A new report on value-based care released this week by Humana reveals that 2.41 million Humana individual Medicare Advantage beneficiaries who receive care from primary care physicians in value-based payment models experienced, on average, better health outcomes, lower costs and more preventive care, as opposed to fee-for-service models. What’s more, an estimated $4 billion in plan-covered medical expenses would have been incurred by Humana Medicare Advantage members if they had they been under original Medicare’s fee-for-service model instead of in value-based agreements.
The report details how the Louisville, Ky.-based health insurer has helped its Medicare Advantage (MA) members, 85 percent of whom were living with at least two chronic conditions in 2019, and supported its primary care physicians in their efforts to better manage patients’ health. Humana’s population health strategy for addressing the impacts of health-related social needs, as well as the company’s response to the COVID-19 pandemic, are also examined in the report.
As of June 30, 2020, Humana’s total Medicare Advantage, both individual and group, membership was approximately 4.5 million members. For the report, Humana compared calendar year 2019 prevention measures for approximately 2.1 million Medicare Advantage members seeking care from providers in a value-based arrangement to approximately 873,800 members who sought care from providers under standard Medicare Advantage settings.
Humana also compared medical cost and utilization for calendar year 2019 for approximately 1.9 million Medicare Advantage members who sought care from providers practicing value-based care to approximately 900,000 members seeking care from providers under standard Medicare Advantage settings, as well as to original fee-for-service Medicare.
The report, which details three key areas of data—prevention, outcomes and utilization, and cost and payments—encompasses several key findings, some of which include:
Humana individual Medicare Advantage members benefitted from preventive screenings. Humana MA members seeking care from physicians in value-based agreements received screenings between 8 percent and 19 percent more often for colorectal screenings, diabetic eye exams, osteoporosis management and controlling blood sugar than those Humana MA members who received care from physicians in MA non-value-based arrangements.
More Humana MA members stayed in their homes, not the hospital. Humana MA members receiving care from physicians in value-based care arrangements with Humana collectively spent 211,000 fewer days as hospital inpatients and less time seeking care in emergency rooms in 2019, compared to those Humana MA members receiving care from physicians in non-value-based care models. More broadly, Humana MA members served by physicians/practices in value-based agreements visited emergency rooms 10.3 percent less often (90,500 fewer visits) and had a 29.2 percent lower rate of hospital admission (165,000 fewer admissions) compared with Original Medicare.
Care costs are lower for Humana Medicare Advantage members. An estimated $4 billion in plan-covered medical expenses would have been incurred by Humana Medicare Advantage members if they had they been under original Medicare’s fee-for-service model instead of in value-based agreements.
Humana President and CEO Bruce Broussard said he believes that, in a value-based care model, providers caring for Medicare Advantage members have reinforced a broader view of caring for people living with multiple chronic conditions. “The premise of human care – where we listen to and address the specific physical health, behavioral health and health-related social needs of our members and their care teams – is amplified in value-based care agreements,” said Broussard. “Our collaboration with primary care physicians and their care teams is helping to deliver simpler and more convenient care and reducing avoidable hospitalizations.”
This is the fourth year that the company has issued the annual report and the seventh for reporting on health, quality and costs results for its Medicare Advantage beneficiaries seeking care from physicians in value-based payment models. Notably, however, Human officials say that the 2019 results, as with the previous results, cannot be directly compared year-over-year due to multiple demographic changes in Humana’s member population.
William Shrank, M.D., Humana’s chief medical and corporate affairs officer, said he believes that value-based care models will become even more effective as we foster even greater interoperability in data and systems, facilitating improved visibility and coordination.
“Value-based care underscores the need to take a holistic view to help members achieve their best health,” said Shrank. “Central to this is the ability for value-based physicians to have access to a full and complete picture of patients’ health - including their clinical, behavioral and social needs. The COVID-19 pandemic further emphasizes the need to address barriers to social isolation, food insecurity, and transportation among seniors. Addressing social determinants of health is the right thing to do, and we believe helps our members spend more Healthy Days at home.”
