Humana’s 2017 value-based care results

Humana compared quality metrics and prevention measures for calendar year 2017 for its approximately 1.74 million Medicare Advantage members affiliated with healthcare providers in value-based reimbursement model agreements to its 130,000 members who were affiliated with providers under standard Medicare Advantage settings1, which doesn’t offer added incentives to providers who meet quality or cost targets.

Humana also compared costs for calendar year 2017 for approximately 1.5 million of its Medicare Advantage members affiliated with providers in value-based reimbursement model agreements to original fee-for-service Medicare and also compared outcomes for those 1.5 million to 146,000 members affiliated with providers under standard Medicare Advantage settings.

MCCI physicians are benefiting from a value-based practice

From our perspective as physicians, you know, the practices are not as burnt out. You don’t find people in our situation really getting burnt out like you do see in the fee-for-service where they’re hustling. I think this is very sustainable and the quality of life is excellent and you get to do what you love practicing medicine but you still have a life outside of that. I wouldn’t be still here after thirty years if I didn’t believe in it, thrived in it.

Initially, where doctors did not want anything to do with managed care, I’m seeing now that they're trying to get into those programs cause they see the benefits in terms of lifestyle, financial return and just overall well-being.

What I get to do on a day-to-day basis is focus on medicine, focus on the patients. I don’t have to worry about the business side of it. I don’t have to worry about running an office and dealing with insurance. It’s all sort of taken care of by the rest of the staff and that is the way it should be. It allows you to focus on what you were trained to do.

You have to see less patients, you can be more proactive with them, spend more time with them, which I think is very important.

When you’re seeing forty patients in a day, you know, did you do your best? I don’t think you can. I really don’t. I don’t believe that we can work to the best of our ability seeing forty patients in a day.

In a normal day, I’ll see between twelve, at most fourteen patients, spread out over a nine-hour day so it’s really manageable. I don’t ever feel rushed.

Plus, you have more time to spend with your families and you can really just focus on the day-to-day care of your patients and again, have the time to do it. We don’t worry about billing and collecting so we can really spend our time mostly focused on keeping our patients well.

You’re rewarded for keeping them healthy and keeping them out of the hospital.

I think that’s why all of us went into medicine, right? To get the patients what they need.

As a physician, you’re rewarded for doing what you were trained to do, what you were passionate about doing when you decided to go to medical school.

You’re aligned financially with what’s important to you as a physician, in your core, which is the well-being of your patient.

Value-based care at the Family Medical Clinic of Harrogate, Tennessee

It was important for me to come back home, because where I had trained at Mayo Clinic, I came and saw the quality of healthcare here and it wasn’t nearly what I had seen in other places and I thought that would be a great place to come back and introduce great quality care.

When I did come in contact with Humana, I did feel as though they were my enemies giving us all these forms about HEDIS measures and giving us Stars reports. And our Stars reports were all red. It looked like a stop light all the way on the paper. Terrible. A lot of these things I didn’t see myself being able to control. So, I didn’t see it was exactly fair to be graded on those things.  I knew our staff was working hard and I knew that I was working hard, but wasn’t able to make the distinction between those numbers and then what we were actually doing. And, so, when they first started here I probably kicked them out two or three times. Walked out a few times.

So the day that I actually came that he kicked me out of the office, I had actually presented him with a check for provider rewards.  He refused the check; he did not want to take the check.

That was kind of our turning point when I gave the check back was that, it’s not about the money and it’s actually about taking care of people and I said “You know, I want to talk to your medical director.” She said “OK.”

He came to Harrogate, TN from Knoxville and the next thing I know he was sitting right where we are today.  Once I understood kind of where Humana was coming from, I understood that they want the same thing I want.

And we wanted the patient to be as well cared for as possible.  With their new EMR systems we’re able to target those populations that are the sickest and we’re able to pull those in. We’re able to see those people more often. It was not just changing our practice, but changing the culture of our patients and our community. That coming to the doctor when you’re well is not a bad thing, and making sure that you’re doing your colonoscopies and mammograms and taking care of yourself is a good thing.

And we’ve actually caught I think to date about fifty-seven or fifty-eight cancers in the last year.  Value-based care incorporates everybody in my team and this truly affected every part of our practice for the good. People don’t realize that when you kind of adopt this value-based system, it makes every other practice in the area better because you exist.  And, ultimately, the patient flourishes in that, and part of that is Humana has helped me do my job and made me better at my job.

Chronic condition management

Chronic conditions continue to adversely impact the Medicare and Medicare Advantage populations. More than six in 10 Medicare beneficiaries are living with more than one chronic condition, according to the Centers for Medicare & Medicaid Services.

To address the rising tide of chronic conditions and social determinants that impact one’s well-being, Humana’s holistic approach to supporting physicians, clinicians and other care professionals has centered on its integrated care delivery model. A key element of the integrated care delivery model is the primary care physician (PCP).

PCPs are the centerpiece of a value-based reimbursement model agreement, managing all aspects of the patient’s care. After all, the PCP coordinates with specialists for the expanded care of those Medicare Advantage member’s with multiple chronic conditions.

Improved quality, improved health

Humana first disclosed Medicare Advantage value-based member results in 2013 and has done so each year since. The 2017 results, as with previous results, cannot be directly compared due to multiple demographic changes in the member population.

Humana’s core measurements, which follow the “triple aim” of population health, shows:

  • A value-based approach is improving quality measures: Providers in value-based reimbursement model agreements with Humana had 20 percent higher Healthcare Effectiveness Data and Information Set (HEDIS®) scores compared to providers in standard Medicare Advantage settings, based on an internal attribution method.
  • Humana Medicare Advantage members benefit from a preventive, holistic approach in a value-based care model: Humana Medicare Advantage members affiliated with providers in value-based reimbursement model agreements experienced 5 percent fewer hospital inpatient admissions and 7 percent fewer emergency department visits than members seen by healthcare providers in standard Medicare Advantage settings.

Helping lower those incidences is that patients treated by physicians in Humana Medicare Advantage (MA) value-based agreements received more preventive care screenings that led to better health outcomes, compared to those in Humana MA fee-for-service agreements.

2017 VBC vs. FFS prevention and adherence

Management and adherence

  • 9% more eye exams
  • 2% more patients with controlled blood sugar levels
  • 4% more adult BMI assessments
  • 4% better management of rheumatoid arthritis
  • 8% more high blood pressure adherence
  • 3% more statin adherence

Diabetes care

  • 8% more eye exams
  • 2% more patients with controlled blood sugar levels
  • 2% more patients with controlled diabetes renal disease
  • 3% more adherence to diabetes medication

Cancer screenings

  • 10% more colorectal screenings
  • 11% more breast cancer screenings

Hospital care

  • 7% fewer emergency department visits
  • 5% fewer hospital inpatient admissions

Lower Costs Obtained Through Value-based Approach: Humana found that medical costs for Medicare Advantage members affiliated with providers in value-based reimbursement model agreements were 15.6 percent lower versus those affiliated with physicians under original fee-for-service Medicare. As previously stated, medical cost reductions such as these can benefit plan members through reduced out-of-pocket costs, lower member premiums and/or additional benefits.

“Based on our experience, the value-based care model helps physicians spend more time with their patients, which builds stronger relationships between physicians and patients,” said Roy A. Beveridge, M.D., Humana’s chief medical officer. “The result is a bond of trust, which serves as the foundation for changing unhealthy behaviors and addressing social determinants of health. As we’ve seen at Humana, supporting physicians with actionable data gives them a deeper understanding of their patients − and that can result in more preventive care, which leads to better chronic condition management.”

For more information or to see Humana’s Value-based Care Report, visit our Value-based Care site, opens new window.

1 Standard Medicare Advantage settings refers to Humana fee-for-service only arrangements and excludes Humana Star Rewards, Model Practice, Medical Home, and Full/Global Value arrangements.