Prevention and adherence are the cornerstones of value-based care

The increasing shift of providers from fee-for-service to value-based payment models continues to evolve the healthcare landscape in the United States, leading to improved health outcomes for many patients.

Embracing value-based care enables holistic and integrated care, championed by primary care physicians. This allows PCPs to engage more frequently and more deeply with patients, resulting in fewer visits to emergency rooms, less time spent in hospitals and lower out-of-pocket costs.

Much of that success stems from access to care and consistent interactions, according to physicians. 86% of Humana MA individual members affiliated with value-based physicians visited their PCP at least once in 2021 compared to 77% of members affiliated with a non-value-based physician. Of those visits, value-based members saw their PCP an average of 4.3 times during the year, while non-value-based members saw theirs 4.0 times.

Value-based affiliated members also spent less time in the hospital, with 251,000 fewer days collectively in 2021 than their non-value-based counterparts.

Measured against physicians in Humana non-value-based arrangements, those in Humana MA value-based agreements saw their patients admitted to a hospital 6% less (36,000 fewer admissions) and visit an emergency room 9% less (90,000 fewer visits).

On a national scale, Humana value-based MA members were admitted to hospitals 25% less (159,000 fewer admissions) and visited emergency rooms 1% less often (15,000 fewer visits) compared to patients in Original Medicare (OM).

Fewer hospitalizations and emergency room visits generally represent a success point in value-based models. Physicians see less patients per day which allows them to have the time to talk to and fully understand their patients. When there is an established, trusting provider-patient relationship, patients are healthier and don’t require as much acute or in-patient care.

“Value-based care allows physicians to focus their time and energy on their patients, which subsequently results in improved quality and patient satisfaction,” said Dr. Seth Dubry, Arizona market medical director of Equality Health. “Practitioners genuinely appreciate the ability to spend extra time with their patients, knowing their success is not predicated on how many patients they can see in a day.”

Value-based care still faces an arduous road ahead to truly create sustainable change in the healthcare system that allows for an all-value model in the future, according to experts.

Prevention and adherence are the cornerstones of value-based care and must continue to remain prioritized. The data shows that with continual emphasis on preventive care and adherence to treatment, patients’ health outcomes are more positive.

“We must continue to build upon what we’ve learned and the innovations that have been developed over the years by finding new ways to expand care capabilities, especially in populations where we see the greatest barriers to care,” Dubry says.

“The practice of medicine no longer only happens in the clinic. To achieve positive health outcomes, healthcare must continue to expand to all corners of a patient’s life—both in their home and community. When physicians are supported, have more resources, and are more in control of their care practices, patients are able to reap the rewards with higher engagement and better health.”