Results

For calendar year 2018, Humana compared quality metrics and prevention measures for its approximately 1.85 million Medicare Advantage members affiliated with healthcare providers in value-based reimbursement model agreements to its approximately 848,000 members who were affiliated with providers under standard Medicare Advantage settings.

Also for 2018, Humana compared medical cost and utilization for approximately 1.63 million Medicare Advantage members who were affiliated with providers in value-based reimbursement models to approximately 855,000 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 2017 and are subject to restatement with the availability of more current CMS data. As of Sept. 30, 2019, Humana’s total Medicare Advantage (individual and group) membership is more than 4.07 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, 82.6% 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 2018 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, show:

• A value-based approach is improving quality measures: Providers in value-based reimbursement model agreements with Humana had 43 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 6 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 incidents 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.

Management and adherence

• 9% more eye exams
• 2% more adult BMI assessments
• 11% better management of rheumatoid arthritis
• 2% more high blood pressure adherence
• 1% more statin adherence

Diabetes care

• 9% more eye exams
• 21% more patients with controlled blood sugar levels
• 3% more patients with controlled diabetes renal disease
• 2% more adherence to diabetes medication

Cancer screenings

• 9% more colorectal screenings
• 9% more breast cancer screenings

Hospital care

• 7% fewer emergency department visits
• 6% fewer hospital inpatient admissions

Medicare Advantage members have reduced cost of care. Humana Medicare Advantage members under the care of physicians in value-based agreements would have incurred an additional $3.5 billion in plan-covered medical expenses had they been under Original Medicare’s fee-for-service model. Prevention screenings, improved medication adherence and effective management of patient treatment plans all contributed to creating these reductions. These medical cost reductions can benefit plan members through reduced out-of-pocket costs -- and, in future years, lower member premiums -- and/or additional benefits.

“The Medicare Advantage plan serves as a rich laboratory for value-based care, as it allows for integrated and coordinated management of chronic conditions, and a holistic view of the patient,” said William Shrank, MD, MPHS, Humana’s Chief Medical and Corporate Affairs Officer. “Moving the industry forward with a focus on value is not something we can do alone. Our dialogue with physicians, community organizations and other health care providers is essential to developing a sustainable system that improves population health and reduces costs for everyone.”

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