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 the first quarter of 2014, we had 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 ↓ 7%
Emergency department visits per 1,000 ↓ 6%
HEDIS star score (a national care rating) ↑ 19%

Source: Humana data, 2015

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

Diabetic blood sugar control ↑ 10%
Osteoporosis management ↑ 13%
Colorectal cancer screening ↑ 8%
Breast cancer screening ↑ 6%
Medication review for older adults ↑ 10%
Pain screening for older adults ↑ 5%

Source: Humana data, 2015

Humana’s accountable care continuum

Humana’s goal is to have 75% of our health plan members in value-based, accountable 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.

Accountable Care Arrow

Fee for service Rewards for meeting national health and quality metrics Rewards for managing population health Full accountability
No accountability for cost or outcome. Primary care provider is paid for each procedure. Example: Provides appropriate preventive and chronic care. Coordinating care across the health care spectrum. Global capitation. Provider gets set payment each month for each health plan member.

Successful national accountable care organization pilot

In Kentucky, Humana teamed up with the Brookings Institution, the Dartmouth Institute for Health Policy & Clinical Practice, and Norton Healthcare in one of five Brookings-Dartmouth pilot programs to develop a national model for accountable care organizations (ACOs). The results after three years show ACOs can help transform the U.S. healthcare system into one that delivers higher quality care while lowering costs. Humana continues its ACO partnership with Norton today.

Year 3 partnership results (2009-2012):
Inpatient admissions per 1,000 ↓ 67%
Inpatient days per 1,000 ↓ 67%
Physician visit within seven days of discharge ↑ 64%

Source: Humana-Norton ACO, 2013

Learn about our accountable care policy here.