Humana 2014 Annual Report Download - page 12

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Health Care Reform Law is discussed more fully in Item 7. – Management’s Discussion and Analysis of Financial
Condition and Results of Operations under the section titled “Health Care Reform.”
Business Segments
On January 1, 2014, we reclassified certain of our businesses from our Healthcare Services segment to our Employer
Group segment to correspond with internal management reporting changes. Our reportable segments remain the same
and prior period segment financial information has been recast to conform to the 2014 presentation. See Note 17 to the
consolidated financial statements included in Item 8. – Financial Statements and Supplementary Data for segment
financial information.
We manage our business with three reportable segments: Retail, Employer Group, and Healthcare Services. In
addition, the Other Businesses category includes businesses that are not individually reportable because they do not
meet the quantitative thresholds required by generally accepted accounting principles. These segments are based on a
combination of the type of health plan customer and adjacent businesses centered on well-being solutions for our health
plans and other customers, as described below. These segment groupings are consistent with information used by our
Chief Executive Officer to assess performance and allocate resources.
Our Products
Our medical and specialty insurance products allow members to access health care services primarily through our
networks of health care providers with whom we have contracted. These products may vary in the degree to which
members have coverage. Health maintenance organizations, or HMOs, generally require a referral from the member’s
primary care provider before seeing certain specialty physicians. Preferred provider organizations, or PPOs, provide
members the freedom to choose a health care provider without requiring a referral. However PPOs generally require
the member to pay a greater portion of the provider’s fee in the event the member chooses not to use a provider
participating in the PPO’s network. Point of Service, or POS, plans combine the advantages of HMO plans with the
flexibility of PPO plans. In general, POS plans allow members to choose, at the time medical services are needed, to
seek care from a provider within the plan’s network or outside the network. In addition, we offer services to our health
plan members as well as to third parties that promote health and wellness, including pharmacy, provider, home based,
and integrated wellness services. At the core of our strategy is our integrated care delivery model, which unites quality
care, high member engagement, and sophisticated data analytics. Three core elements of the model are to improve the
consumer experience by simplifying the interaction, engaging members in clinical programs, and offering assistance
to providers in transitioning from a fee-for-service to a value-based arrangement. Our approach to primary, physician-
directed care for our members aims to provide quality care that is consistent, integrated, cost-effective, and member-
focused. The model is designed to improve health outcomes and affordability for individuals and for the health system
as a whole, while offering our members a simple, seamless healthcare experience. The discussion that follows describes
the products offered by each of our segments.