Humana Withdrawing from Georgia Exchange as Feds Roll Out New Rules

Staff Report From Georgia CEO

Thursday, February 16th, 2017

Humana Inc. announced the mutual termination of its merger agreement with Aetna Inc., following a ruling from the United States District Court for the District of Columbia granting a United States Department of Justice request to enjoin the merger. Under the terms of the merger agreement, Humana is entitled to a breakup fee of $1 billion, or approximately $630 million, net of tax.

“The healthcare industry is in a dynamic state, and the public is looking to companies like Humana to improve the cost of care and the consumer experience,” said Bruce D. Broussard, Humana’s President and Chief Executive Officer. “As an independent company, we will continue to innovate and sharpen our focus on the local healthcare experience of all our members, especially seniors living with chronic conditions. Our strategy not only improves the value we bring to members, doctors and other healthcare professionals, but it also helps reduce costs and enhances the growth platform for both our health plans and our Healthcare Services businesses, thus positioning us well for long-term, sustainable growth.”

Broussard added, “We are very proud of the tremendous effort and commitment of our associates during this extended period of uncertainty and their continuing focus and dedication to helping our members achieve their best health.”

Strategic Update

As an independent company, Humana will continue to build upon its integrated care delivery strategy by intensifying its focus on people living with chronic conditions – particularly those aging into or already in Medicare Advantage or dual eligible plans. This population is fast-growing, with greater than 85 percent of seniors having at least one chronic condition and 65 percent having multiple chronic conditions. To further advance this strategy, the company will maintain its employer group customer focus, continuing to establish relationships with Medicare age-ins, while leveraging its clinical and operating platforms and furthering partnerships with doctors and other healthcare professionals. This brings value-added capabilities to the company’s employer group customers, particularly small to mid-size employers.

As the company’s business model demonstrates, when Humana integrates care with doctors and other healthcare professionals and serves members outside of traditional institutions, its members’ health improves, care is more cost-effective, and consumers are more engaged. These are key drivers to enabling more affordable healthcare for consumers and facilitating higher Star quality ratings, while also improving financial performance.

Humana is enhancing its integrated care delivery strategy in several key areas to further enable a rich, locally delivered healthcare experience for members, by doing the following:

  • Increasing risk-based arrangements through expanding partnerships with risk providers, offering sophisticated population health technology and services, and expanding primary care clinics.

  • Expanding complementary clinical capabilities that assist members outside of the doctors’ offices and institutions, with focus on home health services, local pharmacy access and behavioral health.

  • Integrating technology between healthcare professionals, members and Humana together with advanced analytics to simplify the experience, eliminate “friction points”, increase transparency and make access to care more convenient.

“By extending and expanding the local capabilities of our Healthcare Services businesses and supporting doctors and other healthcare professionals with innovative and unsurpassed population-health tools, we believe we can remove barriers for our members. This will help them achieve their best health by enabling a more simplified healthcare experience – one that combines the lifestyles of our members and the clinical aspects so critical to improving lifelong health and well-being,” said Broussard. “We believe this will, in turn, continue to drive growth across the enterprise and favorable returns for our stockholders.”

The company will continue its practice of evaluating its portfolio of businesses to ensure focus on those lines of business where its integrated care delivery strategy can add value for health plan members, healthcare professionals and its government program and employer group customers.

Regarding the company’s individual commercial medical coverage (Individual Commercial), substantially all of which is offered on-exchange through the federal Marketplaces, Humana has worked over the past several years to address market and programmatic challenges in order to keep coverage options available wherever it could offer a viable product. This has included pursuing business changes, such as modifying networks, restructuring product offerings, reducing the company’s geographic footprint and increasing premiums.

All of these actions were taken with the expectation that the company’s Individual Commercial business would stabilize to the point where the company could continue to participate in the program. However, based on its initial analysis of data associated with the company’s healthcare exchange membership following the 2017 open enrollment period, Humana is seeing further signs of an unbalanced risk pool. Therefore, the company has decided that it cannot continue to offer this coverage for 2018. Through the remainder of 2017, Humana remains committed to serving its current members across 11 states where it offers Individual Commercial products. And, as it has done in the past, Humana will work closely with its state partners as it navigates this process.

Capital Deployment Plans

The company today also announced strategic changes to its capital deployment plans to increase its return of capital to stockholders and to create capacity for strategic investments.

  • The company’s Board of Directors has declared a cash dividend to stockholders of $0.40 per share, payable on April 28, 2017, to stockholders of record on March 31, 2017, an increase of 38 percent from the prior quarter’s cash dividend of $0.29 per share.

  • Humana anticipates share repurchases totaling at least $2.00 billion in 2017, to be accomplished through a variety of means, including a $1.50 billion accelerated share repurchase program in the first quarter of 2017, and open-market repurchases, with at least $500 million in additional share repurchases through the remainder of the year, subject to market conditions. To that end, the company’s Board of Directors has approved a new share repurchase authorization in the aggregate amount of $2.25 billion, expiring December 31, 2017.

  • The company remains committed to a solid balance sheet and an investment grade rating, which provide the capacity and flexibility to invest in growth opportunities. Humana is likely to access the capital markets in the coming months, depending upon market conditions, raising its debt-to-capital ratio to within the range of 30 to 35 percent. The higher debt-to-capital ratio has been anticipated in the company’s financial guidance for the year ending December 31, 2017 (FY17). The company also noted that it would consider going above that range, temporarily, if needed for strategic purposes.

Investor Day 2017

Humana also announced its intention to host an Investor Day in New York, NY on April 25, 2017, where it will provide more detail on the company’s strategic actions and its financial prospects. Specific details for that event will be announced at a later date.

2017 Financial Guidance

Humana provided its Generally Accepted Accounting Principles and Adjusted EPS guidance for FY17 as detailed below. GAAP and Adjusted results for the year ended December 31, 2016 (FY16) are shown below for comparison. Adjusted FY16 results have been recast to exclude the Individual Commercial business given the company’s decision to no longer offer these products beginning in 2018, as discussed above.

 

 

 

 

 

 

 

 

Diluted earnings per common share

 

 

FY17

Guidance (b)

 

 

FY16

Recast (c)

 

GAAP

 

 

$16.65 to $16.85

 

 

$4.07

 

Net (gain) expenses associated with the now-terminated transaction with Aetna (for FY17, primarily the break-up fee)

 

 

(~4.32)

 

 

0.64

 

Amortization of identifiable intangibles

 

 

~0.31

 

 

0.32

 

Beneficial effect of lower effective tax rate in light of pricing and benefit design assumptions associated with the 2017 temporary suspension of the non-deductible health insurance industry fee; excludes Individual Commercial business impact

 

 

(~2.14)

 

 

-

 

Write-off of risk corridor receivables (d)

 

 

-

 

 

2.43

 

Reserve strengthening for the company’s non-strategic closed block of long-term care insurance business (e)

 

 

-

 

 

2.11

 

Estimated guaranty fund assessment expense to support the policyholder obligations of Penn Treaty (an unaffiliated long-term care insurance company)

 

 

~0.13

 

 

-

 

FY16 Adjusted (non-GAAP) – as reported

 

 

-

 

 

$9.57

 

Operating losses associated with the Individual Commercial business given the company’s planned exit on January 1, 2018; FY16 excludes losses associated with the write-off of risk corridor receivables

 

 

~0.17

 

 

1.37

 

Adjusted (non-GAAP) – FY17 projected; FY16 as recast

 

 

$10.80 - $11.00

 

 

$10.94

 

 

 

 

 

 

 

 

 

The company has included financial measures throughout this earnings release that are not in accordance with GAAP.  Management believes that these measures, when presented in conjunction with the comparable GAAP measures, are useful to both management and its investors in analyzing the company’s ongoing business and operating performance.  Consequently, management uses these non-GAAP financial measures as indicators of the company’s business performance, as well as for operational planning and decision making purposes.  Non-GAAP financial measures should be considered in addition to, but not as a substitute for, or superior to, financial measures prepared in accordance with GAAP. All financial measures in this press release are in accordance with GAAP unless otherwise indicated.

 
               

“Our results for 2016 demonstrated Humana’s ability to maintain operational discipline and advance our strategy during periods of uncertainty and change,” said Brian A. Kane, Senior Vice President and Chief Financial Officer for Humana. “As we head into 2017, this experience increases our confidence that we will continue to drive increased consistency and sustainability of earnings, as well as top and bottom line growth.”

Factors expected to impact the company’s projected FY17 earnings growth include:

 

 

 

 

 

 

Midpoints of FY17 estimated ranges used for simplicity

 

Pretax

(in millions)

 

EPS

 

FY16 Adjusted – as reported

 

$2,821

 

$9.57

 

Operating losses associated with the Individual Commercial business given the company’s planned exit on January 1, 2018; excludes FY16 losses associated with the write-off of risk corridor receivables

 

291

 

1.37

 

FY16 Adjusted – as recast

 

$3,112

 

$10.94

 

Excess prior period development not expected to recur in FY17, primarily Medicare Advantage (f)

 

(~180)

 

(~0.74)

 

FY16 Baseline

 

~$2,932

 

~$10.20

 

Projected changes versus the prior year include:

 

 

 

 

 

Retail Segment primarily reflecting:

 

  • Individual Medicare Advantage: (1) higher projected pretax margins approaching the company’s target pretax margin range of 4.5 to 5.0 percent and (2) a projected net increase in individual Medicare Advantage membership in the range of 30,000 to 40,000

  • Group Medicare Advantage: (1) a net increase in group Medicare Advantage membership in the range of 70,000 to 80,000 more than offset by (2) margin pressure associated with the competitive environment

  • Stand-alone PDP: (1) strong membership growth more than offset by (2) a competitive pricing environment

  • State-based contracts primarily reflecting (1) a more favorable Florida rate environment and (2) management operating initiatives

 

~170

 

 

 

Group Segment primarily reflecting (1) consistent pricing discipline and (2) continued focus on cost structure optimization

 

~30

 

 

 

Healthcare Services Segment primarily reflecting the offsetting impacts of:

 

  • Humana Pharmacy Services: (1) higher projected health plan membership, (2) higher anticipated mail-order penetration and (3) improvements in operating cost structure

  • Other Healthcare Services businesses: (1) lower projected earnings in the company’s provider assets, (2) optimization of the company’s clinical programs and (3) continued investments in integrated care delivery capabilities

 

Relatively unchanged

 

 

 

Other changes (primarily investment income and interest expense)

 

(~85)

 

 

 

Total projected changes

 

~115

 

~0.38

 

Lower projected weighted average share count primarily due to anticipated share repurchases

 

 

 

~0.32

 

Projected FY17 Adjusted

 

~$3.05 billion

 

~$10.90

 

 

 

 

 

 

 

 

 

 

 

 

 

 

In accordance with GAAP unless otherwise noted

 

 

FY17 Projections

As of February 14, 2017

 

 

Comments

Diluted earnings per common share (EPS)

 

 

GAAP $16.65 to $16.85

 

Adjustments (5.85)

 

Non-GAAP $10.80 to $11.00

 

 

 

  • See footnote (b) for detail of non-GAAP adjustments

 

 

 

 

 

 

 

Total revenues

 

 

Consolidated $53.5 billion to $54.5 billion

 

Retail segment $45.75 billion to $46.25 billion

 

Group segment $7.00 billion to $7.50 billion

 

Healthcare Services segment $25.50 billion to $26.00 billion

 

 

 

  • Consolidated and segment-level revenue projections include expected investment income

  • Segment-level revenues include amounts that eliminate in consolidation

  • Retail segment revenues include ~$980 million in revenues associated with the Individual Commercial business (ACA compliant and non-ACA compliant combined)

Change in year-end medical membership from prior year end

 

 

  • Individual Medicare Advantage: Up 30,000 to 40,000 (including loss of ~50k members associated with plan exits for 2017)

  • Group Medicare Advantage: Up 70,000 to 80,000

  • Medicare stand-alone PDP: Up 320,000 to 340,000

  • Individual Commercial : Down 530,000 to 550,000

  • Group commercial fully- insured: Down 55,000 to 65,000

Benefit ratios

 

 

Retail segment : 86.0% to 86.5%

 

Group segment: 80.5% to 81.5%

 

 

  • Ratio calculation: benefits expense as a percent of premium revenues

  • No material impact anticipated from non-GAAP adjustments

Consolidated operating cost ratio

 

 

11.25% to 11.75%

 

 

  • Ratio calculation: operating costs excluding depreciation and amortization as a percent of revenues excluding investment income

  • No material impact anticipated from non-GAAP adjustments

  • Net gain on terminated transaction to be presented separately from operating costs; therefore, not included in the ratio

Segment pretax results

 

 

Retail segment: $1.75 billion to $1.80 billion

 

Group segment: $265 million to $285 million

 

Healthcare Services segment: $1.00 billion to $1.10 billion

 

 

  • Retail segment projected pretax results include the impact of ~$45 million in losses associated with the Individual Commercial business

  • No material impact anticipated from non-GAAP adjustments on segment-level results for the Group and Healthcare Services segments

Effective tax rate

 

 

GAAP 36% to 37%

 

Adjustments ~11.0%

 

Non-GAAP 47% to 48%

 

 

 

  • See footnote (b) for detail of non-GAAP adjustments

 

Weighted average share count for diluted EPS

 

 

146 million to 147 million

 

 

  • Includes impact of projected share repurchases

Cash flows from operations

 

 

$2.8 billion to $3.2 billion

 

 

  • Includes impact of transaction break-up fee, net of tax

Capital expenditures

 

 

$550 million to $600 million