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Value-based MA Yields 15% Savings for Humana with Lower Utilization

News  |  By Gregory A. Freeman  
   November 17, 2017

A health plan model that rewards providers for meeting quality and cost targets saves money and improves patient outcomes, Humana reports.

Costs were 15% lower in Humana’s Medicare Advantage value-based plan than in traditional fee-for-service Medicare, and 4% lower than Humana standard Medicare Advantage settings for 2016. The company reports that the value-based approach saves money while also building stronger relationships between the physician and patient.

Humana’s “Making Progress, Seeing Results” value-based care report details the company’s 2016 results for Humana Medicare Advantage members affiliated with providers in value-based reimbursement model agreements.

Humana compared quality metrics for 1.65 million Medicare Advantage members who were affiliated with providers in value-based reimbursement model agreements to 191,000 members affiliated with providers under standard Medicare Advantage settings, and also those in standard fee-for-service plans. The value-based model offers financial incentives to providers who meet quality or cost targets.

In addition to the overall cost savings, the report highlights improvements in outcomes and reduced utilization. Emergency department visits were 7% lower under the value-based Medicare Advantage model versus a standard Medicare Advantage plan, and hospital inpatient admissions were 6% lower. Metrics for controlling blood pressure were 7% higher, diabetes care and controlling blood sugar were 7% higher, and medication adherence  was 2% higher.

The number of preventive screenings was 8% higher for breast cancer and 13% higher for colorectal cancer.

The providers in value-based plans benefitted from the improvements. Primary care physicians in value-based agreements with Humana received 16.2% of the total payments Humana distributed to healthcare providers in 2016, the report says. Primary care providers in non-value-based agreements with Humana received 6.9% of the total payments Humana distributed.

Providers in value-based reimbursement model agreements with Humana had 26% higher Healthcare Effectiveness Data and Information Set (HEDIS) scores compared to providers in standard Medicare Advantage settings based on an internal attribution method.

Humana’s report also references the impact that social determinants of health -- such as food insecurity, loneliness and social isolation -- can have on an elderly Medicare Advantage member’s health and well-being. For example, Humana’s research has shown that an older adult who is lonely or socially isolated is four times more likely to be readmitted to a hospital within a year of discharge.

The report notes that as of September 30, 2017, Humana had reached its calendar year goal of having approximately 66% of Humana individual Medicare Advantage members in value-based payment relationships. Humana’s total Medicare Advantage membership is approximately 3.3 million members, which includes members affiliated with providers in value-based and standard Medicare Advantage settings.

“Based on our experience, the value-based care model helps physicians spend more time with their patients, which builds stronger relationships between the physician and patient,” says Roy A. Beveridge, MD, Humana’s chief medical officer. “The result is a bond of trust, which serves as the foundation for changing unhealthy behaviors and addressing social determinants of health. As we’ve seen at Humana, supporting physicians with actionable data gives them a deeper understanding of their patient − and that can result in more preventive care, which leads to better chronic condition management.”

Gregory A. Freeman is a contributing writer for HealthLeaders.

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