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Humana Reports Second Quarter 2017 Financial Results; Raises Full Year 2017 Guidance; Provides Update on Bonus Year 2018 Star Ratings

  • 2Q17 earnings per diluted common share (EPS) of $4.46 on a GAAP basis, $3.49 Adjusted EPS
  • Full year 2017 guidance raised to approximately $17.83 EPS on a GAAP basis, approximately $11.50 Adjusted EPS
  • Individual Medicare Advantage results significantly outperforming management’s original expectations
  • Approximately 74 percent of the company’s Medicare Advantage members are now expected to be in 4-Star plans or higher for bonus year 2018

Category:

Wednesday, August 2, 2017 6:30 am EDT

Dateline:

LOUISVILLE, Ky.

Public Company Information:

NYSE:
HUM
"We were therefore able to invest this outperformance in 2018 benefit designs, resulting in stable and competitive benefits for 2018 despite certain headwinds, in particular the return of the health insurance industry fee."

LOUISVILLE, Ky.--(BUSINESS WIRE)--Humana Inc. (NYSE: HUM) today reported diluted earnings per common share (EPS) for the quarter ended June 30, 2017 (2Q17) versus the quarter ended June 30, 2016 (2Q16) and for the six months ended June 30, 2017 (1H 2017) versus for the six months ended June 30, 2016 (1H 2016) as follows:

               
Consolidated pretax income

In millions

   

2Q17 (a)

   

2Q16 (b)

   

1H 2017 (c)

   

1H 2016 (d)

Generally Accepted Accounting Principles (GAAP)     $1,042       $636     $2,731       $1,136
Net (gain) expenses associated with the terminated merger agreement (for 1H 2017, primarily the break-up fee)     -       27     (947 )     61
Amortization associated with identifiable intangibles     18       20     36       41
Guaranty fund assessment expense to support the policyholder obligations of Penn Treaty (an unaffiliated long-term care insurance company)     -       -     54       -
Operating (income) losses associated with the Individual Commercial business     (118 )     225     (181 )     237
Adjusted (non-GAAP) – 2Q16 and 1H 2016 as recast     $942       $908     $1,693       $1,475
 
 
Diluted earnings per common share (EPS)     2Q17 (a)     2Q16 (b)    

1H 2017 (c)

   

1H 2016 (d)

GAAP     $4.46       $2.06     $11.98       $3.75
Net (gain) expenses associated with the terminated merger agreement (for 1H 2017, primarily the break-up fee)     -       0.16     (4.31 )     0.37
Amortization associated with identifiable intangibles     0.08       0.08     0.16       0.17
Beneficial effect of lower effective tax rate in light of pricing and benefit design assumptions associated with the 2017 temporary suspension of the non-deductible health insurance industry fee; excludes Individual Commercial business impact     (0.54 )     -     (1.06 )     -
Guaranty fund assessment expense to support the policyholder obligations of Penn Treaty (an unaffiliated long-term care insurance company)     -       -     0.23       -
Operating (income) losses associated with the Individual Commercial business     (0.51 )     0.99     (0.77 )     1.08
Adjusted (non-GAAP) – 2Q16 and 1H 2016 as recast     $3.49       $3.29     $6.23       $5.37
 

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

“With the completion of our first full quarter since the deal break, Humana’s strong 2Q17 results and increase in full-year guidance demonstrate the strength of our integrated care delivery strategy,” said Bruce D. Broussard, Humana’s President and Chief Executive Officer. “It’s our talented team that’s made this possible. Throughout the lengthy deal period, our associates never wavered in their focus and commitment to our members, provider partners and shareholders. It’s because of this that we continue to make strides in advancing our strategy while delivering strong operating performance.”

The GAAP consolidated pretax income for 2Q17 of $1.04 billion rose $406 million, or 64 percent, compared to GAAP consolidated pretax income of $636 million in 2Q16 primarily due to year-over-year improvement in earnings for the company’s individual Medicare Advantage and Individual Commercial businesses, partially offset by lower pretax earnings in the Group and Specialty and Healthcare Services segments.

The Adjusted consolidated pretax income for 2Q17 of $942 million rose $34 million, or 4 percent, versus $908 million in 2Q16 primarily reflecting the same factors impacting the GAAP comparison, while excluding the impact of the items detailed in the consolidated pretax income table above.

GAAP consolidated pretax income for 1H 2017 of $2.73 billion increased $1.60 billion, or 140 percent, from $1.14 billion in 1H 2016. The increase primarily reflects the net gain associated with the terminated merger agreement, mainly the break-up fee recognized in the first quarter of 2017, along with the factors impacting the second quarter comparison.

The Adjusted consolidated pretax income for 1H 2017 of $1.69 billion increased $218 million, or 15 percent, versus $1.48 billion in 1H 2016 primarily reflecting the same factors impacting the GAAP comparison, while excluding the impact of items noted in the table above.

Further discussions of each segment’s financial results are included in the segment highlights below.

The year-over-year changes in GAAP EPS for 2Q17 and 1H 2017 reflected the same factors impacting the GAAP consolidated pretax income comparisons year over year as well as the beneficial effect of the lower effective tax rate in light of pricing and benefit design assumptions associated with the temporary suspension of the health insurance industry fee in 2017. The year-over-year increases in Adjusted EPS for 2Q17 and 1H 2017 reflected the same factors impacting the Adjusted consolidated pretax income comparisons year over year. In addition, the second quarter and year-to-date comparisons of both GAAP and Adjusted EPS are favorably impacted by a lower number of shares used to compute EPS, primarily reflecting share repurchases in the first quarter of 2017, including the previously disclosed accelerated stock repurchase (ASR) program.

“We are pleased that our individual Medicare Advantage business is significantly outperforming our previous expectations, reflecting our focus on operational excellence and the solid execution of our strategy,” said Brian A. Kane, Senior Vice President and Chief Financial Officer. “We were therefore able to invest this outperformance in 2018 benefit designs, resulting in stable and competitive benefits for 2018 despite certain headwinds, in particular the return of the health insurance industry fee.”

2017 Earnings Guidance

Humana today raised its GAAP and Adjusted EPS guidance for the year ending December 31, 2017 (FY17). FY17 GAAP EPS was increased to approximately $17.83 from the previous guidance of at least $16.91, while Adjusted EPS was increased to approximately $11.50 from the previous guidance of at least $11.10. The increases in FY17 guidance for both GAAP and Adjusted EPS were primarily driven by the strong results in the Retail segment, largely attributable to the company’s individual Medicare Advantage business, partially offset by lower than expected Healthcare Services segment pretax income due to lower than anticipated pharmacy utilization and the continued optimization of our chronic care management programs. The individual Medicare Advantage business is exceeding its operational targets, experiencing lower than anticipated utilization, higher than expected revenue on a per member basis and favorable medical fee-for-service claims reserve development (Prior Period Development).

A reconciliation of GAAP to Adjusted EPS for the company’s FY17 projections as well as comparable numbers for the year ended December 31, 2016 (FY16) is shown below:

       
Diluted earnings per common share    

FY17
Guidance (e)

   

FY16 (f)

GAAP     ~$17.83     $4.07
Net (gain) expenses associated with the terminated merger agreement (for FY17, primarily the break-up fee)     (4.36)     0.64
Amortization of identifiable intangibles     0.31     0.32
Beneficial effect of lower effective tax rate in light of pricing and benefit design assumptions associated with the 2017 temporary suspension of the non-deductible health insurance industry fee; excludes Individual Commercial business impact     (2.15)     -
Reserve strengthening for the company’s non-strategic closed block of long-term care insurance business (g)     -     2.11
Guaranty fund assessment expense to support the policyholder obligations of Penn Treaty (an unaffiliated long-term care insurance company)    

0.24

    -
Operating results associated with the Individual Commercial business given the company’s exit on January 1, 2018 as previously disclosed     (0.37)     3.78
Adjusted (non-GAAP) – FY17 projected; FY16 as recast     ~ $11.50     $10.92
 

Star Quality Ratings

The company now expects 74 percent of its June 30, 2017 Medicare Advantage membership to be in 4-Star plans or higher for bonus year 2018. As previously disclosed, in October 2016, the Centers for Medicare and Medicaid Services (CMS) published its Star quality ratings (Star ratings) showing that the percentage of the company’s July 31, 2016 Medicare Advantage membership in 4-Star plans or higher declined to approximately 37 percent for bonus year 2018 compared to approximately 78 percent of the company’s July 31, 2015 membership for bonus year 2017. While Star ratings are based on a number of plan performance measures that are evaluated each year, the projected Star ratings for the company’s plans for the 2018 bonus year included certain reductions that were primarily attributable to the 2015 comprehensive program audit by CMS. The company filed a reconsideration request with CMS, which was denied. The company subsequently decided not to appeal that denial further, and worked through existing CMS processes to rationalize contract structures, resulting in final Star ratings for bonus year 2018 that reflect its commitment to quality products and services for its members. The company remains committed to its partnership with CMS and to delivering quality products and services to its members.

Detailed press release

Humana’s full earnings press release including the statistical pages has been posted to the company’s Investor Relations site and may be accessed at http://phx.corporate-ir.net/phoenix.zhtml?c=92913&p=irol-IRHome 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.

All parties interested in the audio only portion of the company’s 2Q17 earnings conference call are invited to dial 888-625-7430. No password is required. A webcast of the 2Q17 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. Telephone replays will also be available approximately two hours following the live event until midnight eastern time on October 2, 2017 and can be accessed by dialing 855-859-2056 and providing the conference ID #89803304.

Footnotes

(a) 2Q17 Adjusted results exclude the following:

  • Amortization expense for identifiable intangibles of approximately $18 million pretax, or $0.08 per diluted common share; GAAP measures affected in this release include consolidated pretax, EPS, and segment pretax results (for each segment’s amount of such amortization).
  • The one-year beneficial effect of a lower effective tax rate of approximately $0.54 per diluted common share in light of pricing and benefit design assumptions associated with the 2017 temporary suspension of the non-deductible health insurance industry fee; excludes Individual Commercial business impact. GAAP measures affected in this release include consolidated EPS.
  • Operating earnings of approximately $118 million pretax, or $0.51 per diluted common share, for the company’s Individual Commercial business given the company’s planned exit on January 1, 2018, as previously disclosed. GAAP measures affected in this release include consolidated pretax income, EPS, consolidated revenues, consolidated benefit ratio and consolidated operating cost ratio.

(b) 2Q16 Adjusted results (recast) exclude the following:

  • Transaction and integration costs of $27 million pretax, or $0.16 per diluted common share, associated with the then-pending merger agreement; GAAP measures affected in this release include consolidated pretax income and EPS.
  • Amortization expense for identifiable intangibles of approximately $20 million, or $0.08 per diluted common share; GAAP measures affected in this release include consolidated pretax, EPS, and segment pretax results (for each segment’s amount of such amortization).
  • Operating losses of $225 million pretax, or $0.99 per diluted common share, for the company’s Individual Commercial business given the company’s planned exit on January 1, 2018, as previously disclosed. GAAP measures affected in this release include consolidated pretax income, EPS, consolidated revenues, consolidated benefit ratio and consolidated operating cost ratio.

(c) 1H 2017 Adjusted results exclude the following:

  • Net gain from the termination of the merger agreement of approximately $947 million pretax, or $4.31 per diluted common share; includes the net break-up fee and transaction costs net of the tax benefit associated with certain expenses which were previously non-deductible; GAAP measures affected in this release include consolidated pretax income and EPS.
  • Amortization expense for identifiable intangibles of approximately $36 million pretax, or $0.16 per diluted common share; GAAP measures affected in this release include consolidated pretax, EPS, and segment pretax results (for each segment’s amount of such amortization).
  • The one-year beneficial effect of a lower effective tax rate of approximately $1.06 per diluted common share in light of pricing and benefit design assumptions associated with the 2017 temporary suspension of the non-deductible health insurance industry fee; excludes Individual Commercial business impact. GAAP measures affected in this release include consolidated EPS.
  • Guaranty fund assessment expense of approximately $54 million pretax, or $0.23 per diluted common share, to support the policyholder obligations of Penn Treaty (an unaffiliated long-term care insurance company); GAAP measures affected in this release include consolidated pretax income, EPS, and consolidated operating costs ratio. Under state guaranty assessment laws, the company may be assessed (up to prescribed limits) for certain obligations to the policyholders and claimants of insolvent insurance companies that write the same line or lines of business as the company. On March 1, 2017, a court ordered the liquidation of Penn Treaty which triggered assessments from the state guaranty associations.
  • Operating earnings of approximately $181 million pretax, or $0.77 per diluted common share, for the company’s Individual Commercial business given the company’s planned exit on January 1, 2018, as previously disclosed. GAAP measures affected in this release include consolidated pretax income, EPS, consolidated revenues, consolidated benefit ratio and consolidated operating cost ratio.

(d) 1H 2016 Adjusted results (recast) exclude the following:

  • Transaction and integration costs of $61 million pretax, or $0.37 per diluted common share, associated with the then-pending merger agreement; GAAP measures affected in this release include consolidated pretax income and EPS.
  • Amortization expense for identifiable intangibles of approximately $41 million, or $0.17 per diluted common share; GAAP measures affected in this release include consolidated pretax, EPS, and segment pretax results (for each segment’s amount of such amortization).
  • Operating losses of $237 million pretax, or $1.08 per diluted common share, for the company’s Individual Commercial business given the company’s planned exit on January 1, 2018, as previously disclosed. GAAP measures affected in this release include consolidated pretax income, EPS, consolidated revenues, consolidated benefit ratio and consolidated operating cost ratio.

(e) FY17 Adjusted EPS projections exclude the following:

  • Net gain from the termination of the merger agreement of approximately $947 million pretax, or $4.36 per diluted common share; includes the net break-up fee and transaction costs net of the tax benefit associated with certain expenses which were previously non-deductible.
  • Amortization expense for identifiable intangibles of approximately $71 million pretax, or $0.31 per diluted common share.
  • The one-year beneficial effect of a lower effective tax rate of approximately $2.15 per diluted common share in light of pricing and benefit design assumptions associated with the 2017 temporary suspension of the non-deductible health insurance industry fee; excludes Individual Commercial business impact.
  • Guaranty fund assessment expense of approximately $54 million pretax, or $0.24 per diluted common share, to support the policyholder obligations of Penn Treaty (an unaffiliated long-term care insurance company).
  • Operating results of approximately $85 million pretax, or $0.37 per diluted common share, for the company’s Individual Commercial business given the company’s planned exit on January 1, 2018, as previously disclosed.

(f) FY16 Adjusted EPS (recast) exclude the following:

  • Transaction and integration costs of $104 million pretax, or $0.64 per diluted common share, associated with the then-pending merger agreement.
  • Amortization expense for identifiable intangibles of approximately $77 million pretax, or $0.32 per diluted common share.
  • Pretax expenses of $505 million, or $2.11 per diluted common share, of reserve strengthening related to the company’s non-strategic closed block of long-term care insurance business. See related footnote (g).
  • Operating losses of $869 million pretax, or $3.78 per diluted common share, for the company’s Individual Commercial business given the company’s planned exit on January 1, 2018, as previously disclosed. Includes the write-off of receivables associated with the risk corridor premium stabilization program. See related footnote (h).

(g) As noted above, in addition to previously-disclosed adjustments, EPS for FY16 included a strengthening of reserves for the company’s non-strategic closed block of long-term care business. In connection with its acquisition of KMG America in 2007, the company acquired a non-strategic closed block of long-term care insurance policies. These policies were sold between 1995 and 2005, of which approximately 30,800 remained in force as of December 31, 2016. During the fourth quarter of 2016, the company recorded a reserve strengthening for this closed block of policies as it determined the present value of future premiums, together with its existing reserves were not adequate to provide for future policy benefits. This adjustment primarily was driven by emerging experience indicating longer claims duration, a prolonged lower interest rate environment and an increase in policyholder life expectancies.

(h) On November 10, 2016, the U.S. Court of Federal Claims ruled in favor of the government in one of a series of cases filed by insurers against the Department of Health and Human Services (HHS) to collect risk corridor payments, rejecting all of the insurer’s statutory, contract and Constitutional claims for payment. Prior to this decision, the company had maintained the receivable in previous periods in reliance upon the interpretation previously promulgated by HHS that the risk corridor receivables were obligations of the U.S. government. Given this court decision, however, the company’s conclusion with respect to the ultimate collectability of the receivable shifted, and accounting rules required that the receivable be written off. Land of Lincoln Mutual Health Insurance Company v. United States; United States Court of Federal Claims No. 16-744C.

Cautionary Statement

This news release includes forward‐looking statements 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, however, involve extensive judgment, and have considerable inherent variability because they are extremely sensitive to changes in claim payment patterns and medical cost trends, so any reserves the company may establish, including premium deficiency reserves, may be insufficient.
  • If Humana fails to effectively implement its operational and strategic initiatives, particularly its Medicare initiatives, state-based contract strategy, and its participation in the new health insurance exchanges, the company’s business may be materially adversely affected, which is of particular importance given the concentration of the company’s revenues in these products. 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 implement new information systems, to protect Humana’s proprietary rights to its systems, or to defend against cyber-security attacks, 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 relating to rate adjustments resulting from the Balanced Budget and Emergency Deficit Control Act of 1985, as amended, commonly referred to as “sequestration”; other provider contract disputes; and qui tam litigation brought by individuals on behalf of the government) and governmental and internal investigations, 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.
  • The Healthcare Reform Law, including The Patient Protection and Affordable Care Act and The Healthcare and Education Reconciliation Act of 2010, could 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. Additionally, potential legislative changes, including activities to repeal or replace, in whole or in part, the Health Care Reform Law, creates uncertainty for Humana’s business, and when, or in what form, such legislative changes may occur cannot be predicted with certainty.
  • Humana’s continued participation in the federal and state health insurance exchanges, which entail uncertainties associated with mix, volume of business and the operation of premium stabilization programs that are subject to federal administrative action, could adversely affect the company’s results of operations, financial position and cash flows.
  • Humana’s business activities are subject to substantial government regulation. New laws or regulations, or changes in existing laws or regulations or their manner of application could increase the company’s cost of doing business and may adversely affect the company’s business, profitability 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’s pharmacy business is highly competitive and subjects it to regulations 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.
  • If Humana does not continue to earn and retain purchase discounts and volume rebates from pharmaceutical manufacturers at current levels, Humana’s gross margins may decline.
  • 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.

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, 2016;
  • Form 10-Q for the quarter ended March 31, 2017; and
  • Form 8‐Ks filed during 2017.

About Humana

Humana Inc. 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; and
  • Corporate Governance information.

Contact:

Humana Inc.
Investor Relations
Amy Smith, 502-580-2811
Asmith3@humana.com
or
Corporate Communications
Tom Noland, 502-580-3674
Tnoland@humana.com