hum-202302010000049071false00000490712023-02-012023-02-01
UNITED STATES
SECURITIES AND EXCHANGE COMMISSION
Washington, DC 20549
FORM 8-K
CURRENT REPORT
Pursuant to Section 13 or 15(d) of the
Securities Exchange Act of 1934
Date of Report (Date of earliest event reported): February 1, 2023 (February 1, 2023)
Humana Inc.
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(Exact name of registrant as specified in its charter) |
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Delaware | 1-5975 | 61-0647538 |
(State or other jurisdiction of incorporation) | (Commission File Number) | (IRS Employer Identification No.) |
500 West Main Street Louisville, KY 40202
(Address of principal executive offices, including zip code)
502-580-1000
(Registrant’s telephone number, including area code)
(Former name or former address, if changed since last report)
Check the appropriate box below if the Form 8-K filing is intended to simultaneously satisfy the filing obligation of the registrant under any of the following provisions (see General Instruction A.2. below):
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☐ | Written communications pursuant to Rule 425 under the Securities Act (17 CFR 230.425) |
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☐ | Soliciting material pursuant to Rule 14a-12 under the Exchange Act (17 CFR 240.14a-12) |
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☐ | Pre-commencement communications pursuant to Rule 14d-2(b) under the Exchange Act (17 CFR 240.14d-2(b)) |
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☐ | Pre-commencement communications pursuant to Rule 13e-4(c) under the Exchange Act (17 CFR 240.13e-4(c)) |
Securities registered pursuant to Section 12(b) of the Act:
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Title of each class | Trading Symbol(s) | Name of each exchange on which registered |
Common Stock | HUM | New York Stock Exchange |
Indicate by check mark whether the registrant is an emerging growth company as defined in as defined in Rule 405 of the Securities Act of 1933 (17 CFR §230.405) or Rule 12b-2 of the Securities Exchange Act of 1934 (17 CFR §240.12b-2).
Emerging growth company ☐
If an emerging growth company, indicate by check mark if the registrant has elected not to use the extended transition period for complying with any new or revised financial accounting standards provided pursuant to Section 13(a) of the Exchange Act. ☐
Item 2.02 Results of Operations and Financial Condition.
Item 7.01 Regulation FD Disclosure.
Humana Inc. (the "Company") issued a press release this morning reporting financial results for the quarter ended December 31, 2022, and posted a detailed earnings release related to the same period to the Investor Relations portion of the Company’s website at www.humana.com. A copy of each release is attached hereto as Exhibit 99.1 and Exhibit 99.2, respectively, and each release is incorporated herein by reference.
Item 9.01 Financial Statements and Exhibits.
(d)Exhibits:
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Exhibit No. | Description |
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99.1 | | | |
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99.2 | | | |
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104 | Cover Page Interactive Data File (embedded within the Inline XBRL document) | |
SIGNATURES
Pursuant to the requirements of the Securities Exchange Act of 1934, the Registrant has duly caused this Report to be signed on its behalf by the undersigned hereunto duly authorized.
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HUMANA INC. |
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BY: | /s/ John-Paul W. Felter |
| John-Paul W. Felter |
| Senior Vice President, Chief Accounting Officer & Controller |
| (Principal Accounting Officer) |
Dated: February 1, 2023
Document | | | | | |
n e w s r e l e a s e | Exhibit 99.1 Humana Inc. 500 West Main Street P.O. Box 1438 Louisville, KY 40202 http://www.humana.com |
FOR MORE INFORMATION CONTACT:
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Lisa Stoner Humana Investor Relations (502) 580-2652 e-mail: LStamper@humana.com | |
Mark Taylor
Humana Corporate Communications
(317) 753-0345
e-mail: MTaylor108@humana.com
Humana Reports Fourth Quarter 2022 Financial Results;
Provides Full Year 2023 Financial Guidance
•Reports 4Q22 loss per share of $0.12 on a GAAP basis, Adjusted EPS of $1.62; reports full year (FY) 2022 EPS of $22.08 on a GAAP basis, $25.24 on an Adjusted basis
•Announces FY 2023 EPS guidance of at least $27.57 on a GAAP basis; at least $28.00 on an Adjusted basis
•Affirms strong 2023 individual Medicare Advantage membership growth of at least 625,000, or 13.7 percent growth over FY 2022 ending membership; anticipates growth to be meaningfully higher than the industry growth
•Completes realignment into two segments, Insurance and CenterWell, to drive greater collaboration and synergistic growth across the enterprise
LOUISVILLE, KY (February 1, 2023) – Humana Inc. (NYSE: HUM) today reported consolidated pretax results and net earnings (loss) per share (EPS) for the quarter ended December 31, 2022 (4Q22) versus the quarter ended December 31, 2021 (4Q21) and for the year ended December 31, 2022 (FY 2022) versus the year ended December 31, 2021 (FY 2021) as noted in the tables below.
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Consolidated (loss) income before income taxes and equity in net earnings (pretax results) In millions | 4Q22 (a) | 4Q21 (b) | FY 2022 (c) | FY 2021 (d) |
Generally Accepted Accounting Principles (GAAP) | ($71) | | ($60) | | $3,568 | | $3,354 | |
Amortization associated with identifiable intangibles | 20 | | 17 | | 81 | | 65 | |
Gain on Kindred at Home equity method investment | — | | — | | — | | (1,129) | |
Put/call valuation adjustments associated with company's non-consolidating minority interest investments | 84 | | 30 | | 68 | | 597 | |
Transaction and integration costs | 35 | | 35 | | 105 | 128 | |
Change in fair market value of publicly-traded equity securities | 4 | | 144 | | 123 | 341 | |
Charges associated with productivity initiatives related to the previously disclosed $1 billion value creation plan | 188 | | — | | 473 | | — | |
Adjustment (gain) on sale of Kindred at Home's Hospice and Personal Care divisions (KAH Hospice) | 3 | | — | | (237) | | — | |
Adjusted (non-GAAP) | $263 | | $166 | | $4,181 | | $3,356 | |
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Net (loss) earnings per share (EPS) | 4Q22 (a) | 4Q21 (b) | FY 2022 (c) | FY 2021 (d) |
GAAP | ($0.12) | | ($0.11) | | $22.08 | | $22.67 | |
Amortization associated with identifiable intangibles | 0.16 | | 0.14 | | 0.64 | | 0.50 | |
Gain on Kindred at Home equity method investment | — | | — | | — | | (8.73) | |
Put/call valuation adjustments associated with company's non-consolidating minority interest investments | 0.66 | | 0.23 | | 0.53 | | 4.62 | |
Transaction and integration costs | 0.28 | | 0.28 | | 0.83 | | 0.99 | |
Change in fair market value of publicly-traded equity securities | 0.03 | | 1.11 | | 0.97 | | 2.63 | |
Charges associated with productivity initiatives related to the previously disclosed $1 billion value creation plan | 1.49 | | — | | 3.72 | | — | |
Adjustment (gain) on the sale of KAH Hospice | 0.03 | | — | | (1.86) | | — | |
Tax impact of non-GAAP adjustments | ($0.91) | | ($0.41) | | ($1.67) | | ($2.04) | |
Adjusted (non-GAAP) | $1.62 | | $1.24 | | $25.24 | | $20.64 | |
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“Humana is pleased to start the year in a position of strength, with robust 2023 individual Medicare Advantage (MA) membership growth expected to be at least 625,000 for the year, a year-over-year increase of 13.7 percent,” said Bruce D. Broussard, Humana’s President and Chief Executive Officer. "This robust membership outlook reflects high quality growth, with our improvement in retention more than doubling expectations, and marks a continuation of our strong track record of membership growth, with our compounded annual growth from 2018 to 2022 at 10.4 percent as compared to industry growth of 9.7 percent. Humana significantly advanced its strategy in 2022 for continued leadership in integrated value-based care, while delivering 22 percent Adjusted EPS growth. Looking ahead, we are confident in achieving our 2025 Adjusted EPS commitment of $37."
Please refer to the tables above, as well as the consolidated and segment highlight sections in the detailed earnings release for additional discussion of the factors impacting the year-over-comparisons.
In addition, a summary of key consolidated and segment statistics comparing 4Q22 to 4Q21 and FY 2022 to FY 2021 follows the Segment Realignment discussion.
Segment Realignment
During December 2022, Humana realigned certain of its businesses among its previously reportable segments, Retail, Group and Specialty and Healthcare Services, into two distinct segments: Insurance and CenterWell. The Insurance segment includes the businesses that were previously included in the Retail and Group and Specialty segments, as well as the Pharmacy Benefit Manager (PBM) business which was previously included in the Healthcare Services segment. The PBM is included in the Insurance segment as the operations of the business are highly interdependent with the capability needs of the health plan businesses included in the Insurance segment. The CenterWell segment represents the company's payor-agnostic healthcare services offerings, including pharmacy dispensing services, provider services, and home services. In addition to the new segment classifications being utilized to assess performance and allocate resources, Humana believes this simpler structure will create greater collaboration across the Insurance and CenterWell businesses and will accelerate work that is underway to centralize and integrate operations within the organization.
Prior period segment financial information has been recast to conform to the new segment presentation. Please refer to the Segment Realignment Supplementary Information section of the detailed earnings release for the recast information.
In addition to the recast of prior periods to align to the new segmentation, Humana has also provided a view of 4Q22 and FY 2022 results under the previous segment presentation to align with guidance points included as part of the company's third quarter 2022 earnings release dated November 2, 2022. Please refer to the Segment Realignment Supplementary Information section of the detailed earnings release for the recast information.
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Humana Inc. Summary of Results (in millions, except per share amounts) | 4Q22 (a) | 4Q21 (b) | FY 2022 (c) | FY 2021 (d) |
CONSOLIDATED | | | | |
Revenues | $22,439 | $21,054 | $92,870 | $83,064 |
Revenues - Adjusted (non-GAAP) | $22,443 | $21,198 | $92,993 | $83,405 |
Pretax results | ($71) | ($60) | $3,568 | $3,354 |
Pretax results - Adjusted (non-GAAP) | $263 | $166 | $4,181 | $3,356 |
(Net loss per share) EPS | ($0.12) | ($0.11) | $22.08 | $22.67 |
EPS - Adjusted (non-GAAP) | $1.62 | $1.24 | $25.24 | $20.64 |
Benefits expense ratio | 87.3 | % | 87.9 | % | 86.3 | % | 86.7 | % |
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Operating cost ratio | 15.9 | % | 16.1 | % | 13.7 | % | 12.2 | % |
Operating cost ratio - Adjusted (non-GAAP) | 14.9 | % | 15.9 | % | 13.1 | % | 12.1 | % |
Operating cash flows | ($5,127) | ($96) | $4,587 | $2,262 |
Operating cash flows - Adjusted (non-GAAP) (e) | $651 | ($96) | $4,587 | $2,262 |
Parent company cash and short term investments | $934 | $1,334 | | |
Debt-to-total capitalization | 42.0 | % | 43.7 | % | | |
Days in Claims Payable | 45.9 | 43.7 | | |
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INSURANCE SEGMENT | | | | |
Revenues | $21,599 | $20,137 | $88,841 | $80,930 |
Benefits expense ratio | 87.5 | % | 88.5 | % | 86.6 | % | 87.2 | % |
Operating cost ratio | 12.8 | % | 12.7 | % | 10.4 | % | 10.3 | % |
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Income (loss) from operations | $46 | ($105) | $3,022 | $2,412 |
Income (loss) from operations - Adjusted (non-GAAP) (f) | $53 | ($100) | $3,052 | $2,433 |
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CENTERWELL SEGMENT | | | | |
Revenues | $4,141 | $4,085 | $17,307 | $14,058 |
Operating cost ratio | 92.6 | % | 91.7 | % | 91.5 | % | 92.3 | % |
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Income from operations | $263 | $299 | $1,291 | $938 |
Adjusted earnings before interest, taxes, depreciation and amortization (Adjusted EBITDA) (non-GAAP) (g) | $325 | $337 | $1,488 | $1,206 |
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2023 Earnings Guidance
The company provided its GAAP and Adjusted EPS guidance for the year ending December 31, 2023 (FY 2023) as detailed below.
GAAP and Adjusted EPS results for FY 2022 are also shown for comparison.
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Diluted earnings per common share | FY 2023 Guidance (h) | FY 2022 (c) |
GAAP | at least $27.57 | $22.08 | |
Amortization of identifiable intangibles | 0.55 | | 0.64 | |
Put/call valuation adjustments associated with company's non-consolidating minority interest investments | — | | 0.53 | |
Transaction and integration costs | — | | 0.83 | |
Change in fair market value of publicly-traded equity securities | — | | 0.97 | |
Charges associated with productivity initiatives related to the previously disclosed $1 billion value creation plan | — | | 3.72 | |
Net gain on the sale of KAH Hospice | — | | (1.86) | |
Tax impact of non-GAAP adjustments | (0.12) | | (1.67) | |
Adjusted (non-GAAP) – FY 2023 projected; FY 2022 reported | at least $28.00 | $25.24 | |
Detailed Press Release
Humana’s full earnings press release including the statistical pages and segment realignment supplementary information has been posted to the company’s Investor Relations site and may be accessed at https://humana.gcs-web.com/ or via a current report on Form 8-K filed by the company with the Securities and Exchange Commission this morning (available at www.sec.gov or on the company’s website).
Conference Call
Humana will host a conference call at 9:00 a.m. Eastern time today to discuss its financial results for the quarter and the company’s expectations for future earnings.
To participate via phone, please register in advance at this link - https://register.vevent.com/register/BI4189468fb19c466d8457e67cf5a59540.
Upon registration, telephone participants will receive a confirmation email detailing how to join the conference call, including the dial-in number and a unique registrant ID that can be used to access the call. A webcast of the 4Q22 earnings call may also be accessed via Humana’s Investor Relations page at humana.com. The company suggests participants for both the conference call and those listening via the web dial in or sign on at least 15 minutes in advance of the call.
For those unable to participate in the live event, the archive will be available in the Historical Webcasts and Presentations section of the Investor Relations page at humana.com, approximately two hours following the live webcast.
Footnotes
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 (Adjusted) financial measures as indicators of the company’s business performance, as well as for operational planning and decision making purposes. Non-GAAP (Adjusted) 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. Please refer to the footnotes for a detailed description of each item adjusted out of GAAP financial measures to arrive at a non-GAAP (Adjusted) financial measure.
(a) 4Q22 Adjusted results exclude the following:
•Amortization expense for identifiable intangibles - GAAP measures affected in this release include consolidated pretax results, EPS, and segment income from operations (including amortization expense of $7 million in the Insurance segment and $13 million in the CenterWell segment).
•Put/call valuation adjustments associated with Humana’s non-consolidating minority interest investments - GAAP measures affected include consolidated pretax results and EPS.
•Transaction and integration costs - GAAP measures affected include consolidated pretax results, EPS, and the consolidated operating cost ratio. See Operating cost ratio reconciliation below for respective period.
•Change in fair market value of publicly-traded equity securities - GAAP measures affected include consolidated pretax results, EPS, and consolidated revenues. See Consolidated revenues reconciliation below for respective period.
•Initiatives undertaken associated with the company's previously disclosed $1 billion value creation plan - GAAP measures affected include consolidated pretax results, EPS, and the consolidated operating cost ratio. See Operating cost ratio reconciliation below for respective period.
•Gain related to the sale of a 60 percent interest in KAH Hospice in August 2022 - Consolidated pretax results and EPS are the only GAAP measures affected.
•Cumulative net tax benefit of adjustments - EPS is the only GAAP measure affected.
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Consolidated revenues (in millions) | 4Q22 (a) | 4Q21 (b) | FY 2022 (c) | FY 2021 (d) |
GAAP | $22,439 | $21,054 | $92,870 | $83,064 |
Change in fair market value of publicly-traded equity securities | 4 | | 144 | | 123 | 341 | |
Adjusted (non-GAAP) | $ | 22,443 | | $ | 21,198 | | $ | 92,993 | | $ | 83,405 | |
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Operating cost ratio Operating costs excluding depreciation and amortization as a percent of revenues excluding investment income | 4Q22 (a) | 4Q21 (b) | FY 2022 (c) | FY 2021 (d) |
GAAP | 15.9 | % | 16.1 | % | 13.7 | % | 12.2 | % |
Transaction and integration costs | (0.2) | % | (0.2) | % | (0.1) | % | (0.1) | % |
Charges associated with productivity initiatives related to the previously disclosed $1 billion value creation plan | (0.8) | % | — | % | (0.5) | % | — | % |
Adjusted (non-GAAP) | 14.9 | % | 15.9 | % | 13.1 | % | 12.1 | % |
(b) 4Q21 Adjusted results exclude the following:
•Amortization expense for identifiable intangibles - GAAP measures affected include consolidated pretax results, EPS, and segment loss from operations (including amortization expense of $5 million in the Insurance segment and $12 million in the CenterWell segment).
•Put/call valuation adjustments associated with Humana’s non-consolidating minority interest investments - GAAP measures affected include consolidated pretax results and EPS.
•Transaction and integration costs - GAAP measures affected include consolidated pretax results, EPS, and the consolidated operating cost ratio. See Operating cost ratio reconciliation above for respective period.
•Change in fair market value of publicly-traded equity securities - GAAP measures affected include consolidated pretax results, EPS, and consolidated revenues. See Consolidated revenues reconciliation above for respective period.
•Cumulative net tax benefit of adjustments - EPS is the only GAAP measure affected.
c) FY 2022 Adjusted results exclude the following:
•Amortization expense for identifiable intangibles - GAAP measures affected include consolidated pretax results, EPS, and segment income from operations (including amortization expense of $30 million in the Insurance segment and $51 million in the CenterWell segment).
•Put/call valuation adjustments associated with Humana’s non-consolidating minority interest investments - GAAP measures affected include consolidated pretax results and EPS.
•Transaction and integration costs - GAAP measure affected include consolidated pretax results, EPS, and the consolidated operating cost ratio. See Operating cost ratio reconciliation above for respective period.
•Change in fair market value of publicly-traded equity securities - GAAP measures affected include consolidated pretax results, EPS, and consolidated revenues. See Consolidated revenues reconciliation above for respective period.
•Charges related to initiatives undertaken associated with the company's previously disclosed $1 billion value creation plan - GAAP measures affected include consolidated pretax results, EPS, and the consolidated operating cost ratio. See Operating cost ratio reconciliation above for respective period.
•Gain related to the sale of a 60 percent interest in KAH Hospice in August 2022 - Consolidated pretax results and EPS are the only GAAP measures affected.
•Cumulative net tax benefit of adjustments - EPS is the only GAAP measure affected.
d) FY 2021 Adjusted results exclude the following:
•Amortization expense for identifiable intangibles - GAAP measures affected include consolidated pretax results, EPS, and segment income from operations (including amortization expense of $21 million in the Insurance segment and $44 million in the CenterWell segment).
•Gain associated with Kindred at Home equity method investment; the gain was recorded upon closing of the Kindred at Home transaction in August 2021 - GAAP measures affected include consolidated pretax results and EPS.
•Put/call valuation adjustments associated with Humana’s non-consolidating minority interest investments, including the impact of the termination of the put/call agreement related to Kindred at Home as a result of the transaction announced on April 27, 2021 - GAAP measures affected include consolidated pretax results and EPS.
•Transaction and integration costs - GAAP measure affected include consolidated pretax results, EPS, and the consolidated operating cost ratio. See Operating cost ratio reconciliation above for respective period.
•Change in fair market value of publicly-traded equity securities - GAAP measures affected include consolidated pretax results, EPS, and consolidated revenues. See Consolidated revenues reconciliation above for respective period.
•Cumulative net tax benefit of adjustments - EPS is the only GAAP measure affected.
(e) Generally, when the first day of a month falls on a weekend of holiday, with the exception of January 1 (New Year's Day), the company receives its monthly Medicare premium payment from CMS on the last business day of the previous month. On a GAAP basis, this can result in certain quarterly cash flows from operations including more or less than three monthly payments. Consequently, when this occurs, the company reports Adjusted cash flows from operations to reflect three payments in each quarter to match the related expenses.
(f) Reconciliation of Insurance segment income (loss) from operations:
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Insurance segment income (loss) from operations | 4Q22 | 4Q21 | FY 2022 | FY 2021 |
Income (loss) from operations | $46 | ($105) | $3,022 | $2,412 |
Amortization associated with identifiable intangibles | 7 | | 5 | | 30 | | 21 | |
Income (loss) from operations - Adjusted (non-GAAP) | $53 | | ($100) | | $3,052 | | $2,433 | |
(g) The CenterWell segment Adjusted earnings before interest, taxes, depreciation and amortization (Adjusted EBITDA) includes the segment's income from operations with adjustments to add back depreciation and amortization expense, interest expense, and income taxes. Adjusted EBITDA includes results from all lines of business within the segment. Adjusted EBITDA also includes the impact of Humana’s minority interest related to the strategic partnership with Welsh, Carson, Anderson & Stowe (WCAS) to develop and operate senior-focused, payor-agnostic, primary care centers, as well as Humana's minority interest ownership of KAH operations based on the timing of previously disclosed transactions.
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CenterWell segment Adjusted EBITDA (in millions) | 4Q22 | 4Q21 | FY 2022 | FY 2021 |
Income from operations | $263 | $299 | $1,291 | $938 |
Equity in (losses) earnings | (7) | | (4) | | (22) | | 65 | |
Non-controlling interest income | — | | (1) | | (1) | | (1) | |
Depreciation and amortization expense | 47 | | 43 | | 186 | | 165 | |
Interest and taxes | 22 | | — | | 34 | | 39 | |
Adjusted EBITDA (non-GAAP) 4Q and FY 2022 Adjusted EBITDA excludes impact of KAH Hospice gain/adjustment | $325 | | $337 | | $1,488 | | $1,206 | |
(h) FY 2023 projected Adjusted results exclude the following:
•FY 2023 GAAP EPS excludes the impact of fair value changes of the put/call options associated with Humana's non-consolidating minority interest investments as future value changes can't be estimated.
•The fair value of publicly traded securities, their impact on GAAP EPS, and the related non-GAAP adjustment will fluctuate depending on the public trading value of the stock. The guidance set forth herein assumes no further change in the fair value of those investments.
Cautionary Statement
This news release includes forward-looking statements regarding Humana within the meaning of the Private Securities Litigation Reform Act of 1995. When used in investor presentations, press releases, Securities and Exchange Commission (SEC) filings, and in oral statements made by or with the approval of one of Humana’s executive officers, the words or phrases like “expects,” “believes,” “anticipates,” “intends,” “likely will result,” “estimates,” “projects” or variations of such words and similar expressions are intended to identify such forward-looking statements.
These forward-looking statements are not guarantees of future performance and are subject to risks, uncertainties, and assumptions, including, among other things, information set forth in the “Risk Factors” section of the company’s SEC filings, a summary of which includes but is not limited to the following:
•If Humana does not design and price its products properly and competitively, if the premiums Humana receives are insufficient to cover the cost of healthcare services delivered to its members, if the company is unable to implement clinical initiatives to provide a better healthcare experience for its members, lower costs and appropriately document the risk profile of its members, or if its estimates of benefits expense are inadequate, Humana’s profitability could be materially adversely affected. Humana estimates the costs of its benefit expense payments, and designs and prices its products accordingly, using actuarial methods and assumptions based upon, among other relevant factors, claim payment patterns, medical cost inflation, and historical developments such as claim inventory levels and claim receipt patterns. The company continually reviews estimates of future payments relating to benefit expenses for services incurred in the current and prior periods and makes necessary adjustments to its reserves, including premium deficiency reserves, where appropriate. These estimates involve extensive judgment, and have considerable inherent variability because they are extremely sensitive to changes in claim payment patterns and medical cost trends. Accordingly, Humana's reserves may be insufficient.
•If Humana fails to effectively implement its operational and strategic initiatives, including its Medicare initiatives, which are of particular importance given the concentration of the company's revenues in these products, state-based contract strategy, the growth of its CenterWell business, and its integrated care delivery model, the company’s business may be materially adversely affected. In addition, there can be no assurances that the company will be successful in maintaining or improving its Star ratings in future years.
•If Humana fails to properly maintain the integrity of its data, to strategically maintain existing or implement new information systems, to protect Humana’s proprietary rights to its systems, or to defend against cyber-security attacks or prevent other privacy or data security incidents that result in security breaches that disrupt the company's operations or in the unintentional dissemination of sensitive personal information or proprietary or confidential information, the company’s business may be materially adversely affected.
•Humana is involved in various legal actions, or disputes that could lead to legal actions (such as, among other things, provider contract disputes and qui tam litigation brought by individuals on behalf of the government), governmental and internal investigations, and routine internal review of business processes any of which, if resolved unfavorably to the company, could result in substantial monetary damages or changes in its business practices. Increased litigation and negative publicity could also increase the company’s cost of doing business.
•As a government contractor, Humana is exposed to risks that may materially adversely affect its business or its willingness or ability to participate in government healthcare programs including, among other things, loss of material government contracts; governmental audits and investigations; potential inadequacy of government determined payment rates; potential restrictions on profitability; including
by comparison of profitability of the company’s Medicare Advantage business to non-Medicare Advantage business; or other changes in the governmental programs in which Humana participates. Changes to the risk-adjustment model utilized by CMS to adjust premiums paid to Medicare Advantage, or MA, plans according to the health status of covered members, including changes to the methodology used by CMS for risk adjustment data validation audits that fail to address adequately the statutory requirement of actuarial equivalence, if implemented, could have a material adverse effect on the company's operating results, financial position and cash flows.
•Humana's business activities are subject to substantial government regulation. New laws or regulations, or legislative, judicial, or regulatory changes in existing laws or regulations or their manner of application could increase the company's cost of doing business and have a material adverse effect on Humana’s results of operations (including restricting revenue, enrollment and premium growth in certain products and market segments, restricting the company’s ability to expand into new markets, increasing the company’s medical and operating costs by, among other things, requiring a minimum benefit ratio on insured products, lowering the company’s Medicare payment rates and increasing the company’s expenses associated with a non-deductible health insurance industry fee and other assessments); the company’s financial position (including the company’s ability to maintain the value of its goodwill); and the company’s cash flows.
•Humana’s failure to manage acquisitions, divestitures and other significant transactions successfully may have a material adverse effect on the company’s results of operations, financial position, and cash flows.
•If Humana fails to develop and maintain satisfactory relationships with the providers of care to its members, the company’s business may be adversely affected.
•Humana faces significant competition in attracting and retaining talented employees. Further, managing succession for, and retention of, key executives is critical to the Company’s success, and its failure to do so could adversely affect the Company’s businesses, operating results and/or future performance.
•Humana’s pharmacy business is highly competitive and subjects it to regulations and supply chain risks in addition to those the company faces with its core health benefits businesses.
•Changes in the prescription drug industry pricing benchmarks may adversely affect Humana’s financial performance.
•Humana’s ability to obtain funds from certain of its licensed subsidiaries is restricted by state insurance regulations.
•Downgrades in Humana’s debt ratings, should they occur, may adversely affect its business, results of operations, and financial condition.
•The securities and credit markets may experience volatility and disruption, which may adversely affect Humana’s business.
•The spread of, and response to, the novel coronavirus, or COVID-19, underscores certain risks Humana faces, including those discussed above, and the ongoing, heightened uncertainty created by the pandemic precludes any prediction as to the ultimate adverse impact to Humana of COVID-19.
As the COVID-19 pandemic continues, the premiums the company charges may prove to be insufficient to cover the cost of health care services delivered to its members, each of which could be impacted by many factors, including the impacts that Humana has experienced, and may continue to experience, to its revenues due to limitations on its ability to implement clinical initiatives to manage health care costs and chronic conditions of its members, and appropriately document their risk profiles, as a result of the company’s members being unable or unwilling to see their providers due to actions taken to mitigate the spread of COVID-19; increased costs that may result from higher utilization rates of medical facilities and services and other increases in associated hospital and pharmaceutical costs; and shifts in the company’s premium and medical claims cost trends to reflect the demographic impact of higher mortality during the COVID-19 pandemic. In addition, Humana is offering, and has been mandated by legislative and regulatory action (including the Families First Act and CARES Act) to provide, certain expanded benefit coverage to its members, such as waiving, or reimbursing, certain costs for COVID-19 testing, vaccinations and treatment. These measures taken by Humana, or governmental action, to respond to the ongoing impact of COVID-19 (including further expansion or modification of the services delivered to its members, the adoption or modification of regulatory requirements associated with those services and the costs and challenges associated with ensuring timely compliance with such
requirements), and the potential for widespread testing, treatments and the distribution and administration of COVID-19 vaccines, could adversely impact the company’s profitability.
The spread and impact of COVID-19 and additional variants, or actions taken to mitigate this spread, could have material and adverse effects on Humana’s ability to operate effectively, including as a result of the complete or partial closure of facilities or labor shortages. Disruptions in public and private infrastructure, including communications, availability of in-person sales and marketing channels, financial services and supply chains, could materially and adversely disrupt the company’s normal business operations. A significant subset of the company's and the company's third party providers' employee population are in a remote work environment in an effort to mitigate the spread of COVID-19, which may exacerbate certain risks to Humana’s business, including an increased demand for information technology resources, increased risk of phishing and other cybersecurity attacks, and increased risk of unauthorized dissemination of sensitive personal, proprietary, or confidential information. The continued COVID-19 pandemic has severely impacted global economic activity, including the businesses of some of Humana’s commercial customers, and caused significant volatility and negative pressure in the financial markets. In addition to disrupting Humana’s operations, these developments may adversely affect the timing of commercial customer premium collections and corresponding claim payments, the value of the company’s investment portfolio, or future liquidity needs.
The ongoing, heightened uncertainty created by the pandemic precludes any prediction as to the ultimate adverse impact to Humana of COVID-19. Humana is continuing to monitor the spread of COVID-19, changes to the company’s benefit coverages, and the ongoing costs and business impacts of dealing with COVID-19, including the potential costs and impacts associated with lifting or reimposing restrictions on movement and economic activity, the timing and degree in resumption of demand for deferred healthcare services, the pace of administration of COVID-19 vaccines and the effectiveness of those vaccines, and related risks. The magnitude and duration of the pandemic remain uncertain, and its impact on Humana’s business, results of operations, financial position, and cash flows could be material.
In making forward-looking statements, Humana is not undertaking to address or update them in future filings or communications regarding its business or results. In light of these risks, uncertainties, and assumptions, the forward-looking events discussed herein may or may not occur. There also may be other risks that the company is unable to predict at this time. Any of these risks and uncertainties may cause actual results to differ materially from the results discussed in the forward-looking statements.
Humana advises investors to read the following documents as filed by the company with the SEC for further discussion both of the risks it faces and its historical performance:
•Form 10-K for the year ended December 31, 2021;
•Form 10-Q for the quarters ended March 31, 2022; June 30, 2022; September 30, 2022; and
•Form 8-Ks filed during 2022 and 2023.
About Humana
Humana Inc. (NYSE: HUM) is committed to helping our millions of medical and specialty members achieve their best health. Our successful history in care delivery and health plan administration is helping us create a new kind of integrated care with the power to improve health and well-being and lower costs. Our efforts are leading to a better quality of life for people with Medicare, families, individuals, military service personnel, and communities at large.
To accomplish that, we support physicians and other health care professionals as they work to deliver the right care in the right place for their patients, our members. Our range of clinical capabilities, resources and tools – such as in-home
care, behavioral health, pharmacy services, data analytics and wellness solutions – combine to produce a simplified experience that makes health care easier to navigate and more effective.
More information regarding Humana is available to investors via the Investor Relations page of the company’s website at humana.com, including copies of:
•Annual reports to stockholders
•Securities and Exchange Commission filings
•Most recent investor conference presentations
•Quarterly earnings news releases and conference calls
•Calendar of events
•Corporate Governance information
Document | | |
Humana Inc. 500 West Main Street P.O. Box 1438 Louisville, KY 40202 http://www.humana.com |
FOR MORE INFORMATION CONTACT:
| | | | | |
Lisa Stoner Humana Investor Relations (502) 580-2652 e-mail: LStamper@humana.com | |
Mark Taylor
Humana Corporate Communications
(317) 753-0345
e-mail: MTaylor108@humana.com
Humana Reports Fourth Quarter 2022 Financial Results;
Provides Full Year 2023 Financial Guidance
•Reports 4Q22 loss per share of $0.12 on a GAAP basis, Adjusted EPS of $1.62; reports full year (FY) 2022 EPS of $22.08 on a GAAP basis, $25.24 on an Adjusted basis
•Announces FY 2023 EPS guidance of at least $27.57 on a GAAP basis; at least $28.00 on an Adjusted basis
•Affirms strong 2023 individual Medicare Advantage membership growth of at least 625,000, or 13.7 percent growth over FY 2022 ending membership; anticipates growth to be meaningfully higher than the industry growth
•Completes realignment into two segments, Insurance and CenterWell, to drive greater collaboration and synergistic growth across the enterprise
LOUISVILLE, KY (February 1, 2023) – Humana Inc. (NYSE: HUM) today reported consolidated pretax results and net earnings (loss) per share (EPS) for the quarter ended December 31, 2022 (4Q22) versus the quarter ended December 31, 2021 (4Q21) and for the year ended December 31, 2022 (FY 2022) versus the year ended December 31, 2021 (FY 2021) as noted in the tables below.
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Consolidated (loss) income before income taxes and equity in net earnings (pretax results) In millions | 4Q22 (a) | 4Q21 (b) | FY 2022 (c) | FY 2021 (d) |
Generally Accepted Accounting Principles (GAAP) | ($71) | | ($60) | | $3,568 | | $3,354 | |
Amortization associated with identifiable intangibles | 20 | | 17 | | 81 | | 65 | |
Gain on Kindred at Home equity method investment | — | | — | | — | | (1,129) | |
Put/call valuation adjustments associated with company's non-consolidating minority interest investments | 84 | | 30 | | 68 | | 597 | |
Transaction and integration costs | 35 | | 35 | | 105 | 128 | |
Change in fair market value of publicly-traded equity securities | 4 | | 144 | | 123 | 341 | |
Charges associated with productivity initiatives related to the previously disclosed $1 billion value creation plan | 188 | | — | | 473 | | — | |
Adjustment (gain) on sale of Kindred at Home's Hospice and Personal Care divisions (KAH Hospice) | 3 | | — | | (237) | | — | |
Adjusted (non-GAAP) | $263 | | $166 | | $4,181 | | $3,356 | |
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Net (loss) earnings per share (EPS) | 4Q22 (a) | 4Q21 (b) | FY 2022 (c) | FY 2021 (d) |
GAAP | ($0.12) | | ($0.11) | | $22.08 | | $22.67 | |
Amortization associated with identifiable intangibles | 0.16 | | 0.14 | | 0.64 | | 0.50 | |
Gain on Kindred at Home equity method investment | — | | — | | — | | (8.73) | |
Put/call valuation adjustments associated with company's non-consolidating minority interest investments | 0.66 | | 0.23 | | 0.53 | | 4.62 | |
Transaction and integration costs | 0.28 | | 0.28 | | 0.83 | | 0.99 | |
Change in fair market value of publicly-traded equity securities | 0.03 | | 1.11 | | 0.97 | | 2.63 | |
Charges associated with productivity initiatives related to the previously disclosed $1 billion value creation plan | 1.49 | | — | | 3.72 | | — | |
Adjustment (gain) on the sale of KAH Hospice | 0.03 | | — | | (1.86) | | — | |
Tax impact of non-GAAP adjustments | (0.91) | | (0.41) | | (1.67) | | (2.04) | |
Adjusted (non-GAAP) | $1.62 | | $1.24 | | $25.24 | | $20.64 | |
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“Humana is pleased to start the year in a position of strength, with robust 2023 individual Medicare Advantage (MA) membership growth expected to be at least 625,000 for the year, a year-over-year increase of 13.7 percent,” said Bruce D. Broussard, Humana’s President and Chief Executive Officer. "This robust membership outlook reflects high quality growth, with our improvement in retention more than doubling expectations, and marks a continuation of our strong track record of membership growth, with our compounded annual growth from 2018 to 2022 at 10.4 percent as compared to industry growth of 9.7 percent. Humana significantly advanced its strategy in 2022 for continued leadership in integrated value-based care, while delivering 22 percent Adjusted EPS growth. Looking ahead, we are confident in achieving our 2025 Adjusted EPS commitment of $37."
Please refer to the tables above, as well as the consolidated and segment highlight sections that follow for additional discussion of the factors impacting the year-over-year comparisons.
In addition, a summary of key consolidated and segment statistics comparing 4Q22 to 4Q21 and FY 2022 to FY 2021 follows the Segment Realignment discussion.
Segment Realignment
During December 2022, Humana realigned certain of its businesses among its previously reportable segments, Retail, Group and Specialty and Healthcare Services, into two distinct segments: Insurance and CenterWell. The Insurance segment includes the businesses that were previously included in the Retail and Group and Specialty segments, as well as the Pharmacy Benefit Manager (PBM) business which was previously included in the Healthcare Services segment. The PBM is included in the Insurance segment as the operations of the business are highly interdependent with the capability needs of the health plan businesses included in the Insurance segment. The CenterWell segment represents the company's payor-agnostic healthcare services offerings, including pharmacy dispensing services, provider services, and home services. In addition to the new segment classifications being utilized to assess performance and allocate resources, Humana believes this simpler structure will create greater collaboration across the Insurance and CenterWell businesses and will accelerate work that is underway to centralize and integrate operations within the organization.
Prior period segment financial information has been recast to conform to the new segment presentation. For recast of prior period segment financial information, refer to Segment Realignment Supplementary Information starting on page S-20 of this earnings release.
In addition to the recast of prior periods to align to the new segmentation, Humana has also provided a view of 4Q22 and FY 2022 results under the previous segment presentation to align with guidance points included as part of the company's third quarter 2022 earnings release dated November 2, 2022. Refer to Segment Realignment Supplementary Information starting on page S-23 of this earnings release.
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Humana Inc. Summary of Results (in millions, except per share amounts) | 4Q22 (a) | 4Q21 (b) | FY 2022 (c) | FY 2021 (d) |
CONSOLIDATED | | | | |
Revenues | $22,439 | $21,054 | $92,870 | $83,064 |
Revenues - Adjusted (non-GAAP) | $22,443 | $21,198 | $92,993 | $83,405 |
Pretax results | ($71) | ($60) | $3,568 | $3,354 |
Pretax results - Adjusted (non-GAAP) | $263 | $166 | $4,181 | $3,356 |
(Net loss per share) EPS | ($0.12) | ($0.11) | $22.08 | $22.67 |
EPS - Adjusted (non-GAAP) | $1.62 | $1.24 | $25.24 | $20.64 |
Benefits expense ratio | 87.3 | % | 87.9 | % | 86.3 | % | 86.7 | % |
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Operating cost ratio | 15.9 | % | 16.1 | % | 13.7 | % | 12.2 | % |
Operating cost ratio - Adjusted (non-GAAP) | 14.9 | % | 15.9 | % | 13.1 | % | 12.1 | % |
Operating cash flows | ($5,127) | ($96) | $4,587 | $2,262 |
Operating cash flows - Adjusted (non-GAAP) (e) | $651 | ($96) | $4,587 | $2,262 |
Parent company cash and short term investments | $934 | $1,334 | | |
Debt-to-total capitalization | 42.0 | % | 43.7 | % | | |
Days in Claims Payable | 45.9 | 43.7 | | |
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INSURANCE SEGMENT | | | | |
Revenues | $21,599 | $20,137 | $88,841 | $80,930 |
Benefits expense ratio | 87.5 | % | 88.5 | % | 86.6 | % | 87.2 | % |
Operating cost ratio | 12.8 | % | 12.7 | % | 10.4 | % | 10.3 | % |
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Income (loss) from operations | $46 | ($105) | $3,022 | $2,412 |
Income (loss) from operations - Adjusted (non-GAAP) (f) | $53 | ($100) | $3,052 | $2,433 |
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CENTERWELL SEGMENT | | | | |
Revenues | $4,141 | $4,085 | $17,307 | $14,058 |
Operating cost ratio | 92.6 | % | 91.7 | % | 91.5 | % | 92.3 | % |
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Income from operations | $263 | $299 | $1,291 | $938 |
Adjusted earnings before interest, taxes, depreciation and amortization (Adjusted EBITDA) (non-GAAP) (g) | $325 | $337 | $1,488 | $1,206 |
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2023 Earnings Guidance
The company provided its GAAP and Adjusted EPS guidance for the year ending December 31, 2023 (FY 2023) as detailed below.
GAAP and Adjusted EPS results for FY 2022 are also shown for comparison.
Additional FY 2023 guidance points are included in the table on page 17 of this earnings release.
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Diluted earnings per common share | FY 2023 Guidance (h) | FY 2022 (c) |
GAAP | at least $27.57 | $22.08 | |
Amortization of identifiable intangibles | 0.55 | | 0.64 | |
Put/call valuation adjustments associated with company's non-consolidating minority interest investments | — | | 0.53 | |
Transaction and integration costs | — | | 0.83 | |
Change in fair market value of publicly-traded equity securities | — | | 0.97 | |
Charges associated with productivity initiatives related to the previously disclosed $1 billion value creation plan | — | | 3.72 | |
Net gain on the sale of KAH Hospice | — | | (1.86) | |
Tax impact of non-GAAP adjustments | (0.12) | | (1.67) | |
Adjusted (non-GAAP) – FY 2023 projected; FY 2022 reported | at least $28.00 | $25.24 | |
Humana Consolidated Highlights
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Humana Inc. Summary of Results (in millions, except per share amounts) | 4Q22 (a) | 4Q21 (b) | FY 2022 (c) | FY 2021 (d) |
CONSOLIDATED | | | | |
Revenues | $22,439 | $21,054 | $92,870 | $83,064 |
Revenues - Adjusted (non-GAAP) | $22,443 | $21,198 | $92,993 | $83,405 |
Pretax results | ($71) | ($60) | $3,568 | $3,354 |
Pretax results - Adjusted (non-GAAP) | $263 | $166 | $4,181 | $3,356 |
(Net loss per share) EPS | ($0.12) | ($0.11) | $22.08 | $22.67 |
EPS - Adjusted (non-GAAP) | $1.62 | $1.24 | $25.24 | $20.64 |
Benefits expense ratio | 87.3 | % | 87.9 | % | 86.3 | % | 86.7 | % |
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Operating cost ratio | 15.9 | % | 16.1 | % | 13.7 | % | 12.2 | % |
Operating cost ratio - Adjusted (non-GAAP) | 14.9 | % | 15.9 | % | 13.1 | % | 12.1 | % |
Operating cash flows | ($5,127) | ($96) | $4,587 | $2,262 |
Operating cash flows - Adjusted (non-GAAP) (e) | $651 | ($96) | $4,587 | $2,262 |
Parent company cash and short term investments | $934 | $1,334 | | |
Debt-to-total capitalization | 42.0 | % | 43.7 | % | | |
Days in Claims Payable | 45.9 | 43.7 | | |
Consolidated revenues
The favorable year-over-year GAAP consolidated revenues comparison for both the quarter and the FY period were primarily driven by the following factors:
•individual Medicare Advantage and state-based contracts membership growth,
•higher per member individual Medicare Advantage premiums, and
•specific to FY 2022, the impact of Home solutions revenues (The acquisition of the remaining 60 percent interest in Kindred at Home (KAH) was completed in August 2021; this impact was partially offset by the divestiture of the company's 60 percent ownership of KAH Hospice that was completed in August 2022).
These increases were partially offset by the following factors:
•declining year-over-year membership associated with the company's group commercial medical products; and
•the phase-out of COVID-19 sequestration relief in FY 2022.
Refer to the "Footnotes" section included herein for a reconciliation of GAAP to Adjusted consolidated revenues for the respective periods.
Consolidated benefits expense
The year-over-year quarterly and FY declines in the ratio reflect the favorable impact of higher per member individual Medicare Advantage premiums and lower inpatient utilization associated with the individual Medicare Advantage business.
These factors were partially offset by lower favorable prior period medical claims reserve development (Prior Period Development) in 2022. Excluding the impact of the lower favorable Prior Period Development, the consolidated benefit ratio would have been 87.4 percent in 4Q22 compared to 88.2 percent in 4Q21, and 86.8 percent in FY 2022 compared to 87.7 percent in FY 2021.
Furthermore, the 4Q22 and FY 2022 ratios continue to reflect a shift in line of business mix with continued growth in certain government programs, which carry a higher benefits expense ratio, combined with a decline in Medicare stand-alone PDP, which has a lower benefits expense ratio.
Prior Period Medical Claims Reserve Development (Prior Period Development)
The higher levels of favorable Prior Period Development in 2021 reflected the reversal of actions taken in 2020, including the suspension of certain financial recovery programs for a period of time to provide financial and administrative relief for providers facing unprecedented strain as a result of the pandemic.
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Consolidated Favorable Prior Period Development $ in millions Basis points (bps) | First Quarter | Second Quarter | Third Quarter | Fourth Quarter | FY |
Prior Period Development from prior years recognized in 2022 | $360 | $37 | $7 | $11 | $415 |
Decrease to benefits expense ratio | (160 bps) | (20 bps) | (- bps) | (10 bps) | (50 bps) |
Prior Period Development from prior years recognized in 2021 | $555 | $164 | $49 | $57 | $825 |
Decrease to benefits expense ratio | (280 bps) | (80 bps) | (20 bps) | (30 bps) | (100 bps) |
Consolidated operating expenses
The increase in the GAAP consolidated operating cost ratio from FY 2021 to FY 2022 primarily related to the following factors:
•the impact of KAH operations; the business has a significantly higher operating cost ratio than the company's historical consolidated operating cost ratio; the operations added approximately 110 basis points and 170 basis points, respectively, to the 4Q22 and FY 2022 consolidated operating cost ratios compared to 230 basis points and 90 basis points, respectively, to the 4Q21 and FY 2021 ratios,
•the net impact of charges associated with initiatives undertaken associated with the company's previously disclosed $1 billion value creation plan, primarily related to asset and software impairment and abandonment and severance. The charges were recorded at the corporate level and not allocated to the segments, and
•the impact of higher marketing spend in 2022 to support individual Medicare Advantage growth.
These increases were partially offset by scale efficiencies associated with growth in the company's individual Medicare Advantage membership.
The year-over-year quarterly comparison was impacted by the same factors impacting the FY comparison. The slight decrease in the GAAP consolidated operating cost ratio from 4Q21 to 4Q22 was primarily the result of the divestiture of the company's 60 percent ownership of KAH Hospice operations in August 2022.
Refer to the "Footnotes" section included herein for a reconciliation of GAAP to Adjusted consolidated operating cost ratios for the respective periods.
Balance sheet
•Days in claims payable (DCP) of 45.9 days at December 31, 2022 represented a decrease of 0.3 days from 46.2 days at September 30, 2022, and an increase of 2.2 days from 43.7 days at December 31, 2021.
•Humana's debt-to-total capitalization at December 31, 2022 increased 260 basis points to 42.0 percent from 39.4 percent at September 30, 2022. The increase primarily resulted from the company's decrease in total capitalization as a result of the November 2022 accelerated stock repurchase (ASR) program.
Operating cash flows
GAAP cash flows provided by operations in 4Q22 were significantly impacted by the timing of the premium payment from CMS, as the early receipt of the October 2022 Medicare premium payment of $5.78 billion was received in September 2022.
The year-over-year favorable comparison of FY operating cash flows further reflects higher earnings in 2022, excluding the impact of the gains recognized from the respective KAH transactions in each year, combined with positive working capital impacts in 2022, and the 2021 cash flow impact associated with the pay down of claims inventory and capitation for provider surplus amounts earned in 2020, as well as additional provider support.
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Net cash from operating activities (in millions) (Used in) provided by | 4Q22 | 4Q21 | FY 2022 | FY 2021 |
GAAP | $ | (5,127) | | $ | (96) | | $ | 4,587 | | $ | 2,262 | |
Timing of premium payment from CMS (e) | 5,778 | | — | | — | | — | |
Adjusted (non-GAAP) | $ | 651 | | $ | (96) | | $ | 4,587 | | $ | 2,262 | |
Share repurchases
| | | | | |
| FY 2022* |
Total Number of Shares Repurchased | 4,303,800 |
January 2022 ASR November 2022 ASR | 2,431,200 1,872,600 |
Average Price Paid per Share | $ | 464.71 | |
January 2022 ASR November 2022 ASR | $411.32 $534.02 |
Remaining Repurchase Authorization as of January 31, 2023 | $1.00 billion |
*Represents shares purchased under the previously announced ASR programs in January 2022 ($1.00 billion) and November 2022 ($1.00 billion), each part of the $3.00 billion repurchase program authorized by the Board of Directors on February 18, 2021. Final settlement of the January 2022 ASR was completed during the first quarter of 2022, while final settlement of the November 2022 ASR was completed in 4Q22.
Humana’s Insurance Segment
This segment is comprised of insurance products serving Medicare and state-based contract beneficiaries, as well as individuals and employers. The segment also includes the company's Pharmacy Benefit Manager, or PBM, business.
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Insurance Segment Results in millions, except percentages | 4Q22 (a) | 4Q21 (b) | FY 2022 (c) | FY 2021 (d) |
Revenues | $21,599 | $20,137 | $88,841 | $80,930 |
Benefits expense ratio | 87.5 | % | 88.5 | % | 86.6 | % | 87.2 | % |
Operating cost ratio | 12.8 | % | 12.7 | % | 10.4 | % | 10.3 | % |
Income (loss) from operations | $46 | ($105) | $3,022 | $2,412 |
Income (loss) from operations - Adjusted (non-GAAP) (f) | $53 | ($100) | $3,052 | $2,433 |
Insurance Segment Revenues:
The year-over-year increases in Insurance segment revenues, on both a quarter and FY basis, primarily reflect the following items:
•individual Medicare Advantage and state-based contracts membership growth; and
•higher per member individual Medicare Advantage and commercial fully-insured medical premiums.
These factors were partially offset by the phase-out of COVID-19 sequestration relief in FY 2022, along with declining year-over-year membership associated with the company's group commercial medical product.
Insurance Segment Benefits Expense:
The year-over-year quarterly and FY declines in the ratio reflect the favorable impact of higher per member individual Medicare Advantage premiums and lower inpatient utilization associated with the individual Medicare Advantage business.
These factors were partially offset by lower favorable Prior Period Development in 2022. Excluding the impact of the lower favorable Prior Period Development, the segment's benefit ratio would have been 87.6 percent in 4Q22 compared to 88.8 percent in 4Q21, and 87.1 percent in FY 2022 compared to 88.2 percent in FY 2021.
Furthermore, the 4Q22 and FY 2022 ratios continue to reflect a shift in line of business mix within the segment, with growth in individual Medicare Advantage and state-based contracts and other membership, which carry a higher benefits expense ratio, combined with a decline in Medicare stand-alone PDP, which has a lower benefits expense ratio.
Insurance Segment Operating Costs:
The slight increases in the segment's 4Q22 and FY 2022 operating cost ratios from the respective periods in 2021 primarily reflect strategic investments to position the segment for long-term success, including the impact of higher marketing spend in 2022 to support individual Medicare Advantage growth.
These factors were partially offset by scale efficiencies associated with growth in the company's individual Medicare Advantage membership.
Insurance Segment Enrollment:
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in thousands | | | | | Year-over-Year Change | | | Sequential Change |
| December 31, 2022 | December 31, 2021 | September 30, 2022 | | Amount | Percent | | | Amount | Percent |
Medical Membership: | | | | | | | | | | |
Individual Medicare Advantage | 4,565.6 | | 4,409.1 | | 4,564.2 | | | 156.5 | | 3.5 | % | | | 1.4 | | — | % |
Group Medicare Advantage | 565.1 | | 560.6 | | 564.6 | | | 4.5 | | 0.8 | % | | | 0.5 | | 0.1 | % |
Total Medicare Advantage | 5,130.7 | | 4,969.7 | | 5,128.8 | | | 161.0 | | 3.2 | % | | | 1.9 | | — | % |
Medicare stand-alone PDP | 3,551.3 | | 3,606.2 | | 3,569.1 | | | (54.9) | | -1.5 | % | | | (17.8) | | -0.5 | % |
Total Medicare | 8,682.0 | | 8,575.9 | | 8,697.9 | | | 106.1 | | 1.2 | % | | | (15.9) | | -0.2 | % |
State-based contracts and other | 1,137.3 | | 940.1 | | 1,098.9 | | | 197.2 | | 21.0 | % | | | 38.4 | | 3.5 | % |
Medicare Supplement | 313.6 | | 331.9 | | 316.5 | | | (18.3) | | -5.5 | % | | | (2.9) | | -0.9 | % |
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Fully-insured commercial medical | 556.3 | | 674.6 | | 574.5 | | | (118.3) | | -17.5 | % | | | (18.2) | | -3.2 | % |
ASO commercial | 430.1 | | 495.5 | | 438.6 | | | (65.4) | | -13.2 | % | | | (8.5) | | -1.9 | % |
Military services | 5,959.9 | | 6,049.0 | | 5,977.9 | | | (89.1) | | -1.5 | % | | | (18.0) | | -0.3 | % |
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Total Medical Membership | 17,079.2 | | 17,067.0 | | 17,104.3 | | | 12.2 | | 0.1 | % | | | (25.1) | | 0.1 | % |
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Specialty Membership: | | | | | | | | | | |
Dental—fully-insured | 2,416.3 | | 2,543.4 | | 2,435.3 | | | (127.1) | | -5.0 | % | | | (19.0) | | -0.8 | % |
Dental—ASO | 288.1 | | 279.3 | | 287.1 | | | 8.8 | | 3.2 | % | | | 1.0 | | 0.3 | % |
Total Dental | 2,704.4 | | 2,822.7 | | 2,722.4 | | | (118.3) | | -4.2 | % | | | (18.0) | | -0.7 | % |
Vision | 2,081.7 | | 2,062.0 | | 2,078.3 | | | 19.7 | | 1.0 | % | | | 3.4 | | 0.2 | % |
Other supplemental benefits | 408.7 | | 409.6 | | 409.4 | | | (0.9) | | -0.2 | % | | | (0.7) | | -0.2 | % |
Total Specialty Membership (i) | 5,194.8 | | 5,294.3 | | 5,210.1 | | | (99.5) | | -1.9 | % | | | (15.3) | | -0.3 | % |
Individual Medicare Advantage membership includes 668,900 Dual Eligible Special Need Plans (D-SNP) members as of December 31, 2022, a net increase of 92,800, or 16 percent, from 576,100 as of December 31, 2021, and up 1,900, or less than 1 percent, from 667,000 as of September 30, 2022.
January 2023 Ending Membership
January 2023 individual Medicare Advantage membership approximated 5,060,000, up approximately 494,400, or 11 percent from December 31, 2022, reflecting net membership additions during the recently completed 2023 Annual Election Period (AEP). Included within this membership is approximately 741,000 D-SNP members, an increase of 72,100, or 11 percent, from December 31, 2022.
January 2023 group Medicare Advantage membership approximated 517,000, down approximately 48,100, or 9 percent from December 31, 2022, reflecting net membership declines during the 2023 selling season.
January 2023 stand-alone PDP membership approximated 2,985,000, down approximately 566,300, or 16 percent from December 31, 2022, reflecting net membership losses during the recently completed 2023 AEP.
Humana’s CenterWell Segment
This segment includes pharmacy (excluding the PBM operations), provider, and home solutions. The segment also includes the impact of non-consolidating minority interest investments related to the company's strategic partnerships with Welsh, Carson, Anderson & Stowe (WCAS) to develop and operate senior-focused, payor-agnostic, primary care centers, as well as the KAH Hospice operations. Services offered by this segment are designed to enhance the overall healthcare experience. These services may lead to lower utilization associated with improved member health and/or lower drug costs.
| | | | | | | | | | | | | | |
CenterWell Segment Results in millions, except percentages | 4Q22 | 4Q21 | FY 2022 | FY 2021 |
Revenues | $4,141 | $4,085 | $17,307 | $14,058 |
Operating cost ratio | 92.6 | % | 91.7 | % | 91.5 | % | 92.3 | % |
Income from operations | $263 | $299 | $1,291 | $938 |
Adjusted earnings before interest, taxes, depreciation and amortization (Adjusted EBITDA) (non-GAAP) (g) | $325 | $337 | $1,488 | $1,206 |
CenterWell Segment Revenues:
CenterWell segment revenues in 4Q22 and FY 2022 increased compared to the respective periods in 2021; these changes were impacted by the following factors:
◦the company's individual Medicare Advantage membership growth, combined with the impact of greater mail-order pharmacy penetration for Medicare Advantage members, which led to higher pharmacy revenues,
◦higher revenues associated with growth in the company's provider business, and
◦specifically for FY 2022, the impact of Home Solutions revenues (The acquisition of the remaining 60 percent interest in KAH was completed in August 2021; this impact was partially offset by the divestiture of the company's 60 percent ownership of KAH Hospice that was completed in August 2022).
CenterWell Segment Operating Costs:
The year-over-year increase in the 4Q22 operating cost ratio from 4Q21 primarily resulted from the divestiture of the company's 60 percent ownership of KAH Hospice operations in August 2022.
The year-over-year decline in the segment's FY operating cost ratio from 2021 to 2022 primarily represents the impact of the KAH operations being consolidated for the entire FY 2022 period compared to a partial period in 2021 due to the timing of the previously discussed transactions. The KAH operations have a lower operating cost ratio than other businesses within the segment. The year-over-year FY favorability was further impacted by the company's pharmacy operations.
The FY favorability was partially offset by investments in KAH to abate the pressures of the current nursing labor environment.
See additional operational metrics for the CenterWell segment on pages S-15 through S-17 of the statistical supplement included in this release.
Conference Call
Humana will host a conference call at 9:00 a.m. Eastern time today to discuss its financial results for the quarter and the company’s expectations for future earnings.
To participate via phone, please register in advance at this link - https://register.vevent.com/register/BI4189468fb19c466d8457e67cf5a59540.
Upon registration, telephone participants will receive a confirmation email detailing how to join the conference call, including the dial-in number and a unique registrant ID that can be used to access the call. A webcast of the 4Q22 earnings call may also be accessed via Humana’s Investor Relations page at humana.com. The company suggests
participants for both the conference call and those listening via the web dial in or sign on at least 15 minutes in advance of the call.
For those unable to participate in the live event, the archive will be available in the Historical Webcasts and Presentations section of the Investor Relations page at humana.com, approximately two hours following the live webcast.
Footnotes
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 (Adjusted) financial measures as indicators of the company’s business performance, as well as for operational planning and decision making purposes. Non-GAAP (Adjusted) 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. Please refer to the footnotes for a detailed description of each item adjusted out of GAAP financial measures to arrive at a non-GAAP (Adjusted) financial measure.
(a) 4Q22 Adjusted results exclude the following:
•Amortization expense for identifiable intangibles - GAAP measures affected in this release include consolidated pretax results, EPS, and segment income from operations (including amortization expense of $7 million in the Insurance segment and $13 million in the CenterWell segment).
•Put/call valuation adjustments associated with Humana’s non-consolidating minority interest investments - GAAP measures affected include consolidated pretax results and EPS.
•Transaction and integration costs - GAAP measures affected include consolidated pretax results, EPS, and the consolidated operating cost ratio. See Operating cost ratio reconciliation below for respective period.
•Change in fair market value of publicly-traded equity securities - GAAP measures affected include consolidated pretax results, EPS, and consolidated revenues. See Consolidated revenues reconciliation below for respective period.
•Initiatives undertaken associated with the company's previously disclosed $1 billion value creation plan - GAAP measures affected include consolidated pretax results, EPS, and the consolidated operating cost ratio. See Operating cost ratio reconciliation below for respective period.
•Gain related to the sale of a 60 percent interest in KAH Hospice in August 2022 - Consolidated pretax results and EPS are the only GAAP measures affected.
•Cumulative net tax benefit of adjustments - EPS is the only GAAP measure affected.
| | | | | | | | | | | | | | |
Consolidated revenues (in millions) | 4Q22 (a) | 4Q21 (b) | FY 2022 (c) | FY 2021 (d) |
GAAP | $22,439 | $21,054 | $92,870 | $83,064 |
Change in fair market value of publicly-traded equity securities | 4 | | 144 | | 123 | 341 | |
Adjusted (non-GAAP) | $ | 22,443 | | $ | 21,198 | | $ | 92,993 | | $ | 83,405 | |
| | | | | | | | | | | | | | |
Operating cost ratio Operating costs excluding depreciation and amortization as a percent of revenues excluding investment income | 4Q22 (a) | 4Q21 (b) | FY 2022 (c) | FY 2021 (d) |
GAAP | 15.9 | % | 16.1 | % | 13.7 | % | 12.2 | % |
Transaction and integration costs | (0.2) | % | (0.2) | % | (0.1) | % | (0.1) | % |
Charges associated with productivity initiatives related to the previously disclosed $1 billion value creation plan | (0.8) | % | — | % | (0.5) | % | — | % |
Adjusted (non-GAAP) | 14.9 | % | 15.9 | % | 13.1 | % | 12.1 | % |
(b) 4Q21 Adjusted results exclude the following:
•Amortization expense for identifiable intangibles - GAAP measures affected include consolidated pretax results, EPS, and segment loss from operations (including amortization expense of $5 million in the Insurance segment and $12 million in the CenterWell segment).
•Put/call valuation adjustments associated with Humana’s non-consolidating minority interest investments - GAAP measures affected include consolidated pretax results and EPS.
•Transaction and integration costs - GAAP measures affected include consolidated pretax results, EPS, and the consolidated operating cost ratio. See Operating cost ratio reconciliation above for respective period.
•Change in fair market value of publicly-traded equity securities - GAAP measures affected include consolidated pretax results, EPS, and consolidated revenues. See Consolidated revenues reconciliation above for respective period.
•Cumulative net tax benefit of adjustments - EPS is the only GAAP measure affected.
c) FY 2022 Adjusted results exclude the following:
•Amortization expense for identifiable intangibles - GAAP measures affected include consolidated pretax results, EPS, and segment income from operations (including amortization expense of $30 million in the Insurance segment and $51 million in the CenterWell segment).
•Put/call valuation adjustments associated with Humana’s non-consolidating minority interest investments - GAAP measures affected include consolidated pretax results and EPS.
•Transaction and integration costs - GAAP measure affected include consolidated pretax results, EPS, and the consolidated operating cost ratio. See Operating cost ratio reconciliation above for respective period.
•Change in fair market value of publicly-traded equity securities - GAAP measures affected include consolidated pretax results, EPS, and consolidated revenues. See Consolidated revenues reconciliation above for respective period.
•Charges related to initiatives undertaken associated with the company's previously disclosed $1 billion value creation plan - GAAP measures affected include consolidated pretax results, EPS, and the consolidated operating cost ratio. See Operating cost ratio reconciliation above for respective period.
•Gain related to the sale of a 60 percent interest in KAH Hospice in August 2022 - Consolidated pretax results and EPS are the only GAAP measures affected.
•Cumulative net tax benefit of adjustments - EPS is the only GAAP measure affected.
d) FY 2021 Adjusted results exclude the following:
•Amortization expense for identifiable intangibles - GAAP measures affected include consolidated pretax results, EPS, and segment income from operations (including amortization expense of $21 million in the Insurance segment and $44 million in the CenterWell segment).
•Gain associated with Kindred at Home equity method investment; the gain was recorded upon closing of the Kindred at Home transaction in August 2021 - GAAP measures affected include consolidated pretax results and EPS.
•Put/call valuation adjustments associated with Humana’s non-consolidating minority interest investments, including the impact of the termination of the put/call agreement related to Kindred at Home as a result of the transaction announced on April 27, 2021 - GAAP measures affected include consolidated pretax results and EPS.
•Transaction and integration costs - GAAP measure affected include consolidated pretax results, EPS, and the consolidated operating cost ratio. See Operating cost ratio reconciliation above for respective period.
•Change in fair market value of publicly-traded equity securities - GAAP measures affected include consolidated pretax results, EPS, and consolidated revenues. See Consolidated revenues reconciliation above for respective period.
•Cumulative net tax benefit of adjustments - EPS is the only GAAP measure affected.
(e) Generally, when the first day of a month falls on a weekend of holiday, with the exception of January 1 (New Year's Day), the company receives its monthly Medicare premium payment from CMS on the last business day of the previous month. On a GAAP basis, this can result in certain quarterly cash flows from operations including more or less than three monthly payments. Consequently, when this occurs, the company reports Adjusted cash flows from operations to reflect three payments in each quarter to match the related expenses.
(f) Reconciliation of Insurance segment income (loss) from operations:
| | | | | | | | | | | | | | |
Insurance segment income (loss) from operations | 4Q22 | 4Q21 | FY 2022 | FY 2021 |
Income (loss) from operations | $46 | ($105) | $3,022 | $2,412 |
Amortization associated with identifiable intangibles | 7 | | 5 | | 30 | | 21 | |
Income (loss) from operations - Adjusted (non-GAAP) | $53 | | ($100) | | $3,052 | | $2,433 | |
(g) The CenterWell segment Adjusted earnings before interest, taxes, depreciation and amortization (Adjusted EBITDA) includes the segment's income from operations with adjustments to add back depreciation and amortization expense, interest expense, and income taxes. Adjusted EBITDA includes results from all lines of business within the segment. Adjusted EBITDA also includes the
impact of Humana’s minority interest related to the strategic partnership with Welsh, Carson, Anderson & Stowe (WCAS) to develop and operate senior-focused, payor-agnostic, primary care centers, as well as Humana's minority interest ownership of KAH operations based on the timing of previously disclosed transactions.
| | | | | | | | | | | | | | |
CenterWell segment Adjusted EBITDA (in millions) | 4Q22 | 4Q21 | FY 2022 | FY 2021 |
Income from operations | $263 | $299 | $1,291 | $938 |
Equity in (losses) earnings | (7) | | (4) | | (22) | | 65 | |
Non-controlling interest income | — | | (1) | | (1) | | (1) | |
Depreciation and amortization expense | 47 | | 43 | | 186 | | 165 | |
Interest and taxes | 22 | | — | | 34 | | 39 | |
Adjusted EBITDA (non-GAAP) 4Q and FY 2022 Adjusted EBITDA excludes impact of KAH Hospice gain/adjustment | $325 | | $337 | | $1,488 | | $1,206 | |
(h) FY 2023 projected Adjusted results exclude the following:
•FY 2023 GAAP EPS excludes the impact of fair value changes of the put/call options associated with Humana's non-consolidating minority interest investments as future value changes can't be estimated.
•The fair value of publicly traded securities, their impact on GAAP EPS, and the related non-GAAP adjustment will fluctuate depending on the public trading value of the stock. The guidance set forth herein assumes no further change in the fair value of those investments.
(i) The company provides a full range of insured specialty products including dental, vision, and life insurance benefits marketed to individuals and groups. Members included in these products may not be unique to each product since members have the ability to enroll in a medical product and one or more specialty products.
Cautionary Statement
This news release includes forward-looking statements regarding Humana within the meaning of the Private Securities Litigation Reform Act of 1995. When used in investor presentations, press releases, Securities and Exchange Commission (SEC) filings, and in oral statements made by or with the approval of one of Humana’s executive officers, the words or phrases like “expects,” “believes,” “anticipates,” “intends,” “likely will result,” “estimates,” “projects” or variations of such words and similar expressions are intended to identify such forward-looking statements.
These forward-looking statements are not guarantees of future performance and are subject to risks, uncertainties, and assumptions, including, among other things, information set forth in the “Risk Factors” section of the company’s SEC filings, a summary of which includes but is not limited to the following:
•If Humana does not design and price its products properly and competitively, if the premiums Humana receives are insufficient to cover the cost of healthcare services delivered to its members, if the company is unable to implement clinical initiatives to provide a better healthcare experience for its members, lower costs and appropriately document the risk profile of its members, or if its estimates of benefits expense are inadequate, Humana’s profitability could be materially adversely affected. Humana estimates the costs of its benefit expense payments, and designs and prices its products accordingly, using actuarial methods and assumptions based upon, among other relevant factors, claim payment patterns, medical cost inflation, and historical developments such as claim inventory levels and claim receipt patterns. The company continually reviews estimates of future payments relating to benefit expenses for services incurred in the current and prior periods and makes necessary adjustments to its reserves, including premium deficiency reserves, where appropriate. These estimates involve extensive judgment, and have considerable inherent variability because they are extremely sensitive to changes in claim payment patterns and medical cost trends. Accordingly, Humana's reserves may be insufficient.
•If Humana fails to effectively implement its operational and strategic initiatives, including its Medicare initiatives, which are of particular importance given the concentration of the company's revenues in
these products, state-based contract strategy, the growth of its CenterWell business, and its integrated care delivery model, the company’s business may be materially adversely affected. In addition, there can be no assurances that the company will be successful in maintaining or improving its Star ratings in future years.
•If Humana fails to properly maintain the integrity of its data, to strategically maintain existing or implement new information systems, to protect Humana’s proprietary rights to its systems, or to defend against cyber-security attacks or prevent other privacy or data security incidents that result in security breaches that disrupt the company's operations or in the unintentional dissemination of sensitive personal information or proprietary or confidential information, the company’s business may be materially adversely affected.
•Humana is involved in various legal actions, or disputes that could lead to legal actions (such as, among other things, provider contract disputes and qui tam litigation brought by individuals on behalf of the government), governmental and internal investigations, and routine internal review of business processes any of which, if resolved unfavorably to the company, could result in substantial monetary damages or changes in its business practices. Increased litigation and negative publicity could also increase the company’s cost of doing business.
•As a government contractor, Humana is exposed to risks that may materially adversely affect its business or its willingness or ability to participate in government healthcare programs including, among other things, loss of material government contracts; governmental audits and investigations; potential inadequacy of government determined payment rates; potential restrictions on profitability; including by comparison of profitability of the company’s Medicare Advantage business to non-Medicare Advantage business; or other changes in the governmental programs in which Humana participates. Changes to the risk-adjustment model utilized by CMS to adjust premiums paid to Medicare Advantage, or MA, plans according to the health status of covered members, including changes to the methodology used by CMS for risk adjustment data validation audits that fail to address adequately the statutory requirement of actuarial equivalence, if implemented, could have a material adverse effect on the company's operating results, financial position and cash flows.
•Humana's business activities are subject to substantial government regulation. New laws or regulations, or legislative, judicial, or regulatory changes in existing laws or regulations or their manner of application could increase the company's cost of doing business and have a material adverse effect on Humana’s results of operations (including restricting revenue, enrollment and premium growth in certain products and market segments, restricting the company’s ability to expand into new markets, increasing the company’s medical and operating costs by, among other things, requiring a minimum benefit ratio on insured products, lowering the company’s Medicare payment rates and increasing the company’s expenses associated with a non-deductible health insurance industry fee and other assessments); the company’s financial position (including the company’s ability to maintain the value of its goodwill); and the company’s cash flows.
•Humana’s failure to manage acquisitions, divestitures and other significant transactions successfully may have a material adverse effect on the company’s results of operations, financial position, and cash flows.
•If Humana fails to develop and maintain satisfactory relationships with the providers of care to its members, the company’s business may be adversely affected.
•Humana faces significant competition in attracting and retaining talented employees. Further, managing succession for, and retention of, key executives is critical to the Company’s success, and its failure to do so could adversely affect the Company’s businesses, operating results and/or future performance.
•Humana’s pharmacy business is highly competitive and subjects it to regulations and supply chain risks in addition to those the company faces with its core health benefits businesses.
•Changes in the prescription drug industry pricing benchmarks may adversely affect Humana’s financial performance.
•Humana’s ability to obtain funds from certain of its licensed subsidiaries is restricted by state insurance regulations.
•Downgrades in Humana’s debt ratings, should they occur, may adversely affect its business, results of operations, and financial condition.
•The securities and credit markets may experience volatility and disruption, which may adversely affect Humana’s business.
•The spread of, and response to, the novel coronavirus, or COVID-19, underscores certain risks Humana faces, including those discussed above, and the ongoing, heightened uncertainty created by the pandemic precludes any prediction as to the ultimate adverse impact to Humana of COVID-19.
As the COVID-19 pandemic continues, the premiums the company charges may prove to be insufficient to cover the cost of health care services delivered to its members, each of which could be impacted by many factors, including the impacts that Humana has experienced, and may continue to experience, to its revenues due to limitations on its ability to implement clinical initiatives to manage health care costs and chronic conditions of its members, and appropriately document their risk profiles, as a result of the company’s members being unable or unwilling to see their providers due to actions taken to mitigate the spread of COVID-19; increased costs that may result from higher utilization rates of medical facilities and services and other increases in associated hospital and pharmaceutical costs; and shifts in the company’s premium and medical claims cost trends to reflect the demographic impact of higher mortality during the COVID-19 pandemic. In addition, Humana is offering, and has been mandated by legislative and regulatory action (including the Families First Act and CARES Act) to provide, certain expanded benefit coverage to its members, such as waiving, or reimbursing, certain costs for COVID-19 testing, vaccinations and treatment. These measures taken by Humana, or governmental action, to respond to the ongoing impact of COVID-19 (including further expansion or modification of the services delivered to its members, the adoption or modification of regulatory requirements associated with those services and the costs and challenges associated with ensuring timely compliance with such requirements), and the potential for widespread testing, treatments and the distribution and administration of COVID-19 vaccines, could adversely impact the company’s profitability.
The spread and impact of COVID-19 and additional variants, or actions taken to mitigate this spread, could have material and adverse effects on Humana’s ability to operate effectively, including as a result of the complete or partial closure of facilities or labor shortages. Disruptions in public and private infrastructure, including communications, availability of in-person sales and marketing channels, financial services and supply chains, could materially and adversely disrupt the company’s normal business operations. A significant subset of the company's and the company's third party providers' employee population are in a remote work environment in an effort to mitigate the spread of COVID-19, which may exacerbate certain risks to Humana’s business, including an increased demand for information technology resources, increased risk of phishing and other cybersecurity attacks, and increased risk of unauthorized dissemination of sensitive personal, proprietary, or confidential information. The continued COVID-19 pandemic has severely impacted global economic activity, including the businesses of some of Humana’s commercial customers, and caused significant volatility and negative pressure in the financial markets. In addition to disrupting Humana’s operations, these developments may adversely affect the timing of commercial customer premium collections and corresponding claim payments, the value of the company’s investment portfolio, or future liquidity needs.
The ongoing, heightened uncertainty created by the pandemic precludes any prediction as to the ultimate adverse impact to Humana of COVID-19. Humana is continuing to monitor the spread of COVID-19, changes to the company’s benefit coverages, and the ongoing costs and business impacts of dealing with COVID-19, including the potential costs and impacts associated with lifting or reimposing restrictions on movement and economic activity, the timing and degree in resumption of demand for deferred healthcare services, the pace of administration of COVID-19 vaccines and the effectiveness of those vaccines, and related risks. The magnitude and duration of the pandemic remain uncertain, and its impact on Humana’s business, results of operations, financial position, and cash flows could be material.
In making forward-looking statements, Humana is not undertaking to address or update them in future filings or communications regarding its business or results. In light of these risks, uncertainties, and assumptions, the forward-looking events discussed herein may or may not occur. There also may be other risks that the company is unable to
predict at this time. Any of these risks and uncertainties may cause actual results to differ materially from the results discussed in the forward-looking statements.
Humana advises investors to read the following documents as filed by the company with the SEC for further discussion both of the risks it faces and its historical performance:
•Form 10-K for the year ended December 31, 2021;
•Form 10-Q for the quarters ended March 31, 2022; June 30, 2022; September 30, 2022; and
•Form 8-Ks filed during 2022 and 2023.
About Humana
Humana Inc. (NYSE: HUM) is committed to helping our millions of medical and specialty members achieve their best health. Our successful history in care delivery and health plan administration is helping us create a new kind of integrated care with the power to improve health and well-being and lower costs. Our efforts are leading to a better quality of life for people with Medicare, families, individuals, military service personnel, and communities at large.
To accomplish that, we support physicians and other health care professionals as they work to deliver the right care in the right place for their patients, our members. Our range of clinical capabilities, resources and tools – such as in-home care, behavioral health, pharmacy services, data analytics and wellness solutions – combine to produce a simplified experience that makes health care easier to navigate and more effective.
More information regarding Humana is available to investors via the Investor Relations page of the company’s website at humana.com, including copies of:
•Annual reports to stockholders
•Securities and Exchange Commission filings
•Most recent investor conference presentations
•Quarterly earnings news releases and conference calls
•Calendar of events
•Corporate Governance information
| | | | | | | | | |
Humana Inc. Full Year 2023 Projections - AS OF FEBRUARY 1, 2023 in accordance with GAAP unless otherwise noted |
| | | Comments |
Diluted earnings per common share |
GAAP | at least $27.57 | | |
Adjustments | ~$0.43 | |
Non-GAAP | at least $28.00 | |
| | | |
Total Revenues |
Consolidated | $102.7 billion to $104.7 billion | | Consolidated and segment level revenue projections include expected investment income.
Segment level revenues include amounts that eliminate in consolidation. |
Insurance segment | $99.5 billion to $101.0 billion | |
CenterWell segment | $18.0 billion to $18.5 billion | |
| | | |
Change in year-end medical membership from prior year-end |
Individual Medicare Advantage | Growth of at least 625,000 | | |
Group Medicare Advantage | Decline of approx. 60,000 | | |
Medicare stand-alone PDP | Decline of approx. 800,000 | | |
State-based contracts | Growth in range of 25,000 to 100,000 | | State-based contracts guidance includes membership in Florida, Illinois, Kentucky, Louisiana, Ohio, South Carolina, and Wisconsin. Assumes redeterminations to begin on April 1, 2023. |
Group commercial medical | Decline of approx. 300,000 | | Group commercial medical membership includes fully-insured and ASO (self-insured). |
| | | |
Benefit Ratio - Insurance segment | 86.3% to 87.3% | | Ratio calculation: benefits expense as a percent of premiums revenues. |
| | | |
|
Operating Cost Ratio - Consolidated | 11.6% to 12.6% | | Ratio calculation: operating costs excluding depreciation and amortization as a percent of revenues excluding investment income. |
| | | |
| | | |
Segment Results |
Insurance segment income from operations | $3.24 billion to $3.54 billion | | No material impact to segment earnings anticipated from non-GAAP adjustments.
|
CenterWell segment Adjusted EBITDA | $1.30 billion to $1.45 billion | |
| | | |
Effective Tax Rate | 22.9% to 23.5% | | |
Weighted Avg. Share Count for Diluted EPS | 125.4 million to 126.4 million | | |
Cash flows from operations | ~$4.5 billion | | |
Capital expenditures | $1.2 billion | | |
Humana Inc.
Statistical Schedules
and
Supplementary Information
4Q22 Earnings Release
| | | | | |
Humana Inc. Statistical Schedules and Supplementary Information 4Q22 Earnings Release |
|
(S-3 - S-4) | Consolidated Statements of Income |
(S-5) | Consolidated Balance Sheets |
(S-6 - S-7) | Consolidated Statements of Cash Flows |
(S-8 - S-9) | Consolidating Statements of Income - Quarter |
(S-10 - S-11) | Consolidating Statements of Income - Year Ended December 31 |
(S-12) | Membership Detail |
(S-13 - S-14) | Premiums and Services Revenue Detail |
(S-15 - S-17) | CenterWell Segment - Pharmacy Solutions, Provider Services, & Home Solutions |
(S-18) | Footnotes |
| |
Segment Realignment Supplemental Information |
(S-20 - S-22) | Consolidating Statements of Income - Recast of 2022 Quarters in Current Segment Format |
(S-23) | Non-GAAP Presentation of Segment Information - Prior Segment Format Summary of Results - 4Q22, 4Q21, FY 2022, and FY 2021 |
(S-24 - S-25) | Non-GAAP Presentation of Segment Information - Prior Segment Format Consolidating Statements of Income—For the quarters ended December 31, 2022 and December 31, 2021 |
(S-26 - S-27) | Non-GAAP Presentation of Segment Information - Prior Segment Format Consolidating Statements of Income—For the years ended December 31, 2022 and December 31, 2021 |
(S-28) | Footnotes |
Humana Inc.
Consolidated Statements of Income (Unaudited)
Dollars in millions, except per common share results
| | | | | | | | | | | | | | | | | |
| For the three months ended December 31, | | | |
| | | | Dollar | Percentage |
| 2022 | 2021 | | Change | Change |
Revenues: | | | | | |
Premiums | $ | 21,275 | | $ | 19,835 | | | $ | 1,440 | | 7.3 | % |
Services | 1,004 | | 1,253 | | | (249) | | -19.9 | % |
Investment income (loss) | 160 | | (34) | | | 194 | | 570.6 | % |
Total revenues | 22,439 | | 21,054 | | | 1,385 | | 6.6 | % |
Operating expenses: | | | | | |
Benefits | 18,582 | | 17,438 | | | 1,144 | | 6.6 | % |
Operating costs | 3,551 | | 3,395 | | | 156 | | 4.6 | % |
Depreciation and amortization | 182 | | 160 | | | 22 | | 13.8 | % |
Total operating expenses | 22,315 | | 20,993 | | | 1,322 | | 6.3 | % |
Income from operations | 124 | | 61 | | | 63 | | 103.3 | % |
Adjustment on sale of KAH Hospice | 3 | | — | | | 3 | | n/a |
Interest expense | 108 | | 91 | | | 17 | | 18.7 | % |
Other expense, net (A) | 84 | | 30 | | | 54 | | 180.0 | % |
Loss before income taxes and equity in net earnings | (71) | | (60) | | | (11) | | 18.3 | % |
Benefit from income taxes | (58) | | (51) | | | 7 | | 13.7 | % |
Equity in net losses (B) | (5) | | (4) | | | 1 | | 25.0 | % |
Net loss | (18) | | (13) | | | (5) | | -38.5 | % |
Net loss (income) attributable to noncontrolling interests | 3 | | (1) | | | 4 | | 400.0 | % |
Net loss attributable to Humana | $ | (15) | | $ | (14) | | | $ | (1) | | -7.1 | % |
Basic loss per common share | $ | (0.12) | | $ | (0.11) | | | $ | (0.01) | | -9.1 | % |
Diluted loss per common share | $ | (0.12) | | $ | (0.11) | | | $ | (0.01) | | -9.1 | % |
Shares used in computing basic loss per common share (000’s) | 125,644 | | 128,612 | | | | |
Shares used in computing diluted loss per common share (000’s) | 125,644 | | 128,612 | | | | |
Humana Inc.
Consolidated Statements of Income (Unaudited)
Dollars in millions, except per common share results
| | | | | | | | | | | | | | | | | |
| For the year ended December 31, | | | |
| | | | Dollar | Percentage |
| 2022 | 2021 | | Change | Change |
Revenues: | | | | | |
Premiums | $ | 87,712 | | $ | 79,822 | | | $ | 7,890 | | 9.9 | % |
Services | 4,776 | | 3,055 | | | 1,721 | | 56.3 | % |
Investment income | 382 | | 187 | | | 195 | | 104.3 | % |
Total revenues | 92,870 | | 83,064 | | | 9,806 | | 11.8 | % |
Operating expenses: | | | | | |
Benefits | 75,690 | | 69,199 | | | 6,491 | | 9.4 | % |
Operating costs | 12,671 | | 10,121 | | | 2,550 | | 25.2 | % |
| | | | | |
Depreciation and amortization | 709 | | 596 | | | 113 | | 19.0 | % |
Total operating expenses | 89,070 | | 79,916 | | | 9,154 | | 11.5 | % |
Income from operations | 3,800 | | 3,148 | | | 652 | | 20.7 | % |
Gain on sale of KAH Hospice | (237) | | — | | | 237 | | n/a |
Interest expense | 401 | | 326 | | | 75 | | 23.0 | % |
Other expense (income), net (A) | 68 | | (532) | | | 600 | | 112.8 | % |
Income before income taxes and equity in net earnings | 3,568 | | 3,354 | | | 214 | | 6.4 | % |
Provision for income taxes | 762 | | 485 | | | 277 | | 57.1 | % |
Equity in net (losses) earnings (B) | (4) | | 65 | | | 69 | | 106.2 | % |
Net income | 2,802 | | 2,934 | | | (132) | | -4.5 | % |
Net loss (income) attributable to noncontrolling interests | 4 | | (1) | | | 5 | | 500.0 | % |
Net income attributable to Humana | $ | 2,806 | | $ | 2,933 | | | $ | (127) | | -4.3 | % |
Basic earnings per common share | $ | 22.20 | | $ | 22.79 | | | $ | (0.59) | | -2.6 | % |
Diluted earnings per common share | $ | 22.08 | | $ | 22.67 | | | $ | (0.59) | | -2.6 | % |
Shares used in computing basic earnings per common share (000’s) | 126,419 | | 128,688 | | | | |
Shares used in computing diluted earnings per common share (000’s) | 127,094 | | 129,396 | | | | |
Humana Inc.
Consolidated Balance Sheets (Unaudited)
Dollars in millions, except share amounts
| | | | | | | | | | | | | |
| December 31, | December 31, | | |
| 2022 | 2021 | | | |
Assets | | | | | |
Current assets: | | | | | |
Cash and cash equivalents | $ | 5,061 | | $ | 3,394 | | | | |
Investment securities | 13,881 | | 13,192 | | | | |
Receivables, net | 1,674 | | 1,814 | | | | |
Other current assets | 5,567 | | 6,493 | | | | |
| | | | | |
Total current assets | 26,183 | | 24,893 | | | | |
Property and equipment, net | 3,221 | | 3,073 | | | | |
Long-term investment securities | 380 | | 780 | | | | |
Equity method investments | 749 | | 141 | | | | |
Goodwill | 9,142 | | 11,092 | | | | |
Other long-term assets | 3,380 | | 4,379 | | | | |
| | | | | |
Total assets | $ | 43,055 | | $ | 44,358 | | | | |
Liabilities and Stockholders’ Equity | | | | | |
Current liabilities: | | | | | |
Benefits payable | $ | 9,264 | | $ | 8,289 | | | | |
Trade accounts payable and accrued expenses | 5,238 | | 4,509 | | | | |
Book overdraft | 298 | | 326 | | | | |
Unearned revenues | 286 | | 254 | | | | |
Short-term debt | 2,092 | | 1,953 | | | | |
| | | | | |
Total current liabilities | 17,178 | | 15,331 | | | | |
Long-term debt | 9,034 | | 10,541 | | | | |
Other long-term liabilities | 1,473 | | 2,383 | | | | |
| | | | | |
Total liabilities | 27,685 | | 28,255 | | | | |
Commitments and contingencies | | | | | |
Stockholders’ equity: | | | | | |
Preferred stock, $1 par; 10,000,000 shares authorized, none issued | — | | — | | | | |
Common stock, $0.16 2/3 par; 300,000,000 shares authorized; 198,666,598 issued at December 31, 2022 | 33 | | 33 | | | | |
Capital in excess of par value | 3,246 | | 3,082 | | | | |
Retained earnings | 25,492 | | 23,086 | | | | |
Accumulated other comprehensive (loss) income | (1,304) | | 42 | | | | |
Treasury stock, at cost, 73,691,955 shares at December 31, 2022 | (12,156) | | (10,163) | | | | |
Noncontrolling interests | 59 | | 23 | | | | |
Total stockholders’ equity | 15,370 | | 16,103 | | | | |
Total liabilities and stockholders’ equity | $ | 43,055 | | $ | 44,358 | | | | |
Debt-to-total capitalization ratio | 42.0 | % | 43.7 | % | | | |
Humana Inc.
Consolidated Statements of Cash Flows (Unaudited) Dollars in millions
| | | | | | | | | | | |
| For the three months ended December 31, | | | |
| 2022 | 2021 | | | |
Cash flows from operating activities | | | | | |
Net loss | $ | (18) | | $ | (13) | | | | |
Adjustments to reconcile net loss to net cash used in operating activities: | | | | | |
Adjustment on sale of KAH Hospice | 3 | | — | | | | |
| | | | | |
Loss on investment securities, net | 69 | | 112 | | | | |
Equity in net losses | 5 | | 4 | | | | |
Impairment on property and equipment | 104 | | — | | | | |
Depreciation | 194 | | 172 | | | | |
Amortization | 23 | | 22 | | | | |
Stock-based compensation | 43 | | 48 | | | | |
(Benefit) provision from deferred income taxes | (67) | | 15 | | | | |
Changes in operating assets and liabilities, net of effect of businesses acquired and dispositions: | | | | | |
Receivables | (65) | | 14 | | | | |
Other assets | 2 | | (15) | | | | |
Benefits payable | 27 | | (469) | | | | |
Other liabilities | 239 | | (31) | | | | |
Unearned revenues | (5,726) | | 19 | | | | |
Other, net | 40 | | 26 | | | | |
Net cash used in operating activities | (5,127) | | (96) | | | | |
Cash flows from investing activities | | | | | |
Acquisitions, net of cash and cash equivalents acquired | (44) | | (228) | | | | |
Proceeds from sale of KAH Hospice, net | (7) | | — | | | | |
Purchases of property and equipment, net | (258) | | (371) | | | | |
Purchases of investment securities | (1,309) | | (624) | | | | |
Maturities of investment securities | 151 | | 494 | | | | |
Proceeds from sales of investment securities | 455 | | 627 | | | | |
| | | | | |
Net cash used in investing activities | (1,012) | | (102) | | | | |
Cash flows from financing activities | | | | | |
Withdrawals from contract deposits, net | (1,794) | | (911) | | | | |
Proceeds from issuance of senior notes | 1,238 | | — | | | | |
Repayment of senior notes | (1,000) | | — | | | | |
Proceeds from commercial paper, net | 284 | | 159 | | | | |
Debt issue costs | (4) | | (2) | | | | |
Proceeds from issuance of term loan | — | | 2,000 | | | | |
Repayment of term loan | — | | (1,928) | | | | |
Change in book overdraft | 61 | | 86 | | | | |
Common stock repurchases | (1,064) | | (43) | | | | |
Dividends paid | (101) | | (91) | | | | |
Other | 22 | | 18 | | | | |
Net cash used in financing activities | (2,358) | | (712) | | | | |
Decrease in cash and cash equivalents | (8,497) | | (910) | | | | |
Cash and cash equivalents at beginning of period | 13,558 | | 4,304 | | | | |
Cash and cash equivalents at end of period | $ | 5,061 | | $ | 3,394 | | | | |
Humana Inc.
Consolidated Statements of Cash Flows (Unaudited) Dollars in millions
| | | | | | | | | | | |
| For the year ended December 31, | | | |
| 2022 | 2021 | | | |
Cash flows from operating activities | | | | | |
Net income | $ | 2,802 | | $ | 2,934 | | | | |
Adjustments to reconcile net income to net cash provided by operating activities: | | | | | |
Gain on sale of KAH Hospice | (237) | | — | | | | |
Gain on Kindred at Home equity method investment | — | | (1,129) | | | | |
Loss on investment securities, net | 205 | | 130 | | | | |
Equity in net loss (earnings) | 4 | | (65) | | | | |
Impairment of property and equipment | 248 | | — | | | | |
Depreciation | 749 | | 640 | | | | |
Amortization | 96 | | 73 | | | | |
Stock-based compensation | 216 | | 180 | | | | |
(Benefit) provision from deferred income taxes | (100) | | 15 | | | | |
Changes in operating assets and liabilities, net of effect of businesses acquired and dispositions: | | | | | |
Receivables | (54) | | (280) | | | | |
Other assets | (463) | | (491) | | | | |
Benefits payable | 975 | | 104 | | | | |
Other liabilities | 44 | | 176 | | | | |
Unearned revenues | 32 | | (65) | | | | |
Other, net | 70 | | 40 | | | | |
Net cash provided by operating activities | 4,587 | | 2,262 | | | | |
Cash flows from investing activities | | | | | |
Acquisitions, net of cash and cash equivalents acquired | (337) | | (4,187) | | | | |
Proceeds from sale of KAH Hospice, net | 2,701 | | — | | | | |
Purchases of property and equipment, net | (1,120) | | (1,316) | | | | |
Purchases of investment securities | (6,049) | | (7,197) | | | | |
Maturities of investment securities | 1,365 | | 2,597 | | | | |
Proceeds from sales of investment securities | 2,434 | | 3,547 | | | | |
Net cash used in investing activities | (1,006) | | (6,556) | | | | |
Cash flows from financing activities | | | | | |
Receipts (withdrawals) from contract deposits, net | 1,993 | | (306) | | | | |
Proceeds from issuance of senior notes | 1,982 | | 2,984 | | | | |
Repayment of senior notes | (1,000) | | — | | | | |
(Repayment) proceeds from the issuance of commercial paper, net | (376) | | 352 | | | | |
Proceeds from issuance of term loan | — | | 2,500 | | | | |
Repayment of term loan | (2,000) | | (2,078) | | | | |
Debt issue costs | (6) | | (31) | | | | |
Change in book overdraft | (28) | | 6 | | | | |
Common stock repurchases | (2,096) | | (79) | | | | |
Dividends paid | (392) | | (354) | | | | |
Other | 9 | | 21 | | | | |
Net cash (used in) provided by financing activities | (1,914) | | 3,015 | | | | |
Increase (decrease) in cash and cash equivalents | 1,667 | | (1,279) | | | | |
Cash and cash equivalents at beginning of period | 3,394 | | 4,673 | | | | |
Cash and cash equivalents at end of period | $ | 5,061 | | $ | 3,394 | | | | |
Humana Inc.
Consolidating Statements of Income—For the three months ended December 31, 2022 (Unaudited)
In millions
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
| Insurance | | | | CenterWell | | | | | | Eliminations/ Corporate | | Consolidated |
Revenues—external customers Premiums: | | | | | | | | | | | | | |
Individual Medicare Advantage | $ | 15,840 | | | | | $ | — | | | | | | | $ | — | | | $ | 15,840 | |
Group Medicare Advantage | 1,773 | | | | | — | | | | | | | — | | | 1,773 | |
Medicare stand-alone PDP | 490 | | | | | — | | | | | | | — | | | 490 | |
Total Medicare | 18,103 | | | | | — | | | | | | | — | | | 18,103 | |
Fully-insured | 1,094 | | | | | — | | | | | | | — | | | 1,094 | |
Specialty | 422 | | | | | — | | | | | | | — | | | 422 | |
Medicaid and other (C) | 1,656 | | | | | — | | | | | | | — | | | 1,656 | |
Total premiums | 21,275 | | | | | — | | | | | | | — | | | 21,275 | |
Services revenue: | | | | | | | | | | | | | |
Home solutions (D) | — | | | | | 336 | | | | | | | — | | | 336 | |
Pharmacy solutions | — | | | | | 279 | | | | | | | — | | | 279 | |
Provider services | — | | | | | 159 | | | | | | | — | | | 159 | |
ASO and other (E) | 230 | | | | | — | | | | | | | — | | | 230 | |
Total services revenue | 230 | | | | | 774 | | | | | | | — | | | 1,004 | |
Total revenues—external customers | 21,505 | | | | | 774 | | | | | | | — | | | 22,279 | |
| | | | | | | | | | | | | |
| | | | | | | | | | | | | |
| | | | | | | | | | | | | |
Intersegment revenues | 14 | | | | | 3,365 | | | | | | | (3,379) | | | — | |
Investment income | 80 | | | | | 2 | | | | | | | 78 | | | 160 | |
Total revenues | 21,599 | | | | | 4,141 | | | | | | | (3,301) | | | 22,439 | |
Operating expenses: | | | | | | | | | | | | | |
Benefits | 18,623 | | | | | — | | | | | | | (41) | | | 18,582 | |
Operating costs | 2,765 | | | | | 3,833 | | | | | | | (3,047) | | | 3,551 | |
Depreciation and amortization | 165 | | | | | 45 | | | | | | | (28) | | | 182 | |
Total operating expenses | 21,553 | | | | | 3,878 | | | | | | | (3,116) | | | 22,315 | |
Income (loss) from operations | 46 | | | | | 263 | | | | | | | (185) | | | 124 | |
Adjustment on sale of KAH Hospice | — | | | | | 3 | | | | | | | — | | | 3 | |
Interest expense | — | | | | | — | | | | | | | 108 | | | 108 | |
Other expense, net (A) | — | | | | | — | | | | | | | 84 | | | 84 | |
Income (loss) before income taxes and equity in net earnings | 46 | | | | | 260 | | | | | | | (377) | | | (71) | |
Equity in net earnings (losses) (B) | 2 | | | | | (7) | | | | | | | — | | | (5) | |
Segment earnings (loss) | 48 | | | | | 253 | | | | | | | (377) | | | (76) | |
Net loss attributable to non-controlling interests | 3 | | | | | — | | | | | | | — | | | 3 | |
Segment earnings (loss) attributable to Humana | $ | 51 | | | | | $ | 253 | | | | | | | $ | (377) | | | $ | (73) | |
Benefit ratio | 87.5 | % | | | | | | | | | | | | 87.3 | % |
Operating cost ratio | 12.8 | % | | | | 92.6 | % | | | | | | | | 15.9 | % |
Humana Inc.
Consolidating Statements of Income—For the three months ended December 31, 2021 (Unaudited)
In millions
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
| Insurance | | | | CenterWell | | | | | | Eliminations/ Corporate | | Consolidated |
Revenues—external customers Premiums: | | | | | | | | | | | | | |
Individual Medicare Advantage | $ | 14,612 | | | | | $ | — | | | | | | | $ | — | | | $ | 14,612 | |
Group Medicare Advantage | 1,688 | | | | | — | | | | | | | — | | | 1,688 | |
Medicare stand-alone PDP | 504 | | | | | — | | | | | | | — | | | 504 | |
Total Medicare | 16,804 | | | | | — | | | | | | | — | | | 16,804 | |
Fully-insured | 1,228 | | | | | — | | | | | | | — | | | 1,228 | |
Specialty | 433 | | | | | — | | | | | | | — | | | 433 | |
Medicaid and other (C) | 1,370 | | | | | — | | | | | | | — | | | 1,370 | |
Total premiums | 19,835 | | | | | — | | | | | | | — | | | 19,835 | |
Services revenue: | | | | | | | | | | | | | |
Home solutions (D) | — | | | | | 743 | | | | | | | — | | | 743 | |
Pharmacy solutions | — | | | | | 151 | | | | | | | — | | | 151 | |
Provider services | — | | | | | 115 | | | | | | | — | | | 115 | |
ASO and other (E) | 244 | | | | | — | | | | | | | — | | | 244 | |
Total services revenue | 244 | | | | | 1,009 | | | | | | | — | | | 1,253 | |
Total revenues—external customers | 20,079 | | | | | 1,009 | | | | | | | — | | | 21,088 | |
| | | | | | | | | | | | | |
| | | | | | | | | | | | | |
| | | | | | | | | | | | | |
Intersegment revenues | 10 | | | | | 3,075 | | | | | | | (3,085) | | | — | |
Investment income (loss) | 48 | | | | | 1 | | | | | | | (83) | | | (34) | |
Total revenues | 20,137 | | | | | 4,085 | | | | | | | (3,168) | | | 21,054 | |
Operating expenses: | | | | | | | | | | | | | |
Benefits | 17,552 | | | | | — | | | | | | | (114) | | | 17,438 | |
Operating costs | 2,546 | | | | | 3,743 | | | | | | | (2,894) | | | 3,395 | |
Depreciation and amortization | 144 | | | | | 43 | | | | | | | (27) | | | 160 | |
Total operating expenses | 20,242 | | | | | 3,786 | | | | | | | (3,035) | | | 20,993 | |
(Loss) income from operations | (105) | | | | | 299 | | | | | | | (133) | | | 61 | |
| | | | | | | | | | | | | |
Interest expense | — | | | | | — | | | | | | | 91 | | | 91 | |
Other expense, net (A) | — | | | | | — | | | | | | | 30 | | | 30 | |
(Loss) income before income taxes and equity in net earnings | (105) | | | | | 299 | | | | | | | (254) | | | (60) | |
Equity in net losses (B) | — | | | | | (4) | | | | | | | — | | | (4) | |
Segment (loss) earnings | (105) | | | | | 295 | | | | | | | (254) | | | (64) | |
Net income attributable to non-controlling interests | — | | | | | (1) | | | | | | | — | | | (1) | |
Segment (loss) earnings attributable to Humana | $ | (105) | | | | | $ | 294 | | | | | | | $ | (254) | | | $ | (65) | |
Benefit ratio | 88.5 | % | | | | | | | | | | | | 87.9 | % |
Operating cost ratio | 12.7 | % | | | | 91.7 | % | | | | | | | | 16.1 | % |
Humana Inc.
Consolidating Statements of Income—For the year ended December 31, 2022 (Unaudited)
In millions
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
| Insurance | | | | CenterWell | | | | | | Eliminations/ Corporate | | Consolidated |
Revenues—external customers Premiums: | | | | | | | | | | | | | |
Individual Medicare Advantage | $ | 65,591 | | | | | $ | — | | | | | | | $ | — | | | $ | 65,591 | |
Group Medicare Advantage | 7,297 | | | | | — | | | | | | | — | | | 7,297 | |
Medicare stand-alone PDP | 2,269 | | | | | — | | | | | | | — | | | 2,269 | |
Total Medicare | 75,157 | | | | | — | | | | | | | — | | | 75,157 | |
Fully-insured | 4,476 | | | | | — | | | | | | | — | | | 4,476 | |
Specialty | 1,703 | | | | | — | | | | | | | — | | | 1,703 | |
Medicaid and other (C) | 6,376 | | | | | — | | | | | | | — | | | 6,376 | |
Total premiums | 87,712 | | | | | — | | | | | | | — | | | 87,712 | |
Services revenue: | | | | | | | | | | | | | |
Home solutions (D) | — | | | | | 2,333 | | | | | | | — | | | 2,333 | |
Pharmacy solutions | — | | | | | 1,025 | | | | | | | — | | | 1,025 | |
Provider services | — | | | | | 568 | | | | | | | — | | | 568 | |
ASO and other (E) | 850 | | | | | — | | | | | | | — | | | 850 | |
Total services revenue | 850 | | | | | 3,926 | | | | | | | — | | | 4,776 | |
Total revenues—external customers | 88,562 | | | | | 3,926 | | | | | | | — | | | 92,488 | |
| | | | | | | | | | | | | |
| | | | | | | | | | | | | |
| | | | | | | | | | | | | |
Intersegment revenues | 56 | | | | | 13,373 | | | | | | | (13,429) | | | — | |
Investment income | 223 | | | | | 8 | | | | | | | 151 | | | 382 | |
Total revenues | 88,841 | | | | | 17,307 | | | | | | | (13,278) | | | 92,870 | |
Operating expenses: | | | | | | | | | | | | | |
Benefits | 75,934 | | | | | — | | | | | | | (244) | | | 75,690 | |
Operating costs | 9,251 | | | | | 15,835 | | | | | | | (12,415) | | | 12,671 | |
Depreciation and amortization | 634 | | | | | 181 | | | | | | | (106) | | | 709 | |
Total operating expenses | 85,819 | | | | | 16,016 | | | | | | | (12,765) | | | 89,070 | |
Income (loss) from operations | 3,022 | | | | | 1,291 | | | | | | | (513) | | | 3,800 | |
Gain on sale of KAH Hospice | — | | | | | (237) | | | | | | | — | | | (237) | |
Interest expense | — | | | | | — | | | | | | | 401 | | | 401 | |
Other expense, net (A) | — | | | | | — | | | | | | | 68 | | | 68 | |
Income (loss) before income taxes and equity in net earnings | 3,022 | | | | | 1,528 | | | | | | | (982) | | | 3,568 | |
Equity in net earnings (losses) (B) | 18 | | | | | (22) | | | | | | | — | | | (4) | |
Segment earnings (loss) | 3,040 | | | | | 1,506 | | | | | | | (982) | | | 3,564 | |
Net loss (income) attributable to non-controlling interests | 5 | | | | | (1) | | | | | | | — | | | 4 | |
Segment earnings (loss) attributable to Humana | $ | 3,045 | | | | | $ | 1,505 | | | | | | | $ | (982) | | | $ | 3,568 | |
Benefit ratio | 86.6 | % | | | | | | | | | | | | 86.3 | % |
Operating cost ratio | 10.4 | % | | | | 91.5 | % | | | | | | | | 13.7 | % |
Humana Inc.
Consolidating Statements of Income—For the year ended December 31, 2021 (Unaudited)
In millions
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
| Insurance | | | | CenterWell | | | | | | Eliminations/ Corporate | | Consolidated |
Revenues—external customers Premiums: | | | | | | | | | | | | | |
Individual Medicare Advantage | $ | 58,654 | | | | | $ | — | | | | | | | $ | — | | | $ | 58,654 | |
Group Medicare Advantage | 6,955 | | | | | — | | | | | | | — | | | 6,955 | |
Medicare stand-alone PDP | 2,371 | | | | | — | | | | | | | — | | | 2,371 | |
Total Medicare | 67,980 | | | | | — | | | | | | | — | | | 67,980 | |
Fully-insured | 5,002 | | | | | — | | | | | | | — | | | 5,002 | |
Specialty | 1,731 | | | | | — | | | | | | | — | | | 1,731 | |
Medicaid and other (C) | 5,109 | | | | | — | | | | | | | — | | | 5,109 | |
Total premiums | 79,822 | | | | | — | | | | | | | — | | | 79,822 | |
Services revenue: | | | | | | | | | | | | | |
Home solutions (D) | — | | | | | 1,166 | | | | | | | — | | | 1,166 | |
Pharmacy solutions | — | | | | | 623 | | | | | | | — | | | 623 | |
Provider services | — | | | | | 413 | | | | | | | — | | | 413 | |
ASO and other (E) | 853 | | | | | — | | | | | | | — | | | 853 | |
Total services revenue | 853 | | | | | 2,202 | | | | | | | — | | | 3,055 | |
Total revenues—external customers | 80,675 | | | | | 2,202 | | | | | | | — | | | 82,877 | |
| | | | | | | | | | | | | |
| | | | | | | | | | | | | |
| | | | | | | | | | | | | |
Intersegment revenues | 41 | | | | | 11,852 | | | | | | | (11,893) | | | — | |
Investment income | 214 | | | | | 4 | | | | | | | (31) | | | 187 | |
Total revenues | 80,930 | | | | | 14,058 | | | | | | | (11,924) | | | 83,064 | |
Operating expenses: | | | | | | | | | | | | | |
Benefits | 69,639 | | | | | — | | | | | | | (440) | | | 69,199 | |
Operating costs | 8,340 | | | | | 12,968 | | | | | | | (11,187) | | | 10,121 | |
| | | | | | | | | | | | | |
Depreciation and amortization | 539 | | | | | 152 | | | | | | | (95) | | | 596 | |
Total operating expenses | 78,518 | | | | | 13,120 | | | | | | | (11,722) | | | 79,916 | |
Income (loss) from operations | 2,412 | | | | | 938 | | | | | | | (202) | | | 3,148 | |
| | | | | | | | | | | | | |
Interest expense | — | | | | | — | | | | | | | 326 | | | 326 | |
Other income, net (A) | — | | | | | — | | | | | | | (532) | | | (532) | |
Income before income taxes and equity in net earnings | 2,412 | | | | | 938 | | | | | | | 4 | | | 3,354 | |
Equity in net earnings (B) | — | | | | | 65 | | | | | | | — | | | 65 | |
Segment earnings | 2,412 | | | | | 1,003 | | | | | | | 4 | | | 3,419 | |
Net income attributable to non-controlling interests | — | | | | | (1) | | | | | | | — | | | (1) | |
Segment earnings attributable to Humana | $ | 2,412 | | | | | $ | 1,002 | | | | | | | $ | 4 | | | $ | 3,418 | |
Benefit ratio | 87.2 | % | | | | | | | | | | | | 86.7 | % |
Operating cost ratio | 10.3 | % | | | | 92.3 | % | | | | | | | | 12.2 | % |
Humana Inc.
Membership Detail (Unaudited)
In thousands
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
| | | | | | Year-over-Year Change | | | | Sequential Change |
| December 31, 2022 | Average 4Q22 | | December 31, 2021 | | Amount | Percent | | September 30, 2022 | | Amount | Percent |
Medical Membership: | | | | | | | | | | | | |
Individual Medicare Advantage | 4,565.6 | | 4,565.4 | | | 4,409.1 | | | 156.5 | | 3.5 | % | | 4,564.2 | | | 1.4 | | — | % |
Group Medicare Advantage | 565.1 | | 565.2 | | | 560.6 | | | 4.5 | | 0.8 | % | | 564.6 | | | 0.5 | | 0.1 | % |
Total Medicare Advantage | 5,130.7 | | 5,130.6 | | | 4,969.7 | | | 161.0 | | 3.2 | % | | 5,128.8 | | | 1.9 | | — | % |
Medicare stand-alone PDP | 3,551.3 | | 3,556.3 | | | 3,606.2 | | | (54.9) | | -1.5 | % | | 3,569.1 | | | (17.8) | | -0.5 | % |
Total Medicare | 8,682.0 | | 8,686.9 | | | 8,575.9 | | | 106.1 | | 1.2 | % | | 8,697.9 | | | (15.9) | | -0.2 | % |
State-based contracts and other (F) | 1,137.3 | | 1,126.5 | | | 940.1 | | | 197.2 | | 21.0 | % | | 1,098.9 | | | 38.4 | | 3.5 | % |
Medicare Supplement | 313.6 | | 314.7 | | | 331.9 | | | (18.3) | | -5.5 | % | | 316.5 | | | (2.9) | | -0.9 | % |
| | | | | | | | | | | | |
Fully-insured commercial medical | 556.3 | | 560.7 | | | 674.6 | | | (118.3) | | -17.5 | % | | 574.5 | | | (18.2) | | -3.2 | % |
ASO commercial | 430.1 | | 432.9 | | | 495.5 | | | (65.4) | | -13.2 | % | | 438.6 | | | (8.5) | | -1.9 | % |
Military services | 5,959.9 | | 5,971.7 | | | 6,049.0 | | | (89.1) | | -1.5 | % | | 5,977.9 | | | (18.0) | | -0.3 | % |
| | | | | | | | | | | | |
| | | | | | | | | | | | |
| | | | | | | | | | | | |
| | | | | | | | | | | | |
Total Medical Membership | 17,079.2 | | 17,093.4 | | | 17,067.0 | | | 12.2 | | 0.1 | % | | 17,104.3 | | | (25.1) | | 0.1 | % |
| | | | | | | | | | | | |
Specialty Membership: | | | | | | | | | | | | |
Dental—fully-insured (G) | 2,416.3 | | 2,425.7 | | | 2,543.4 | | | (127.1) | | -5.0 | % | | 2,435.3 | | | (19.0) | | -0.8 | % |
Dental—ASO | 288.1 | | 287.8 | | | 279.3 | | | 8.8 | | 3.2 | % | | 287.1 | | | 1.0 | | 0.3 | % |
Total Dental | 2,704.4 | | 2,713.5 | | | 2,822.7 | | | (118.3) | | -4.2 | % | | 2,722.4 | | | (18.0) | | -0.7 | % |
Vision | 2,081.7 | | 2,080.6 | | | 2,062.0 | | | 19.7 | | 1.0 | % | | 2,078.3 | | | 3.4 | | 0.2 | % |
Other supplemental benefits (H) | 408.7 | | 409.0 | | | 409.6 | | | (0.9) | | -0.2 | % | | 409.4 | | | (0.7) | | -0.2 | % |
Total Specialty Membership | 5,194.8 | | 5,203.1 | | | 5,294.3 | | | (99.5) | | -1.9 | % | | 5,210.1 | | | (15.3) | | -0.3 | % |
| | | | | | | | | | | | |
| | | | | | | | | | | | |
| December 31, 2022 | Member Mix December 31, 2022 | | December 31, 2021 | | Member Mix December 31, 2021 | | | | | | |
Individual Medicare Advantage Membership | | | | | | | | | | | | |
HMO | 2,618.6 | | 57 | % | | 2,610.0 | | | 59 | % | | | | | | |
PPO/PFFS | 1,947.0 | | 43 | % | | 1,799.1 | | | 41 | % | | | | | | |
Total Individual Medicare Advantage | 4,565.6 | | 100 | % | | 4,409.1 | | | 100 | % | | | | | | |
Individual Medicare Advantage Membership (I) | | | | | | | | | | | | |
Shared Risk (J) | 1,562.9 | | 35 | % | | 1,427.0 | | | 32 | % | | | | | | |
Path to Risk (K) | 1,612.6 | | 35 | % | | 1,582.6 | | | 36 | % | | | | | | |
Total Value-based | 3,175.5 | | 70 | % | | 3,009.6 | | | 68 | % | | | | | | |
Other | 1,390.1 | | 30 | % | | 1,399.5 | | | 32 | % | | | | | | |
Total Individual Medicare Advantage | 4,565.6 | | 100 | % | | 4,409.1 | | | 100 | % | | | | | | |
Humana Inc.
Premiums and Services Revenue Detail (Unaudited)
Dollars in millions, except per member per month
| | | | | | | | | | | | | | | | | | | | | | | | | | |
| For the three months ended December 31, | | | | | Per Member per Month (N) For the three months ended December 31, |
| | | | Dollar | Percentage | | |
| 2022 | 2021 | | Change | Change | | 2022 | 2021 |
| | | | | | | | |
Insurance | | | | | | | | |
Individual Medicare Advantage | $ | 15,840 | | $ | 14,612 | | | $ | 1,228 | | 8.4 | % | | $ | 1,157 | | $ | 1,104 | |
Group Medicare Advantage | 1,773 | | 1,688 | | | 85 | | 5.0 | % | | 1,046 | | 1,004 | |
Medicare stand-alone PDP | 490 | | 504 | | | (14) | | -2.8 | % | | 46 | | 46 | |
State-based contracts and other (C) | 1,656 | | 1,370 | | | 286 | | 20.9 | % | | 490 | | 490 | |
Medicare Supplement | 188 | | 186 | | | 2 | | 1.1 | % | | 199 | | 187 | |
Fully-insured commercial medical | 906 | | 1,042 | | | (136) | | -13.1 | % | | 539 | | 511 | |
Commercial ASO & other services (E) | 67 | | 76 | | | (9) | | -11.8 | % | | | |
Military services (L) | 152 | | 158 | | | (6) | | -3.8 | % | | | |
Specialty (M) | 422 | | 433 | | | (11) | | -2.5 | % | | 29 | | 29 | |
Other services | 25 | | 20 | | | 5 | | 25.0 | % | | | |
Total | 21,519 | | 20,089 | | | 1,430 | | 7.1 | % | | | |
| | | | | | | | |
| | | | | | | | |
CenterWell | | | | | | | | |
Pharmacy solutions | 2,724 | | 2,459 | | | 265 | | 10.8 | % | | | |
Provider services | 878 | | 733 | | | 145 | | 19.8 | % | | | |
Home solutions (D) | 537 | | 892 | | | (355) | | -39.8 | % | | | |
Total | 4,139 | | 4,084 | | | 55 | | 1.3 | % | | | |
| | | | | | | | |
Humana Inc.
Premiums and Services Revenue Detail (Unaudited)
Dollars in millions, except per member per month
| | | | | | | | | | | | | | | | | | | | | | | | | | |
| For the year ended December 31, | | | | | Per Member per Month (N) For the year ended December 31, |
| | | | Dollar | Percentage | | | |
| 2022 | 2021 | | Change | Change | | 2022 | 2021 |
| | | | | | | | |
Insurance | | | | | | | | |
Individual Medicare Advantage | $ | 65,591 | | $ | 58,654 | | | $ | 6,937 | | 11.8 | % | | $ | 1,200 | | $ | 1,124 | |
Group Medicare Advantage | 7,297 | | 6,955 | | | 342 | | 4.9 | % | | 1,079 | | 1,038 | |
Medicare stand-alone PDP | 2,269 | | 2,371 | | | (102) | | -4.3 | % | | 53 | | 54 | |
State-based contracts and other (C) | 6,376 | | 5,109 | | | 1,267 | | 24.8 | % | | 500 | | 484 | |
Medicare Supplement | 743 | | 731 | | | 12 | | 1.6 | % | | 195 | | 184 | |
Fully-insured commercial medical | 3,733 | | 4,271 | | | (538) | | -12.6 | % | | 523 | | 506 | |
Commercial ASO & other services (E) | 267 | | 288 | | | (21) | | -7.3 | % | | | |
Military services (L) | 540 | | 528 | | | 12 | | 2.3 | % | | | |
Specialty (M) | 1,703 | | 1,731 | | | (28) | | -1.6 | % | | 29 | | 29 | |
Other services | 99 | | 78 | | | 21 | | 26.9 | % | | | |
Total | 88,618 | | 80,716 | | | 7,902 | | 9.8 | % | | | |
| | | | | | | | |
CenterWell | | | | | | | | |
Pharmacy solutions | 10,865 | | 9,647 | | | 1,218 | | 12.6 | % | | | |
Provider services | 3,548 | | 2,889 | | | 659 | | 22.8 | % | | | |
Home solutions (D) | 2,886 | | 1,518 | | | 1,368 | | 90.1 | % | | | |
Total | 17,299 | | 14,054 | | | 3,245 | | 23.1 | % | | | |
| | | | | | | | |
Humana Inc.
CenterWell Segment - Pharmacy Solutions (Unaudited)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
| For the three months ended December 31, 2022 | For the three months ended December 31, 2021 | | Year-over-Year Difference | | For the three months ended September 30, 2022 | | Sequential Difference | |
| | | | | | | | | |
Generic Dispense Rate | | | | | | | | | |
| | | | | | | | | |
| | | | | | | | | |
| | | | | | | | | |
Total Medicare | 91.7 | % | 91.7 | % | | — | % | | 91.7 | % | | — | % | |
| | | | | | | | | |
Mail-Order Penetration | | | | | | | | | |
| | | | | | | | | |
| | | | | | | | | |
| | | | | | | | | |
Total Medicare | 30.6 | % | 30.7 | % | | -0.1 | % | | 30.6 | % | | — | % | |
| | | | | | | | | |
| | | | | | | | | | | | | | | | | |
| For the year ended December 31, 2022 | For the year ended December 31, 2021 | | Year-over-Year Difference | |
| | | | | |
Generic Dispense Rate | | | | | |
| | | | | |
| | | | | |
| | | | | |
Total Medicare | 91.7 | % | 91.6 | % | | 0.1 | % | |
| | | | | |
Mail-Order Penetration | | | | | |
| | | | | |
| | | | | |
| | | | | |
Total Medicare | 30.5 | % | 30.2 | % | | 0.3 | % | |
| | | | | |
Humana Inc.
CenterWell Segment - Provider Services (O) (Unaudited)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
| As of December 31, 2022 | | As of December 31, 2021 | | Year-over-Year Growth |
| | Primary | | | | Primary | | | | Primary | |
| Center | Care | Patients | | Center | Care | Patients | | Center | Care | Patients |
| Count | Providers | Served (P) | | Count | Providers | Served (P) | | Count | Providers | Served |
De novo | 50 | | 104 | 19,300 | | | 32 | 66 | 10,100 | | | 56.3 | % | 57.6 | % | 91.1 | % |
Wholly-owned | 185 | 567 | 171,900 | | | 174 | 473 | 167,600 | | | 6.3 | % | 19.9 | % | 2.6 | % |
Independent Physician Associations | | | 56,700 | | | | | 57,100 | | | | | (0.7) | % |
| 235 | 671 | | 247,900 | | | 206 | 539 | | 234,800 | | | 14.1 | % | 24.5 | % | 5.6 | % |
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
| | | As of September 30, 2022 | | Sequential Growth |
| | | | | | Primary | | | | Primary | |
| | | | | Center | Care | Patients | | Center | Care | Patients |
| | | | | Count | Providers | Served (P) | | Count | Providers | Served |
De novo | | | | | 42 | | 92 | 17,500 | | | 19.0 | % | 13.0 | % | 10.3 | % |
Wholly-owned | | | | | 180 | 563 | 164,600 | | | 2.8 | % | 0.7 | % | 4.4 | % |
Independent Physician Associations | | | | | | | 60,600 | | | | | (6.4) | % |
| | | | | 222 | 655 | | 242,700 | | | 5.9 | % | 2.4 | % | 2.1 | % |
Humana Inc.
CenterWell Segment - Home Solutions (Unaudited)
| | | | | | | | | | | |
| For the quarter ended December 31, 2022 | For the quarter ended December 31, 2021 | Year-over-Year Growth |
| | | |
Episodic Admissions (Q) | 68,306 | | 63,478 | | 7.6 | % |
Total Admissions - Same Store (R) | 88,118 | | 80,796 | | 9.1 | % |
| | | | | | | | | | | |
| For the year ended December 31, 2022 | For the year ended December 31, 2021 | Year-over-Year Growth |
| | | |
Episodic Admissions (Q) | 276,245 | | 263,610 | | 4.8 | % |
Total Admissions - Same Store (R) | 354,994 | | 333,972 | | 6.3 | % |
| | | | | | | | | | | | | | |
| December 31, 2022 | December 31, 2021 | Year-over-Year Growth |
Members covered by a value-based home care model (S) | 760,600 | 271,100 | 180.6% |
Humana Inc.
Footnotes to Statistical Schedules and Supplementary Information
4Q22 Earnings Release
(A)Put/call valuation adjustments associated with the company's non-consolidating minority interest investments.
(B)Net earnings (losses) associated with the company's non-consolidating minority interest investments.
(C)The Medicaid and other category includes premiums associated with the company’s Medicaid business, as well as premiums associated with the health plan's direct contracting entity.
(D)Reflects results from the company's home health line of business, including the impact of the previously disclosed transactions in August 2021 and August 2022.
(E)The ASO and other category is primarily comprised of Administrative Services Only (ASO) fees and other ancillary services fees, including military services unless separately disclosed. The line also includes external revenues associated with the PBM.
(F)Membership includes Medicaid Temporary Assistance for Needy Families (TANF), dual-eligible demonstration, and Long-Term Support Services (LTSS) from state-based contracts, as well as members associated with the health plan's direct contracting entity.
(G)Fully-insured dental membership as reported does not include Humana members that have a Medicare Advantage plan that includes an embedded dental benefit.
(H)Other supplemental benefits include group life policies.
(I)Members and plans connected to Humana's 2021 Independent Care Health Plan (iCare) acquisition are being integrated into the company's systems, as such, there may be fluctuations in the value-based care distribution as the integration effort is finalized.
(J)In certain circumstances, the company contracts with providers to accept financial risk for a defined set of Medicare Advantage membership. In transferring this risk, the company prepays these providers a monthly fixed-fee per member to coordinate substantially all of the medical care for their Medicare Advantage members assigned or attributed to their provider panel, including some health benefit administrative functions and claims processing. For these capitated Shared Risk arrangements, the company generally agrees to payment rates that target a benefit expense ratio. The result is a high level of engagement on the part of the provider.
(K)A Path to Risk provider is one who has a high level of engagement and participates in one of Humana’s pay-for-performance programs (Model Practice or Medical Home) or has a risk contract in place with a trigger (future date or membership threshold) which has not yet been met. In addition to earning incentives, these providers may also have a shared savings component by which they can share in achieved surpluses when the actual cost of the medical services provided to patients assigned or attributed to their panel is less than the agreed upon medical expense target.
(L)The amounts primarily reflect services revenues under the TRICARE East Region contract that generally are contracted on a per-member basis.
(M)Specialty per member per month is computed based on reported specialty premiums and average fully-insured specialty membership for the period. Included with specialty premiums are stop-loss ASO premiums.
(N)Computed based on average membership for the period (i.e. monthly ending membership during the period divided by the number of months in the period).
(O)De novo refers to all new centers opened since 2020 under a WCAS joint venture. Wholly-owned refers to all centers outside a WCAS joint venture.
(P)Represents Medicare Advantage (MA) risk, MA path to risk, MA value-based, Direct Contracting Entity, and Accountable Care Organization patients.
(Q)Reflects patient admissions under the Patient Driven Groupings Model (PDGM) payment model.
(R)Reflects all patient admissions regardless of reimbursement model. Same store is defined as care centers that have been operated at least the last twelve months and startups that are an expansion of a same store care center.
(S)Members covered under the full value-based home model, which coordinates care and optimizes spend across home health, DME, and infusion provider categories.
Humana Inc.
Segment Realignment
Supplementary Information
2/1/23
Recast of 2022 Quarters in Current Segment Format
Consolidating Statements of Income—For the quarter ended March 31, 2022 (Unaudited)
In millions
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
| Insurance | | | | CenterWell | | | | | | Eliminations/ Corporate | | Consolidated |
Revenues—external customers Premiums: | | | | | | | | | | | | | |
Individual Medicare Advantage | $ | 17,052 | | | | | $ | — | | | | | | | $ | — | | | $ | 17,052 | |
Group Medicare Advantage | 1,875 | | | | | — | | | | | | | — | | | 1,875 | |
Medicare stand-alone PDP | 639 | | | | | — | | | | | | | — | | | 639 | |
Total Medicare | 19,566 | | | | | — | | | | | | | — | | | 19,566 | |
Fully-insured | 1,154 | | | | | — | | | | | | | — | | | 1,154 | |
Specialty | 429 | | | | | — | | | | | | | — | | | 429 | |
Medicaid and other | 1,554 | | | | | — | | | | | | | — | | | 1,554 | |
Total premiums | 22,703 | | | | | — | | | | | | | — | | | 22,703 | |
Services revenue: | | | | | | | | | | | | | |
Home solutions | — | | | | | 726 | | | | | | | | | 726 | |
Pharmacy solutions | — | | | | | 221 | | | | | | | — | | | 221 | |
Provider services | — | | | | | 113 | | | | | | | — | | | 113 | |
ASO and other | 204 | | | | | — | | | | | | | — | | | 204 | |
Total services revenue | 204 | | | | | 1,060 | | | | | | | — | | | 1,264 | |
Total revenues—external customers | 22,907 | | | | | 1,060 | | | | | | | — | | | 23,967 | |
| | | | | | | | | | | | | |
| | | | | | | | | | | | | |
| | | | | | | | | | | | | |
Intersegment revenues | 14 | | | | | 3,303 | | | | | | | (3,317) | | | — | |
Investment income | 46 | | | | | 2 | | | | | | | (45) | | | 3 | |
Total revenues | 22,967 | | | | | 4,365 | | | | | | | (3,362) | | | 23,970 | |
Operating expenses: | | | | | | | | | | | | | |
Benefits | 19,734 | | | | | — | | | | | | | (109) | | | 19,625 | |
Operating costs | 2,087 | | | | | 3,948 | | | | | | | (3,149) | | | 2,886 | |
| | | | | | | | | | | | | |
Depreciation and amortization | 150 | | | | | 47 | | | | | | | (27) | | | 170 | |
Total operating expenses | 21,971 | | | | | 3,995 | | | | | | | (3,285) | | | 22,681 | |
Income (loss) from operations | 996 | | | | | 370 | | | | | | | (77) | | | 1,289 | |
| | | | | | | | | | | | | |
Interest expense | — | | | | | — | | | | | | | 90 | | | 90 | |
Other income, net | — | | | | | — | | | | | | | (21) | | | (21) | |
Income (losses) before income taxes and equity in net earnings | 996 | | | | | 370 | | | | | | | (146) | | | 1,220 | |
Equity in net losses | — | | | | | (4) | | | | | | | — | | | (4) | |
Segment earnings (losses) | $ | 996 | | | | | $ | 366 | | | | | | | $ | (146) | | | $ | 1,216 | |
Benefit ratio | 86.9 | % | | | | | | | | | | | | 86.4 | % |
Operating cost ratio | 9.1 | % | | | | 90.5 | % | | | | | | | | 12.0 | % |
| | | | | | | | | | | | | |
Recast of 2022 Quarters in Current Segment Format
Consolidating Statements of Income—For the quarter ended June 30, 2022 (Unaudited)
In millions
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
| Insurance | | | | CenterWell | | | | | | Eliminations/ Corporate | | Consolidated |
Revenues—external customers Premiums: | | | | | | | | | | | | | |
Individual Medicare Advantage | $ | 16,692 | | | | | $ | — | | | | | | | $ | — | | | $ | 16,692 | |
Group Medicare Advantage | 1,857 | | | | | — | | | | | | | — | | | 1,857 | |
Medicare stand-alone PDP | 606 | | | | | — | | | | | | | — | | | 606 | |
Total Medicare | 19,155 | | | | | — | | | | | | | — | | | 19,155 | |
Fully-insured | 1,128 | | | | | — | | | | | | | — | | | 1,128 | |
Specialty | 427 | | | | | — | | | | | | | — | | | 427 | |
Medicaid and other | 1,556 | | | | | — | | | | | | | — | | | 1,556 | |
Total premiums | 22,266 | | | | | — | | | | | | | — | | | 22,266 | |
Services revenue: | | | | | | | | | | | | | |
Home solutions | — | | | | | 752 | | | | | | | | | 752 | |
Pharmacy solutions | — | | | | | 254 | | | | | | | — | | | 254 | |
Provider services | — | | | | | 137 | | | | | | | — | | | 137 | |
ASO and other | 206 | | | | | — | | | | | | | — | | | 206 | |
Total services revenue | 206 | | | | | 1,143 | | | | | | | — | | | 1,349 | |
Total revenues—external customers | 22,472 | | | | | 1,143 | | | | | | | — | | | 23,615 | |
| | | | | | | | | | | | | |
| | | | | | | | | | | | | |
| | | | | | | | | | | | | |
Intersegment revenues | 14 | | | | | 3,383 | | | | | | | (3,397) | | | — | |
Investment income | 46 | | | | | 1 | | | | | | | — | | | 47 | |
Total revenues | 22,532 | | | | | 4,527 | | | | | | | (3,397) | | | 23,662 | |
Operating expenses: | | | | | | | | | | | | | |
Benefits | 19,164 | | | | | — | | | | | | | (65) | | | 19,099 | |
Operating costs | 2,105 | | | | | 4,125 | | | | | | | (3,057) | | | 3,173 | |
| | | | | | | | | | | | | |
Depreciation and amortization | 156 | | | | | 44 | | | | | | | (25) | | | 175 | |
Total operating expenses | 21,425 | | | | | 4,169 | | | | | | | (3,147) | | | 22,447 | |
Income (loss) from operations | 1,107 | | | | | 358 | | | | | | | (250) | | | 1,215 | |
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Interest expense | — | | | | | — | | | | | | | 101 | | | 101 | |
Other income, net | — | | | | | — | | | | | | | (8) | | | (8) | |
Income (loss) before income taxes and equity in net earnings | 1,107 | | | | | 358 | | | | | | | (343) | | | 1,122 | |
Equity in net earnings (losses) | 8 | | | | | (6) | | | | | | | — | | | 2 | |
Segment earnings (losses) | 1,115 | | | | | 352 | | | | | | | (343) | | | 1,124 | |
Net income attributable to non-controlling interests | — | | | | | (1) | | | | | | | — | | | (1) | |
Segment earnings (loss) attributable to Humana | $ | 1,115 | | | | | $ | 351 | | | | | | | $ | (343) | | | $ | 1,123 | |
Benefit ratio | 86.1 | % | | | | | | | | | | | | 85.8 | % |
Operating cost ratio | 9.4 | % | | | | 91.1 | % | | | | | | | | 13.4 | % |
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Recast of 2022 Quarters in Current Segment Format
Consolidating Statements of Income—For the quarter ended September 30, 2022 (Unaudited)
In millions
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
| Insurance | | | | CenterWell | | | | | | Eliminations/ Corporate | | Consolidated |
Revenues—external customers Premiums: | | | | | | | | | | | | | |
Individual Medicare Advantage | $ | 16,007 | | | | | $ | — | | | | | | | $ | — | | | $ | 16,007 | |
Group Medicare Advantage | 1,792 | | | | | — | | | | | | | — | | | 1,792 | |
Medicare stand-alone PDP | 534 | | | | | — | | | | | | | — | | | 534 | |
Total Medicare | 18,333 | | | | | — | | | | | | | — | | | 18,333 | |
Fully-insured | 1,100 | | | | | — | | | | | | | — | | | 1,100 | |
Specialty | 425 | | | | | — | | | | | | | — | | | 425 | |
Medicaid and other | 1,610 | | | | | — | | | | | | | — | | | 1,610 | |
Total premiums | 21,468 | | | | | — | | | | | | | — | | | 21,468 | |
Services revenue: | | | | | | | | | | | | | |
Home solutions | — | | | | | 519 | | | | | | | | | 519 | |
Pharmacy solutions | — | | | | | 271 | | | | | | | — | | | 271 | |
Provider services | — | | | | | 159 | | | | | | | — | | | 159 | |
ASO and other | 210 | | | | | — | | | | | | | — | | | 210 | |
Total services revenue | 210 | | | | | 949 | | | | | | | — | | | 1,159 | |
Total revenues—external customers | 21,678 | | | | | 949 | | | | | | | — | | | 22,627 | |
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Intersegment revenues | 14 | | | | | 3,322 | | | | | | | (3,336) | | | — | |
Investment income | 51 | | | | | 3 | | | | | | | 118 | | | 172 | |
Total revenues | 21,743 | | | | | 4,274 | | | | | | | (3,218) | | | 22,799 | |
Operating expenses: | | | | | | | | | | | | | |
Benefits | 18,413 | | | | | — | | | | | | | (29) | | | 18,384 | |
Operating costs | 2,294 | | | | | 3,929 | | | | | | | (3,162) | | | 3,061 | |
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Depreciation and amortization | 163 | | | | | 45 | | | | | | | (26) | | | 182 | |
Total operating expenses | 20,870 | | | | | 3,974 | | | | | | | (3,217) | | | 21,627 | |
Income (loss) from operations | 873 | | | | | 300 | | | | | | | (1) | | | 1,172 | |
Gain on sale of KAH Hospice | — | | | | | (240) | | | | | | | — | | | (240) | |
Interest expense | — | | | | | — | | | | | | | 102 | | | 102 | |
Other expense, net | — | | | | | — | | | | | | | 13 | | | 13 | |
Income (loss) before income taxes and equity in net earnings | 873 | | | | | 540 | | | | | | | (116) | | | 1,297 | |
Equity in net earnings (losses) | 8 | | | | | (5) | | | | | | | — | | | 3 | |
Segment earnings (losses) | 881 | | | | | 535 | | | | | | | (116) | | | 1,300 | |
Net loss attributable to non-controlling interests | 2 | | | | | — | | | | | | | — | | | 2 | |
Segment earnings (losses) attributable to Humana | $ | 883 | | | | | $ | 535 | | | | | | | $ | (116) | | | $ | 1,302 | |
Benefit ratio | 85.8 | % | | | | | | | | | | | | 85.6 | % |
Operating cost ratio | 10.6 | % | | | | 92.0 | % | | | | | | | | 13.5 | % |
Non-GAAP Presentation of Segment Information - Prior Segment Format Summary of Results - 4Q22, 4Q21, FY 2022, and FY 2021 (Unaudited)
Footnotes follow on page S-28
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Humana Inc. Summary of Results (dollars in millions, except per share amounts) | 4Q22 | 4Q21 | FY 2022 | FY 2021 | |
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Non-GAAP RETAIL SEGMENT | | | | | |
Revenues | $20,030 | $18,411 | $82,516 | $74,044 | |
Benefits expense ratio | 88.4 | % | 89.0 | % | 87.5 | % | 87.9 | % | |
Operating cost ratio | 11.8 | % | 11.5 | % | 9.3 | % | 9.2 | % | |
(Loss) income from operations | ($93) | ($149) | $2,341 | $1,937 | |
(Loss) income from operations - Adjusted (a) | ($87) | ($145) | $2,366 | $1,953 | |
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Non-GAAP GROUP AND SPECIALTY SEGMENT | | | | | |
Revenues | $1,566 | $1,722 | $6,314 | $6,872 | |
Benefits expense ratio | 78.5 | % | 86.6 | % | 77.0 | % | 82.5 | % | |
Operating cost ratio | 27.8 | % | 26.8 | % | 26.8 | % | 24.6 | % | |
Income (loss) from operations | $66 | ($37) | $348 | $149 | |
Income (loss) from operations - Adjusted (b) | $67 | ($36) | $353 | $154 | |
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Non-GAAP HEALTHCARE SERVICES SEGMENT | | | | | |
Revenues | $8,747 | $8,482 | $35,277 | $31,242 | |
Operating cost ratio | 95.6 | % | 94.9 | % | 94.8 | % | 95.4 | % | |
Income from operations | $336 | $380 | $1,624 | $1,264 | |
Adjusted earnings before interest, taxes, depreciation and amortization (Adjusted EBITDA) (c) | $405 | $425 | $1,845 | $1,557 | |
Non-GAAP Presentation of Segment Information - Prior Segment Format
Consolidating Statements of Income—For the quarter ended December 31, 2022 (Unaudited)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
| Retail | | Group and Specialty | | Healthcare Services | | | | | | Eliminations/ Corporate | | Consolidated |
Revenues—external customers Premiums: | | | | | | | | | | | | | |
Individual Medicare Advantage | $ | 15,840 | | | $ | — | | | $ | — | | | | | | | $ | — | | | $ | 15,840 | |
Group Medicare Advantage | 1,773 | | | — | | | — | | | | | | | — | | | 1,773 | |
Medicare stand-alone PDP | 490 | | | — | | | — | | | | | | | — | | | 490 | |
Total Medicare | 18,103 | | | — | | | — | | | | | | | — | | | 18,103 | |
Fully-insured | 188 | | | 906 | | | — | | | | | | | — | | | 1,094 | |
Specialty | — | | | 422 | | | — | | | | | | | — | | | 422 | |
Medicaid and other | 1,656 | | | — | | | — | | | | | | | — | | | 1,656 | |
Total premiums | 19,947 | | | 1,328 | | | — | | | | | | | — | | | 21,275 | |
Services revenue: | | | | | | | | | | | | | |
Home Solutions | — | | | — | | | 336 | | | | | | | — | | | 336 | |
Pharmacy Solutions | — | | | — | | | 282 | | | | | | | — | | | 282 | |
Provider Services | — | | | — | | | 159 | | | | | | | — | | | 159 | |
ASO and other | 9 | | | 218 | | | — | | | | | | | — | | | 227 | |
Total services revenue | 9 | | | 218 | | | 777 | | | | | | | — | | | 1,004 | |
Total revenues—external customers | 19,956 | | | 1,546 | | | 777 | | | | | | | — | | | 22,279 | |
Intersegment revenues | — | | | 14 | | | 7,968 | | | | | | | (7,982) | | | — | |
Investment income | 74 | | | 6 | | | 2 | | | | | | | 78 | | | 160 | |
Total revenues | 20,030 | | | 1,566 | | | 8,747 | | | | | | | (7,904) | | | 22,439 | |
Operating expenses: | | | | | | | | | | | | | |
Benefits | 17,633 | | | 1,043 | | | — | | | | | | | (94) | | | 18,582 | |
Operating costs | 2,354 | | | 434 | | | 8,359 | | | | | | | (7,596) | | | 3,551 | |
Depreciation and amortization | 136 | | | 23 | | | 52 | | | | | | | (29) | | | 182 | |
Total operating expenses | 20,123 | | | 1,500 | | | 8,411 | | | | | | | (7,719) | | | 22,315 | |
(Loss) income from operations | (93) | | | 66 | | | 336 | | | | | | | (185) | | | 124 | |
Adjustment on sale of KAH Hospice | — | | | — | | | 3 | | | | | | | — | | | 3 | |
Interest expense | — | | | — | | | — | | | | | | | 108 | | | 108 | |
Other expense, net | — | | | — | | | — | | | | | | | 84 | | | 84 | |
(Loss) income before income taxes and equity in net earnings | (93) | | | 66 | | | 333 | | | | | | | (377) | | | (71) | |
Equity in net earnings (losses) | 2 | | | — | | | (7) | | | | | | | — | | | (5) | |
Segment (loss) earnings | (91) | | | 66 | | | 326 | | | | | | | (377) | | | (76) | |
Net loss attributable to non-controlling interests | 3 | | | — | | | — | | | | | | | — | | | 3 | |
Segment (loss) earnings attributable to Humana | $ | (88) | | | $ | 66 | | | $ | 326 | | | | | | | $ | (377) | | | $ | (73) | |
Benefit ratio | 88.4 | % | | 78.5 | % | | | | | | | | | | 87.3 | % |
Operating cost ratio | 11.8 | % | | 27.8 | % | | 95.6 | % | | | | | | | | 15.9 | % |
Non-GAAP Presentation of Segment Information - Prior Segment Format
Consolidating Statements of Income—For the quarter ended December 31, 2021 (Unaudited)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
| Retail | | Group and Specialty | | Healthcare Services | | | | | Eliminations/ Corporate | | Consolidated |
Revenues—external customers Premiums: | | | | | | | | | | | | |
Individual Medicare Advantage | $ | 14,612 | | | $ | — | | | $ | — | | | | | | $ | — | | | $ | 14,612 | |
Group Medicare Advantage | 1,688 | | | — | | | — | | | | | | — | | | 1,688 | |
Medicare stand-alone PDP | 504 | | | — | | | — | | | | | | — | | | 504 | |
Total Medicare | 16,804 | | | — | | | — | | | | | | — | | | 16,804 | |
Fully-insured | 186 | | | 1,042 | | | — | | | | | | — | | | 1,228 | |
Specialty | — | | | 433 | | | — | | | | | | — | | | 433 | |
Medicaid and other | 1,370 | | | — | | | — | | | | | | — | | | 1,370 | |
Total premiums | 18,360 | | | 1,475 | | | — | | | | | | — | | | 19,835 | |
Services revenue: | | | | | | | | | | | | |
Home Solutions | — | | | — | | | 743 | | | | | | — | | | 743 | |
Pharmacy Solutions | — | | | — | | | 155 | | | | | | — | | | 155 | |
Provider Services | — | | | — | | | 115 | | | | | | — | | | 115 | |
ASO and other | 6 | | | 234 | | | — | | | | | | — | | | 240 | |
Total services revenue | 6 | | | 234 | | | 1,013 | | | | | | — | | | 1,253 | |
Total revenues—external customers | 18,366 | | | 1,709 | | | 1,013 | | | | | | — | | | 21,088 | |
Intersegment revenues | — | | | 10 | | | 7,468 | | | | | | (7,478) | | | — | |
Investment income (loss) | 45 | | | 3 | | | 1 | | | | | | (83) | | | (34) | |
Total revenues | 18,411 | | | 1,722 | | | 8,482 | | | | | | (7,561) | | | 21,054 | |
Operating expenses: | | | | | | | | | | | | |
Benefits | 16,333 | | | 1,277 | | | — | | | | | | (172) | | | 17,438 | |
Operating costs | 2,111 | | | 460 | | | 8,052 | | | | | | (7,228) | | | 3,395 | |
Depreciation and amortization | 116 | | | 22 | | | 50 | | | | | | (28) | | | 160 | |
Total operating expenses | 18,560 | | | 1,759 | | | 8,102 | | | | | | (7,428) | | | 20,993 | |
(Loss) income from operations | (149) | | | (37) | | | 380 | | | | | | (133) | | | 61 | |
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Interest expense | — | | | — | | | — | | | | | | 91 | | | 91 | |
Other expense, net | — | | | — | | | — | | | | | | 30 | | | 30 | |
(Loss) income before income taxes and equity in net earnings | (149) | | | (37) | | | 380 | | | | | | (254) | | | (60) | |
Equity in net losses | — | | | — | | | (4) | | | | | | — | | | (4) | |
Segment (loss) earnings | (149) | | | (37) | | | 376 | | | | | | (254) | | | (64) | |
Net income attributable to non-controlling interests | — | | | — | | | (1) | | | | | | — | | | (1) | |
Segment (loss) earnings attributable to Humana | $ | (149) | | | $ | (37) | | | $ | 375 | | | | | | $ | (254) | | | $ | (65) | |
Benefit ratio | 89.0 | % | | 86.6 | % | | | | | | | | | 87.9 | % |
Operating cost ratio | 11.5 | % | | 26.8 | % | | 94.9 | % | | | | | | | 16.1 | % |
Non-GAAP Presentation of Segment Information - Prior Segment Format
Consolidating Statements of Income—For the year ended December 31, 2022 (Unaudited)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
| Retail | | Group and Specialty | | Healthcare Services | | | | | Eliminations/ Corporate | | Consolidated |
Revenues—external customers Premiums: | | | | | | | | | | | | |
Individual Medicare Advantage | $ | 65,591 | | | $ | — | | | $ | — | | | | | | $ | — | | | $ | 65,591 | |
Group Medicare Advantage | 7,297 | | | — | | | — | | | | | | — | | | 7,297 | |
Medicare stand-alone PDP | 2,269 | | | — | | | — | | | | | | — | | | 2,269 | |
Total Medicare | 75,157 | | | — | | | — | | | | | | — | | | 75,157 | |
Fully-insured | 743 | | | 3,733 | | | — | | | | | | — | | | 4,476 | |
Specialty | — | | | 1,703 | | | — | | | | | | — | | | 1,703 | |
Medicaid and other | 6,376 | | | — | | | — | | | | | | — | | | 6,376 | |
Total premiums | 82,276 | | | 5,436 | | | — | | | | | | — | | | 87,712 | |
Services revenue: | | | | | | | | | | | | |
Home Solutions | — | | | — | | | 2,333 | | | | | | — | | | 2,333 | |
Pharmacy Solutions | — | | | — | | | 1,036 | | | | | | — | | | 1,036 | |
Provider Services | — | | | — | | | 568 | | | | | | — | | | 568 | |
ASO and other | 33 | | | 806 | | | — | | | | | | — | | | 839 | |
Total services revenue | 33 | | | 806 | | | 3,937 | | | | | | — | | | 4,776 | |
Total revenues—external customers | 82,309 | | | 6,242 | | | 3,937 | | | | | | — | | | 92,488 | |
Intersegment revenues | — | | | 56 | | | 31,332 | | | | | | (31,388) | | | — | |
Investment income | 207 | | | 16 | | | 8 | | | | | | 151 | | | 382 | |
Total revenues | 82,516 | | | 6,314 | | | 35,277 | | | | | | (31,237) | | | 92,870 | |
Operating expenses: | | | | | | | | | | | | |
Benefits | 71,985 | | | 4,186 | | | — | | | | | | (481) | | | 75,690 | |
Operating costs | 7,663 | | | 1,689 | | | 33,448 | | | | | | (30,129) | | | 12,671 | |
Depreciation and amortization | 527 | | | 91 | | | 205 | | | | | | (114) | | | 709 | |
Total operating expenses | 80,175 | | | 5,966 | | | 33,653 | | | | | | (30,724) | | | 89,070 | |
Income (loss) from operations | 2,341 | | | 348 | | | 1,624 | | | | | | (513) | | | 3,800 | |
Gain on sale of KAH Hospice | — | | | — | | | (237) | | | | | | — | | | (237) | |
Interest expense | — | | | — | | | — | | | | | | 401 | | | 401 | |
Other expense, net | — | | | — | | | — | | | | | | 68 | | | 68 | |
Income (loss) before income taxes and equity in net earnings | 2,341 | | | 348 | | | 1,861 | | | | | | (982) | | | 3,568 | |
Equity in net earnings (losses) | 18 | | | — | | | (22) | | | | | | — | | | (4) | |
Segment earnings (loss) | 2,359 | | | 348 | | | 1,839 | | | | | | $ | (982) | | | 3,564 | |
Net loss (income) attributable to non-controlling interests | 5 | | | — | | | (1) | | | | | | — | | | 4 | |
Segment earnings (loss) attributable to Humana | $ | 2,364 | | | $ | 348 | | | $ | 1,838 | | | | | | $ | (982) | | | $ | 3,568 | |
Benefit ratio | 87.5 | % | | 77.0 | % | | | | | | | | | 86.3 | % |
Operating cost ratio | 9.3 | % | | 26.8 | % | | 94.8 | % | | | | | | | 13.7 | % |
Non-GAAP Presentation of Segment Information - Prior Segment Format
Consolidating Statements of Income—For the year ended December 31, 2021 (Unaudited)
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| Retail | | Group and Specialty | | Healthcare Services | | | | | | Eliminations/ Corporate | | Consolidated |
Revenues—external customers Premiums: | | | | | | | | | | | | | |
Individual Medicare Advantage | $ | 58,654 | | | $ | — | | | $ | — | | | | | | | $ | — | | | $ | 58,654 | |
Group Medicare Advantage | 6,955 | | | — | | | — | | | | | | | — | | | 6,955 | |
Medicare stand-alone PDP | 2,371 | | | — | | | — | | | | | | | — | | | 2,371 | |
Total Medicare | 67,980 | | | — | | | — | | | | | | | — | | | 67,980 | |
Fully-insured | 731 | | | 4,271 | | | — | | | | | | | — | | | 5,002 | |
Specialty | — | | | 1,731 | | | — | | | | | | | — | | | 1,731 | |
Medicaid and other | 5,109 | | | — | | | — | | | | | | | — | | | 5,109 | |
Total premiums | 73,820 | | | 6,002 | | | — | | | | | | | — | | | 79,822 | |
Services revenue: | | | | | | | | | | | | | |
Home Solutions | — | | | — | | | 1,166 | | | | | | | — | | | 1,166 | |
Pharmacy Solutions | — | | | — | | | 637 | | | | | | | — | | | 637 | |
Provider Services | — | | | — | | | 413 | | | | | | | — | | | 413 | |
ASO and other | 23 | | | 816 | | | — | | | | | | | — | | | 839 | |
Total services revenue | 23 | | | 816 | | | 2,216 | | | | | | | — | | | 3,055 | |
Total revenues—external customers | 73,843 | | | 6,818 | | | 2,216 | | | | | | | — | | | 82,877 | |
Intersegment revenues | 1 | | | 40 | | | 29,022 | | | | | | | (29,063) | | | — | |
Investment income | 200 | | | 14 | | | 4 | | | | | | | (31) | | | 187 | |
Total revenues | 74,044 | | | 6,872 | | | 31,242 | | | | | | | (29,094) | | | 83,064 | |
Operating expenses: | | | | | | | | | | | | | |
Benefits | 64,907 | | | 4,951 | | | — | | | | | | | (659) | | | 69,199 | |
Operating costs | 6,764 | | | 1,687 | | | 29,801 | | | | | | | (28,131) | | | 10,121 | |
Depreciation and amortization | 436 | | | 85 | | | 177 | | | | | | | (102) | | | 596 | |
Total operating expenses | 72,107 | | | 6,723 | | | 29,978 | | | | | | | (28,892) | | | 79,916 | |
Income (loss) from operations | 1,937 | | | 149 | | | 1,264 | | | | | | | (202) | | | 3,148 | |
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Interest expense | — | | | — | | | — | | | | | | | 326 | | | 326 | |
Other income, net | — | | | — | | | — | | | | | | | (532) | | | (532) | |
Income before income taxes and equity in net earnings | 1,937 | | | 149 | | | 1,264 | | | | | | | 4 | | | 3,354 | |
Equity in net earnings | — | | | — | | | 65 | | | | | | | — | | | 65 | |
Segment earnings | 1,937 | | | 149 | | | 1,329 | | | | | | | 4 | | | 3,419 | |
Net income attributable to non-controlling interests | — | | | — | | | (1) | | | | | | | — | | | (1) | |
Segment earnings attributable to Humana | $ | 1,937 | | | $ | 149 | | | $ | 1,328 | | | | | | | $ | 4 | | | $ | 3,418 | |
Benefit ratio | 87.9 | % | | 82.5 | % | | | | | | | | | | 86.7 | % |
Operating cost ratio | 9.2 | % | | 24.6 | % | | 95.4 | % | | | | | | | | 12.2 | % |
Footnotes
(a) Reconciliation of Retail segment (loss) income from operations:
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Non-GAAP Retail (loss) income from operations (in millions) | 4Q22 | 4Q21 | FY 2022 | FY 2021 |
(Loss) income from operations | ($93) | ($149) | $2,341 | $1,937 |
Amortization associated with identifiable intangibles | 6 | | 4 | | 25 | | 16 | |
(Loss) income from operations - Adjusted | ($87) | | ($145) | | $2,366 | | $1,953 | |
(b) Reconciliation of Group and Specialty income (loss) from operations:
| | | | | | | | | | | | | | |
Non-GAAP Group and Specialty income (loss) from operations (in millions) | 4Q22 | 4Q21 | FY 2022 | FY 2021 |
Income (loss) from operations | $66 | ($37) | $348 | $149 |
Amortization associated with identifiable intangibles | 1 | | 1 | | 5 | | 5 | |
Income (loss) from operations - Adjusted | $67 | | ($36) | | $353 | | $154 | |
(c) The Healthcare Services segment Adjusted earnings before interest, taxes, depreciation and amortization (Adjusted EBITDA) includes GAAP segment earnings attributable to Humana with adjustments to add back depreciation and amortization expense, interest expense, and income taxes. Adjusted EBITDA includes results from all lines of business within the segment. Adjusted EBITDA also includes the impact of Humana’s minority interest related to the strategic partnership with Welsh, Carson, Anderson & Stowe (WCAS) to develop and operate senior-focused, payor-agnostic, primary care centers, as well as Humana's minority interest ownership of KAH operations based on the timing of previously disclosed transactions..
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Non-GAAP Healthcare Services Adjusted EBITDA (in millions) | 4Q22 | 4Q21 | FY 2022 | FY 2021 |
Income from operations | $336 | $380 | $1,624 | $1,264 |
Equity in net (losses) earnings | (7) | | (4) | | (22) | | 65 | |
Non-controlling interest income | — | | (1) | | (1) | | (1) | |
Depreciation and amortization expense | 54 | | 50 | | 210 | | 190 | |
Interest and taxes | 22 | | — | | 34 | | 39 | |
Adjusted EBITDA 4Q and FY 2022 Adjusted EBITDA excludes impact of KAH Hospice gain/adjustment | $405 | | $425 | | $1,845 | | $1,557 | |