In an analysis published online in the Health Affairs Blog on July 3, Humana CEO Bruce D. Broussard, and chief medical officer William H. Shrank, M.D., look at the gains in quality and effectiveness being made in the Medicare Advantage program, as the entire U.S. healthcare system begins to shift in earnest towards value.
Under the headline “Medicare Advantage And The Future Of Value-Based Care,” Broussard and Shrank begin by contexting the Medicare Advantage program itself, noting that it was originally “established by the Balanced Budget Act (BBA) of 1997 as a vehicle to bring private-sector competition and innovation to Medicare beneficiaries. When the program was announced, the goal was to create greater competition on benefits, care management, and costs, and to offer greater choice and consumer-centricity to America’s seniors.” Indeed, as the health plan executives note, “At the time, value-based care, where providers are reimbursed for the health outcomes of their patients as opposed to the volume of services provided, was not yet the rallying cry of a health system in need of transformation. The impact of private competition on value-based care likely was not even contemplated at the time the legislation was passed. A closer look at the evolution of MA demonstrates that the private sector has proven to be a remarkable laboratory for innovation and progress in our health system’s core evolution—to align the payment and care delivery system with value and the outcomes we care about most for America’s seniors.”
Now, as the U.S. healthcare system is being pushed towards greater value, Broussard and Shrank note, “The average premium for MA plans that include pharmacy coverage will be $40 per month in 2019, down from $46 per month in 2018, and MA plans offer out-of-pocket cost caps to reduce beneficiary exposure to excessive medical costs. Flexibility in MA benefits,” they state, “allows private health plans to provide supplemental benefits such as preventive dental care, vision, and hearing assistance at no additional cost, benefits that are not provided by traditional Medicare. This helps seniors, many of whom are on a fixed budget, limit their exposure to high costs.”
The two senior Humana executives assert that “Our success” in making upstream, community-focused interventions, “highlights an emerging strategy that private payers can apply to positively impact the health of the communities they serve. For providers that are not participating in large vertically integrated health systems, such responsibility—to address these upstream social needs and determinants of health—would be quite onerous.”
