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.

Here's why:

  • Americans are getting sicker: Six in ten Americans live with at least one chronic disease1
  • Chronic conditions go unmanaged
  • 46 percent of people with hypertension don’t have their blood pressure under control2
  • 43 percent of people with diagnosed diabetes have poorly controlled blood sugar levels3
  • More than 70 percent of people with high cholesterol don’t have it under control4

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.

Humana has an extensive and growing value-based care presence. As of Sept. 30, 2018, Humana has more than 2 million individual Medicare Advantage members and approximately 115,000 commercial members who are cared for by more than 52,000 primary care physicians in more than 1,000 value-based relationships across 43 states and Puerto Rico. Humana’s total Medicare Advantage membership is more than 3.5 million, which includes members affiliated with healthcare providers in value-based and standard Medicare Advantage settings.

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. We will be at the following upcoming conferences and events in 2019:

  • MGMA Annual Conference
    October 13-16
    New Orleans
  • American Academy of Family Physicians (AAFP)
    Sept. 24-28
    Philadelphia
  • American College of Physicians (ACP)
    April 23-25, 2020
    Los Angeles

Sources

  1. “National Center for Chronic Disease Prevention and Health Promotion,” Centers for Disease Control and Prevention, last accessed March 21, 2019, https://www.cdc.gov/chronicdisease/index.htm. , opens new window
  2. “High Blood Pressure Facts,” Centers for Disease Control and Prevention, last accessed March 21, 2019, 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 March 21, 2019, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5117523/. , opens new window
  4. “High Cholesterol Facts,” Centers for Disease Control and Prevention, last accessed March 21, 2019, 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.