Value-based care—the future of healthcare

A large wooden ship encased in glass sits prominently in the lobby of Humana’s Louisville headquarters. Its placement seems out of the ordinary, until you understand its symbolic purpose.

The ship reminds us of the team collaboration that’s necessary to focus on patient well-being. We must all row together to make progress and help those we serve live their healthiest lives.

Physicians. Nurses. Health coaches. Pharmacists. Health plans. And many others.

Collaboration and teamwork are critical to what we do– now and in the future. We just do it at different points along the way.

America’s healthcare industry continues to make strides in helping people achieve well-being goals through a value-based clinical approach. In this, our 9th annual Value-based Care Report, data tells us that members affiliated with physicians in value-based agreements receive more preventive screenings, spend less time in the hospital and pay less out-of-pocket than those affiliated with non-value-based physicians.

But it’s not just the data that tells us this. Members with value-based physicians tell us through surveys they are satisfied with this approach.

The average patient experience Stars score for value-based members was almost 25% higher in 2021 compared to non-value-based. Members gave their highest marks to overall rating of drug coverage and overall rating of the health plan.

We also saw, and have consistently seen over time, that those value-based members visited their primary care physicians more frequently throughout the year, were more adherent to their medications and experienced fewer complications with specialized care.

Certainly, those results are encouraging. But there is plenty of opportunity for improvement. None of those numbers are perfect, and there are still some 32% of our individual Medicare Advantage population being cared for by physicians in traditional fee-for-service models that often result in quantity over quality-based care.

The senior population is large and growing, expected to reach 95 million by 2060. With that patient pool expanding, we need to solidify the approach toward care delivery. Now.

Success requires us to deliver value for members. Not just in outcomes, premiums and benefits, but in simplicity of their experience and how to help them in their continuing journey of health.

Over the last year in particular, it’s been clear that we’re working better. We’re collaborating in new ways with new levels of creativity and driving results aligned with our missions and a sense of passion.

Together, we’re minimizing unnecessary and costly avoidable admissions. We’re getting members more engaged in their well-being. We’re making healthcare more accessible – for everyone.

Through those collective efforts, we’re clearly demonstrating the value of value-based care to the tune of nearly $6 billion in estimated cost savings in 2021 compared to Original Medicare. That’s a huge sum from 1 health plan but is only representative of a tiny portion of the nation’s overall healthcare spending.

Imagine the difference that could be made by the collective industry joining us on this path.

As another year of living the “new normal” ends, as an industry, we take stock of the challenges endured— but also overcome.

The wide availability of COVID-19 vaccines, test kits and anti-viral treatments have lessened the strain on the healthcare system and our front-line healthcare workers.

Continued expansion of telemedicine and in-home care benefits have allowed patients to access care quicker and without having to leave home.

Investments in quality improvement programs and the inclusion of pharmacists, social workers, care coordinators and other health professionals as part of the care team have strengthened primary care practices and enabled them to focus, not only on the physical health of patients, but also on their emotional, mental and financial health– whole-person care.

And while we cannot predict if and when another public health crisis may occur, we do know that by remaining nimble and innovative, payers and providers alike can lean in on the capabilities of value-based care delivery organizations to strengthen primary care and provide comprehensive, quality care to members and patients.

We have seen these successes first-hand in value-based care practices across the country.

Looking ahead, we anticipate continued growth of value-based care membership, and we must continue to make new investments in capabilities and technology that strengthen primary care and address all aspects of a person’s health.

At least 2 areas should remain in focus to achieve this.

The first is addressing the lack of any meaningful social risk adjustment in patients that may exacerbate inequities. By adopting methods that account for all factors, including social risk factors, that influence a patient’s risk, we could help create a more equitable healthcare payment system to better serve all patients.

The second is continued interoperability efforts coupled with the update of current privacy regulations. To make social determinant of health data actionable for healthcare providers, data formats need to be standardized across all platforms and systems.

This is especially important for value-based care providers as it will allow them to coordinate care for patients and help them to tap into other social supports. Value-based systems can be strengthened by the adoption of legislative revisions that would permit the sharing of some personal health information with social services agencies, community-based organizations and other similar third parties that provide health-related services for care coordination and case management.

Back in the Humana headquarters, that wooden ship still sits, a reminder that no person or team alone can achieve the sustainable changes needed to improve the health of a population.

Value-based care is not a fad, but rather the future of our healthcare system. The value-based health ecosystem is both built upon and relies on strong primary care and a roster of players, each playing a specific and equally essential role in the whole-person care of members and patients.

Much like the crew who rows the ship across the sea with ease.

Take the next step toward value-based care

Read our VBC report

See prevention, outcomes and utilization, costs and payments data for physicians in value-based agreements.

Connect with colleagues

Explore value-based care with a representative in your area and learn how to get started.

VBC resources

Access more value-based care research, professional training and patient resources.