Rewarding commitment and ensuring quality

Humana's Chief Medical Officer answers questions about new partnerships the company is forming with physicians and provider organizations.

We at Humana think that the healthcare system is very complicated. There's no one simple solution. But I think two guiding principles are: one, we need to listen to the patient and understand what's important to us all since we're all patients, and the second is to listen to our doctors.

One, doctors are concerned that the system is broken—that they spend more time in front of a computer than they spend in front of their patients. Two, they don't think that they’re getting paid sufficiently well for all the work that now is needed for the care of patients that are becoming increasingly complex. And finally, what we hear from physicians is that it’s too complicated.

I think physicians would be surprised by many things that are going on at Humana. I think that the emphasis on quality care, the emphasis in terms of ensuring that patients are treated very well but that physicians are compensated appropriately, meaning more, is something that I would think would surprise a lot of physicians.

Where we work with physicians and pay them based on quality metrics, what we find is that the number of patients who have better cancer screening is significantly higher. We find that patients with diabetes have better diabetic control. We find that patients who have Alzheimer's are in more engaged classes to prevent the progression of disease. In short, no matter what patient population we look at, where there are quality metrics, we find that there's an improvement for the patient.

I think there are 2 major things that physicians get from this. The first is that the quality of care that they render is significantly higher. And we can see this based on measures in terms of HEDIS and stars scores. They're significantly higher in this situation. The second thing, which is more practical but certainly very important, is that they're paid more. We pay significant amounts of money in terms of quality bonuses. In fact, last year we spent almost 76 million dollars in terms of quality bonuses to our physicians.

I think that's a great question and I think that it wasn't that many years ago that physicians and payers had contentious relationships. In this new world, the payer is much much more than a payer. Humana at this point is a health company and our alignment with the physician, with the clinician, with the nurse, with the pharmacist is absolutely integral in terms of how all of us are going to be successful.

A new model of care

Healthcare is rapidly changing as the shift from fee-for-service to value-based care gains momentum. While this shift is a substantial change for many physicians and other healthcare professionals, the move to a value-based model and population health approach is imperative to improve the health of the U.S. population and reduce healthcare costs.

According to the Centers for Disease Control and Prevention, more than half of Americans are living with at least 1 chronic disease, like heart disease, cancer, stroke or diabetes, which are the leading cause of death or disability and rising healthcare costs.1 Many chronic conditions go unmanaged. For example:

  • 1 in 5 U.S. adults still do not know they have high blood pressure2
  • An estimated 28.9 million adults have diabetes and many are undiagnosed or not managing their condition3
  • 78 million U.S. adults are at risk for heart disease and stroke, but since high cholesterol has no symptoms, many people are not aware their cholesterol is too high4

For physicians, a value-based care model recognizes their commitment to their patients' health and compensates them for the high-quality, complex care they deliver. This model of care combines the practice of proactive population medicine with an aligned payment structure—one that reimburses physicians for care that leads to better health and a better experience for their patients.

Value-based care at Humana means physicians and other healthcare professionals have access to sophisticated tools, capabilities and services designed to make population health management easier.

Today, 66% of people with Humana's Medicare Advantage plan (roughly 1.9 million) are cared for by physicians in value-based care relationships with Humana.

Aligning on value

Dr. Pepe Armas, CEO of MCCI, shares how he got started in value-based care and why he chose to partner with Humana.

I'm Dr. Pepe Armas and I’m the CEO and managing partner for Medical Care Consortium, a primary care physician group. When I was in private practice, I’d have to see 30, 40 patients in the office, go to 1 hospital, see another 5 patients inpatient, never really feeling that I was giving my patients everything that I could.

At that point, we made a decision to try to look at different possibilities and different models of how we could position ourselves. We got together a group of approximately 10 to 12 docs. We learned to work in an organized fashion. Approximately 30 years ago, it wasn’t a model that was well understood.

When we chose Humana as our partner, they had the vision and continue to have the vision that instead of cost shifting, instead of withholding care or negotiating contracts down to a point where it becomes unbearable for physicians and providers, we were paid a bundle payment. We were given a certain amount of money and we were responsible for the care of our patients.

We were completely aligned with Humana as our partner, with the primary care physician group and some of the subsequent specialists and hospital contracting. So everybody was aligned with the sole idea of if we have better outcomes for our patients, if the health of our patients is better and is maintained and is sustainable, then it should be cheaper and more efficient for us to do as opposed to all the other different, classical ways of payment and trying to make money.

Events and conferences

Across the country, our physician leaders exhibit at conferences and host speaking engagements about value-based care and population health. We join with outside physicians, industry leaders and share insights and expertise on the evolving healthcare climate. Here are the upcoming conferences and events we will be at below.

  • MGMA Annual Conference
    Sept. 30 – Oct. 3
    Boston
  • AAFP Family Medicine Experience
    Oct. 9-13
    New Orleans

     

Sources

  1. “National Center for Chronic Disease Prevention and Health Promotion,” Centers for Disease Control and Prevention, last accessed November 13, 2018, https://www.cdc.gov/chronicdisease/index.htm. , opens new window
  2. “High Blood Pressure Facts,” Centers for Disease Control and Prevention, last accessed November 13, 2018, https:// www.cdc.gov/bloodpressure/facts.htm. , opens new window
  3. “Type 2 Diabetes Detection and Management Among Insured Adults,” National Center for Biotechnology Information, last accessed November 13, 2018, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5117523/. , opens new window
  4. “High Cholesterol Facts,” Centers for Disease Control and Prevention, last accessed November 13, 2018, https://www.cdc.gov/ cholesterol/facts.htm. , opens new window

Contact your colleagues

Humana is here to support you and your practice. We have representatives available to help with administrative needs, and we have physician colleagues in your area to talk with you about value-based care.