Results

For calendar year 2019, Humana compared quality metrics and prevention measures for its approximately 2.1 million Medicare Advantage members affiliated with healthcare providers in value-based reimbursement model agreements to its approximately 873,800 members who were affiliated with providers under standard Medicare Advantage settings.

Also for 2019, Humana compared medical cost and utilization for approximately 1.9 million Medicare Advantage members who were affiliated with providers in value-based reimbursement models to approximately 900,000 members who were affiliated with providers under standard Medicare Advantage settings as well as to Original fee-for-service Medicare.

Original Medicare costs, admission and emergency room estimates were derived using CMS Limited Data Set Files from 2018 and are subject to restatement with the availability of more current CMS data. As of June 30, 2020, Humana’s total Medicare Advantage (individual and group) membership is more than 4.5 million members.

Chronic conditions continue to adversely impact the Medicare and Medicare Advantage populations. Approximately six in 10 Medicare beneficiaries are living with more than one chronic condition, according to the Centers for Medicare & Medicaid Services. Additionally, 85.1% of Humana Medicare Advantage members have at least two chronic conditions.

To address the rising tide of chronic conditions and the 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 members with multiple chronic conditions.

Humana first disclosed Medicare Advantage value-based member results in 2013 and has done so each year since. The 2019 data, 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, show:

• Humana individual Medicare Advantage members benefitted from preventive screenings. Humana MA members seeking care from physicians in value-based agreements received screenings between 8% and 19% more often for colorectal screenings, diabetic eye exams, osteoporosis management and controlling blood sugar than those Humana MA members who received care from physicians in MA non-value-based arrangements.
• More Humana MA members stayed in their homes, not the hospital. Humana MA members receiving care from physicians in value-based care arrangements with Humana collectively spent 211,000 fewer days as hospital inpatients and less time seeking care in emergency rooms in 2019, compared to those Humana MA members receiving care from physicians in non-value-based care models. More broadly, Humana MA members served by physicians/practices in value-based agreements visited emergency rooms 10.3% less often (90,500 fewer visits) and had a 29.2% lower rate of hospital admission (165,000 fewer admissions) compared with Original Medicare.
• Care costs are lower for Humana Medicare Advantage members. An estimated $4 billion in plan-covered medical expenses would have been incurred by Humana Medicare Advantage members if they had they been under Original Medicare’s fee-for-service model instead of in value-based agreements.

Management and adherence

• 9% better management of osteoporosis
• 9% more adult BMI assessments
• 4% better management of rheumatoid arthritis
• 2% more high blood pressure adherence
• 1% more statin adherence

Diabetes care

• 10% more eye exams
• 19% more patients with controlled blood sugar levels
• 2% more patients with controlled diabetes renal disease
• 2% more adherence to diabetes medication

Cancer screenings

• 8% more colorectal screenings
• 7% more breast cancer screenings

“Value-based care underscores the need to take a holistic view to help members achieve their best health,” said William Shrank, M.D., MPHS, Humana’s chief medical and corporate affairs officer. “Central to this is the ability for value-based physicians to have access to a full and complete picture of patients’ health – including their clinical, behavioral and social needs."

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