've made with your bids that were submitted last week. But you have alluded to potential exits in some selective cases. Is there anything you can say directionally about the extent? Is that going to be a highly, highly limited dynamic? Do you expect to see a lot more of it from others in the industry based on what you're hearing, chatter at least?

James H. Bloem

Well, as I mentioned, the seventh alternative or the seventh tool you can use is market exits. And we talked about -- when the preliminary rate notice came out, the industry -- the immediate response from various competitors, they vary. Everybody had a different view about what it meant. And some competitors talked about that exits would have to be a substantial part of what might be the consequences. In our case, we acknowledge that exits are always a possibility. We terminate products. We do things every year that would signify exits. But what we wanted, what we were trying to do with the statement that says, "We expect to grow membership in '14," was to say, "Yes, exits are a possibility," and that -- and you're right, I can't go beyond that, just in the year. But again, it'll all be known in around the 1st of October. But when that -- when we made that statement, we wanted people to know that we still -- we don't expect membership to go down. So we're confident about membership.

Matthew Borsch - Goldman Sachs Group Inc., Research Division

And coming back to the issue of how you stand competitively. Certainly, Humana has a number of advantages that we can see relative to competitors and smaller plans with respect to scale and sophistication and perhaps the -- just the entrepreneurial drive of the company's for-profit discipline and all that, that's sort of good stuff. On the other side of the ledger, there are some headwinds there. Number one, you start off -- although, again there's variation here, but the nonpublic transaction, we have higher Star scores than -- and even as I measure it, with just slightly higher than Humana even though you're better off than the other public companies. How that difference changes remains to be seen as we go forward. The other dynamic is that the industry fee -- some plans will be fully subject to the industry fee, like the Blue Cross plans; but some will be partially exempt, integrated not-for-profits. And some, which are maybe the provider-sponsored Medicaid, Medicare-only, will be fully exempt. And so that's a source of advantage that increases in 2015. Do -- how do you -- how does that factor into your thinking?

James H. Bloem

Yes, those are all excellent observations, and we would concur with most of them. The way we think about it too is the same thing as if you look at those not-for-profits, first of all not being subject to the premium tax, that's one of those subjects where, a few minutes ago, you asked, "What do you talk to the agency about?" That would be how you would count [ph] to Congress about. That would be one thing because, again, I think there's a sort of an equity that flows through. And then in equity, say, well, if you don't have any empathy for the companies, it really isn't really the company's problems as much as it's going to be how that's going to be -- how that's going to -- how that tax is going to come through to all the beneficiaries. So that would be one. The fact that you mentioned about the Star ratings being higher in the, what I would call, the more integrated plans. And that's where our integrated care delivery model, I think, is really so effective, and it has the ability to really help us over the years because we've assembled that in a very capital-efficient way. Now the not-for-profits and the plans that are associated, let's say, with health systems, in their area are very difficult plus competitors, but they don't -- they're not in a lot of different places. And so because they're not in a lot of different places, those are -- those might be some of the places you would look at. Again, I'm not saying that, surely, you -- that's why a market-by-market analysis is very important. And so if you have one of those plans, they have all those advantages. Now what they don't have that we have, even let's say we're in an area where we -- you compete with a plan like that, we have scale and other things that help us in the administrative area. And the other things offset some of that because there's a tremendous regulatory burden, I would say, or increased cost that's come with the Affordable Care Act that everybody -- regardless of what their status is or whether they're subject to tax or not or whether they've got good Star ratings or not, everybody is going to have to follow. And so I think that's sort of a counterweight. But again, I think of those other plans as being very specialized and very effective in the areas they're in.

Matthew Borsch - Goldman Sachs Group Inc., Research Division

And let me just make sure, we do have time for a question or 2 from the audience, if anybody is sitting on a question that they really want to ask. Otherwise, I will keep going here. And I mentioned I wanted to come back to a couple of questions here on things that you had touched on. When you think back to the 2012 experience and that you have this inflow of larger-than-expected enrollment growth and ultimately, for a temporary period of time, it through a -- skew your guidance and you've readjusted to that, I mean, arguably, from a long-term perspective, the growth is good. The -- I guess my question is just, should you go through a similar experience where, let's say, going to next year, you have -- instead of just a little bit, you end up with a lot of enrollment growth because you have products out there where others exit and they all flow into it. Is that going to -- would that maybe be a factor that would -- that you would adjust guidance downward on because you would need that time to catch up with those members?

James H. Bloem

Yes, we would agree with you about what you said with '12 and I guess point out that we enrolled twice as many as our original guidance. But that's always a possibility too. So it's a good question to ask. What we did, in response to that, as -- would help us mitigate what you indicated in your question, and that is we've shortened the cycle time which we need to basically document these new members. We always knew because of our long experience that, when we get a new member, the sooner we can interact with that member and we can get them engaged in the cost and effectiveness of their healthcare, the better everybody is going to be. So by shortening the time, and I think I mentioned a few minutes ago, be to -- let's say, from 9 -- to 9 to 12 months from 18 to 24 months, that would mitigate that versus '12. If that were to happen next year. So that would be number one. Plus, I think the whole experience has taught us how -- what we would be looking for when it -- when we come out with original -- with our original guidance for '14 on November 6.

Matthew Borsch - Goldman Sachs Group Inc., Research Division

Okay.

Steven E. McCulley

I would also just add that it's not just the documentation but it's getting them into the right clinical programs. We've built a lot of infrastructure around conditions to help members manage their care in the most quality-efficient manner. And we've continued to build that out. We shortened the time line between when we are able to identify the numbers with the chronic conditions and get them enrolled in programs which benefit their utilization and their quality sooner rather than later.

Matthew Borsch - Goldman Sachs Group Inc., Research Division

Let me ask you a couple more questions and first just apologize that, given the timing, we're sticking on one product, I recognize you do have other areas of business, I just want to say that: commercial, TRICARE, Medicare drug plan. But the debate, as it relates to the outlook, is then centered in of the generate [ph]. Some of that has been around Medicare Advantage. So with that as an apology, I'll continue on that topic: Just picking up a couple of things that you touched on when we had a breakfast meeting this morning. And correct me if I get this wrong, but you never -- you do not expect that the product review process that you'll have with CMS over the summer will be contentious. At least, that's you're going-in assumption, number one. And number two, somewhat related to that, you don't think that there are going to be many areas where the $34 total beneficiary cost change threshold will be a problem for you.

James H. Bloem

Yes, I'll take a stab at that, maybe in reverse order. The $34 ben Med referring to the TBC limit is a number that really varies versus the benchmarks. So it can be a larger number; in some cases, a smaller number. And as we go through our bidding process, it's certainly part of the consideration that, as I've maybe spoken with some of you all about, we think of a bidding process as we have a large number of bids that we have to go through geography by geography. We have a certain market position in every geography and a long-term view of those markets where we think are good long-term HMO markets for us where we think all the conditions exist for us to have a good long-term foundation in a particular marketplace. So as we go through the continuum, there's a lot of markets that are very sound today. And we're going to do -- we've done well historically, we're going to continue to do well, but there'll be markets kind of at the bottom of the list that are -- maybe directionally don't -- we think we're going to be more challenged in, whether it's a market where that we don't have a critical mass, maybe they're not HMO markets for us, maybe our existing book of business hasn't performed well, for whatever reason. And then maybe in that particular market, there's not enough -- there's not much -- enough for us to change benefits and premiums in order to make that sustainable. Now that might be a market exit situation for us. But really for the most part, most -- not a large percentage of the markets are in that bucket. So we didn't -- we don't see the TBC in 2014 as being a drastic event for us. The other question was...

Matthew Borsch - Goldman Sachs Group Inc., Research Division

That contentiousness, or not...

James H. Bloem

Oh yes. Yes, historically, I think that the CMS review of the bid is a very technical process. There's a -- the office of the actuary goes through. And then the bids are pretty complicated, and they seem to get more complicated. And there's a lot of rules to follow, and then -- and we have a lot of documentation around how we followed all the rules, as firms, as all companies do. And I think there's a good, healthy audit kind of review process that goes on during the summer. But it's a very technical process. I don't view it as any kind of a political process or any judgmental process that's very technical in nature.

Matthew Borsch - Goldman Sachs Group Inc., Research Division

But it's still in front of us, so....

James H. Bloem

It's still in front of us, that's true.

Matthew Borsch - Goldman Sachs Group Inc., Research Division

Okay. And on that note, in terms of milestones to look for, do you anticipate that you would make some sort of announcement in terms of how you're positioning things ahead of the -- I guess, the regular unveiling would be the beginning of open -- pre-open enrollment October 1?

James H. Bloem

Yes, right, we give all our detailed guidance points in the Third Quarter Call, which is around the end of October. And there -- we will get -- I'm assuming that we'll get that approval status sometime -- I don't know when that typically occurs, Regina. Maybe it's August, September...

Steven E. McCulley

[indiscernible] Labor Day...

Regina Nethery

It's -- the bid approvals are usually during September.

James H. Bloem

Yes. So if we -- the conclusion of that process, I wouldn't -- I think we historically issue an 8-K or something saying that the bid has been approved. And then -- but what will happen in -- on October 1 is that everybody -- you get to see all the benefits and how things play out. And we have to spend a few weeks rolling up our sleeves, looking at how we're positioned in every market. And then we can refine our estimates and what our growth estimates are. And if we -- the margins aren't necessarily the same in every market, so depending on how that growth plays out in one market versus another may impact our overall margin and therefore in new markets where we anticipate more growth of new members. You asked the question earlier about more members might mean temporarily lower-margin, long-term better profit. And we'll have some time in October to look at that landscape and evaluate that whole situation.

Matthew Borsch - Goldman Sachs Group Inc., Research Division

Okay. Well, we have actually run out of time. So that's probably a good point to end. And again, thank you very much for coming again this year.

Regina Nethery

Thank you for having us, Matt.

James H. Bloem

Thank you.

Steven E. McCulley

Thanks, Matt. If anybody has any questions of us later, feel free to contact us.

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Source: Humana Inc. Presents at Goldman Sachs 34th Annual Global Healthcare Conference, Jun-12-2013 11:20 AM
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