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Understanding the Landscape in For-Profit, Nonprofit, and Government-Based Human
Service Organizations
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Understanding the Landscape in For-Profit, Nonprofit, and Government-Based
Human Service Organizations
Introduction
Humana Health Insurance was founded in 1961 and has, over the years, greatly prospered
in providing various human-related services with the primary goal of diversifying healthcare
service standards. Humana is one of the leading for-profit organizations based in Louisville,
Kentucky, and it specializes in the provision of various health insurance coverages, pharmacy
coverage, dental services, vision, and Medicare supplements throughout America (IBM, 2023).
Additionally, Humana provides and supports wellness programs and initiatives in various states
in the US, which range from the provision of rewards for people engaged in healthy physical
exercises to programs that support smoking cessation and human vitality, where individuals are
encouraged to donate blood. Further, the organization has, for over a decade, been actively
involved in the TRICARE program, which is offered within the Department of Defense as part of
its plans to provide solutions to issues encountered by veterans. This paper analyzes the
landscape in for-profit, nonprofit, and government-based human service organizations using the
case study of Humana Health Insurance.
Organizational political and social landscape
Human service organizations operate in an ever-changing social and political
environment, which directly affects their service delivery and performance. Health is a
significant factor in the American political space and has been identified as a key determining
factor during the last election. This significance explains the increased need to address the
existing health inequity among most Americans. For instance, the 2023 proposals, which
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included the rate and rule notice aimed at incentivizing the existing social needs through
intervention and screening (Humana, 2022). These proposals include the Special Needs Plans
(SNPs) needing to add standardization questions on various service proposals following new star
ratings in assessing the contract of the enrollees. For example, the proposed Medicaid and
Medicare cuts are likely to negatively affect Humana, which is one of the great beneficiaries
serving millions of Medicare and Medicaid clients. This is likely to affect the number of services
afforded by the organization to the community and force them to reduce their budget to fit the
current budget cuts, thereby increasing the likelihood of health inequalities within the society.
Regarding the social factors, the increased need for various community-related services,
which include home health, home care, and other forms of social housing, has increased the
demand for social services across the population, thus the increased demand for human service
organizations. These social factors have been exacerbated by the increase in the aging population
in America, increased competitiveness, and infrastructural and capacity-related challenges,
especially among the smaller community-related agencies, thus leading to the need for more
equipped human service organizations (Smith & Phillips, 2016). Further, the current
organizations offering various human services, such as Humana Health Insurance, have attracted
increased attention and demand as a result of the existing policies. For example, the Affordable
Care Act (ACA), which was initially known as Obamacare, has contributed to an increased
demand for human services within various health community clinics and centers, which,
however, varies based on their locality and state (Smith & Phillips, 2016).
Forces that impact Humana health insurance
As aforementioned, human service organizations often operate in an ever-changing and
uncertain environment. This is attributed to the changing needs of the population served, the
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changing needs of the clients, government regulations, and other factors that positively and
negatively affect their operations. Mosley and Smith (2018) assert that the current environment
of human service organizations is coupled with the question of impact on the community,
performance, as well as the ever-increasing demand and competition for social services in the
community. The question of impact has been a major driving force in ascertaining various
factors and forces that are impacting the operations of these human service organizations. In the
case of Humana Health Insurance, various forces have been identified as crucial in impacting the
delivery of human services to the population served.
The first force is the political factors. Humana operates in a political environment, and
the organization is regularly affected by the political space in which it operates. These political
aspects include the health reforms and policies in the US, which range from the continued
debates regarding policies such as the ACA. The continuous changes and requirements put in
place require organizations such as Humana to ensure that they align their products and services
as stipulated by ACA, which may require continuous changes within the organization (DCF.FM,
2024). Also, the proposed funding cuts by Medicaid and Medicare, which comprise a majority of
Humana’s clients, are likely to affect the organization’s profitability negatively.
The second force is economic factors, which influence the strategies and performance of
the organization. Economic downturns, which include economic recession, negatively affect the
productivity and profitability of Humana. This was depicted by the recent COVID-19 pandemic,
which negatively affected household incomes, thus leading to a noticeable shift regarding the
management and prioritization of consumers' health insurance spending in the organization.
Besides, sociological factors such as the upsurge in the aging population in the US, the
increased attention towards the social determinants of health, and the changes towards the need
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for consumer-driven choices of healthcare have significantly transformed the operations of
Humana Health Insurance. For example, the rise in the aging population, which is a majority of
Humana’s clients, has greatly created a need for the organization to develop effective programs
that fit their needs, especially regarding chronic illnesses management and geriatric and mental
health-related services. These sociological shifts and changes thus pose various challenges and
opportunities for the organization, especially in developing effective strategies to remain
competitive in the market (DCF.FM, 2024).
Lastly, technological changes in the healthcare environment are also resulting in various
impacts on the operations of Humana. The adoption of remote healthcare services, telemedicine,
electronic health records (EHRs), big data analytics, and AI are posing a significant challenge to
the operation of human service agencies. In this regard, Humana has quickly adopted recent
technological advancements, including EHRs, which enhance the accuracy of its records, thereby
improving patient outcomes (DCF.FM, 2024).
Leadership challenges related to internal or external forces
As a result of the above-described forces, Humana encounters various leadership
challenges. Although Humana is among the fastest growing human service organizations in the
US, the organization is currently facing a leadership crisis due to a lack of qualified managers to
run the organization, especially with the ever-changing health environment. Hopkins et al.
(2014) assert that there is a growing shortage of managers in human service organizations as the
majority of those in leadership positions lack appropriate skills to manage the organizations.
Also, poor performance is a key challenge facing Humana due to increased competition.
Organizations such as Humana are faced with various leadership challenges, which include the
ability of the managers to balance the mission of the organization and achieve sustainability
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financially. The mission of Humana is actively working to advance healthy equity among the
population by eliminating the existing injustice in health and removing barriers to accessing
healthcare services. However, it becomes challenging for those holding leadership positions to
balance between the organizational mission and achieving financial sustainability due to the
changing environment in which Humana operates.
The challenge regarding the lack of qualified managers is complex because a majority of
managers in leadership positions often acknowledge a deficit in leadership skills. Thus, they
need to adopt new approaches to increase their ability to tackle technological, social, political,
and economic changes in this industry (Hopkins et al., 2014). Also, although organizations such
as Humana may opt to hire professional managers to manage the organization, the process must
be approved by the funders, which thus increases pressure on the organization, making the issue
more complex. Regarding poor performance, it is important to note that Humana operates in an
environment affected by frequent changes in rules and regulations that govern healthcare. For
example, a reduction in funding is likely to impact the ability of Humana’s service provision,
especially to vulnerable populations. Another complexity results from the requirement to comply
with the regulations of different localities and states, which thus requires the organization to
invest greatly in in-house staff training to manage the allocated resources effectively.
Improving leadership ability to respond
In addressing the existing leadership challenges and complexities, there is a need to
ensure that a leader has the required skills and ability to influence groups of individuals.
Nurwahyuliningsih, et al. (2023) assert that having the required skills provides adequate
competence, which is essential in achieving the organizational mission, goals, and success in the
market. Leaders often identify their limitations in leadership abilities and thus the need to adopt
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new competencies and approaches to help them improve the performance of the organization.
For example, for a leader to be successful in human services such as Humana, they should
possess the right set of professional competencies and social values that align with human
service organizations and social work. For instance, such leaders should possess aspects such as
the ability to utilize organizational resources effectively, provide the required motivation and
support to the staff, global thinking, creation of a vision, self-confidence, self-awareness, and a
clear understanding of existing cultural stereotypes.
One of the key resources in improving the ability of human service managers at Humana
to address the leadership challenges is the translation of knowledge in healthcare. According to
Oborn et al. (2013), in recent years, there has been an increased need for the translation of
knowledge from research into practice with the primary goal of increasing importance in
healthcare service delivery. This involves the use of evidence-based practice models, especially
concerning the adoption of models that increase patient interaction and decision-making.
Another resource is organizational learning, which involves the transfer of knowledge among an
organization's employees. Oborn et al. (2013) asserts that the failure of an organization to
transfer knowledge among its employees may depict failure of the organization in the future.
This can be done through regular personnel training, observations, and interaction with day-to-
day clients.
Summary/conclusions
Humana Health Insurance, like other human service organizations, operates in a complex
environment shaped by various factors and forces that influence its operations. Mosley and
Smith (2018) assert that these forces directly affect the performance, management, and
operations of these organizations, depicting the competitiveness that exists in the healthcare
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market. Humana deals with the provision of various health services and is affected by
technological, organizational, political, economic, and sociological forces. For example, the need
for regulatory compliance, the aging population, and ACA proposals significantly impacts
Humana’s operations. Various leadership challenges such as lack of adequate managerial skills
and poor performance due to competition arise from these forces impacting Humana. Therefore,
leaders in Humana need to adopt new competencies and approaches to help them improve the
performance of the organization.
References
DCF.FM. (2024). PESTEL Analysis of Humana Inc. (HUM). https://dcf.fm/products/hum-
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Hopkins, K., Meyer, M., Shera, W., & Peters, S. C. (2014). Leadership challenges facing
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Humana. (2022). Social Determinants of Health Data Issue Brief.
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