Aligning accountable care incentives

Aligning accountable care incentives

The health reform law encourages the development of integrated “accountable care organizations” as an alternative to the traditional fee-for-service system. But Humana has had accountable care relationships for more than 25 years. In fact, today, Humana has more than 900 accountable care relationships—that is, relationships with providers who are completely accountable for the costs and care of the Humana population they serve. Under our programs, organizations that operate efficiently and meet quality standards are rewarded for doing so.

Now we are working to bring more of the providers we work with into accountable care relationships. Our experience shows that when providers are given incentives to improve outcomes, quality and costs, then positive results follow:

Accountability leads to better health for Humana Medicare Advantage members

Inpatient hospital admissions per 1,000 ↓ 6%
Emergency department visits per 1,000 ↓ 7%
HEDIS star score (a national care rating) ↑ 26%

Source: Humana data, 2016

Accountability also results in improved clinical management and more patient screenings. For example:

MA plans' clinical quality scores are better on average compared to original medicare FFS for all measures

Source: Humana data, 2016

Humana’s accountable care continuum

Sixty-six (66) percent of Humana’s individual MA members are currently in value-based care relationships. Our strategy centers on a gradual, multi-step approach we developed to support primary care providers as they move along a continuum of integration and accountability. It is designed to help them transition away from the traditional reimbursement system—where they are paid for every procedure or service they provide, regardless of outcome—to a new system, where they have financial incentives to take on responsibility for cost, quality and patient health outcomes.

Humana has been evolving toward a system of care that truly integrates provider and health plan activity

Learn about our accountable care policy here.