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Analysis

Value-Based Care Leads to Reductions in ER Visits and Admissions

By Jack O'Brien  
   November 13, 2018

Humana's fifth annual value-based care study found that patients seen by physicians in value-based agreements had a 7% drop in emergency room visits and a 5% drop in hospital admissions year-over-year.

For half a decade, value-based care has slowly delivered meaningful clinical and financial returns to physicians operating in an integrated approach, according to a Humana study released Tuesday morning. 

Throughout last year, emergency room visits have decreased by 7% while hospital admissions declined by 5% among Humana Medicare Advantage members affiliated with physicians participating in value-based care arrangements. Similarly, colorectal and breast cancer screenings rose by double digit percentages compared to 2016 among physicians in value-based agreements. 

On the financial end, medical costs for patients were nearly 16% lower due to physicians embracing value-based care. 

Related: CMS Home Health Final Rule Pushes Modernization and Value-Based Care

Dr. Roy Beveridge, chief medical officer of Humana, told HealthLeaders that there has been continual improvement in the quality and efficiency of value-based care models over the past five years.

Beveridge questioned why a greater number of clinicians had not embraced value-based care payment methodology given that the care administered is higher while the costs associated with it are lower.

"Data from American Academy of Family Physicians (AAFP) and data from our own study show that 6% of the dollars spent in the system are on primary care," Beveridge said. "If you look at our commitment to the family practioner being the focal point on care, what we're finding is that 16.8% of [the spending] are going to primary care physicians. That's a big statement in terms of our commitment to pay primary care and vlaue-based care." 

Related: Physicians Disillusioned by How EHR Systems, Value-Based Care Changing Profession

Additional highlights of the Humana study:

  • Seventy percent of physician practices participating in Humana's value-based care model witnessed savings last year.
  • Humana Medicare Advantage value-based care physician practices saw a 10% increase in shared savings from 2016 to 2017. 
  • Beveridge said the study showed that the more engaged a physician is with value-based care, the more likely it is that they will assist patients and lower the chances they will have a return admission or ER visit. 

Correction: An earlier version of this story referred to AAFP as the "American Association of Family Physicians," instead of the "American Academy of Family Physicians. This article has been updated to reflect that change.

Jack O'Brien is the finance editor at HealthLeaders, a Simplify Compliance brand.


KEY TAKEAWAYS

There has been an improvement in the quality and efficiency of value-based care models over the past five years, according to Dr. Roy Beveridge, chief medical officer of Humana.

Colorectal and breast cancer screenings rose by double digit percentages compared to 2016 among physicians in value-based agreements.


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