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Value-based Care Report: Prevention

Value-based care drives preventive care

Amid an ever-changing healthcare system, an agile care model allows value-based practices to focus on efforts to better connect with their patients.

The data shows the impact

Value-based physicians outperformed those in non-value-based in all Healthcare Effectiveness Data and Information Set (HEDIS®) preventive screenings and adherence measures for Humana MA members in 2021.

See the results

More screenings

Screenings were generally between 6% and 19% higher for the value-based cohort.

Higher Stars ratings

A full-Star difference in the HEDIS average Stars rating: 4.2 Stars for value-based and 3.1 Stars for non-value-based.

Better patient engagement

47% of individual value-based Humana MA members received an AWV in 2021, compared to just 33% of non-value-based members.

So our report is divided into a number of sections that are focused on different areas of improvement and measurement that are really important for value based care. So I wanted to start by focusing on prevention and quality metrics. Our report shows that overall, our physicians and other clinicians that are part of value-based care arrangements and the members that are assigned to those physicians actually overall do better on a variety of different types of quality metrics, including screenings are very important stars ratings for screenings.

Overall adherence to screening is just higher among value-based practices. Close to nine value-based practices. And I'd like for each of you briefly to maybe speak to how, you know, you and your organization are focusing on prevention with your patients, how you're ensuring that your patients get the care that they need and how they stay engaged in their overall well-being.

So maybe, Dr. Suresh, could we start with you?

Absolutely. Preventive care. We really are heavily focused on preventive care throughout the year, especially in the beginning of the year. Right. So we focus on education and support. So by my education, I mean teaching our physicians how to organize their practices to accommodate preventive care visits and providing the support, by the way, of the embedded care nurses. So the organization has embedded nurses in each of the Primary Care Physicians office, and they provide a strong support to our primary care physician.

They make outreaches to members every day, every month, and they ensure that these members have real open access to their primary care physicians and discuss with them members the importance of having a preventive care visit and also highlighting the advantages in terms of incentives to. So some of our patients may not be motivated by just going in and seeing their PCP, but may be motivated by, hey, there is a small incentive.

If you do get your annual wellness exam completed, he'll be the focus of our value based care nurses who are embedded in the offices is to make outreaches to all the members and they focus strategically on the most frail members. So in order to provide that, we have the population health platform that identifies these patients with the highest frailty score so that the most complex members, the most poorly chronic conditions are on the top of their list.

So they reach out to these patients and their families and ensure that they have open access or are being able to scheduled for an office visit for an annual wellness visit with their primary care physicians. And this this is a this is a process that happens daily. So that each nurse works with a focused attention for that office.

And, for example, if a BCT has 100 members, they work on getting at least all of those members situated and the focus in the first quarter and there's different strategy for each quarters and each month in the first quarter, they focus on new members because of just patients having signed up with AP, we focus on new members, especially with those with multiple chronic conditions, and make sure these patients have the annual illnesses have completed and the annual wellness visit.

Our physicians do a great job in identifying or using the annual wellness visit, not only to complete an annual wellness preventative visit, but also to establish a frequency of follow up future visits. So that really helps them in two ways for the physicians. I know this patient is complex and I know how often I need to see this patient in order to get these patients appropriately situated.

Number two, they also identify patients who need that support, additional support in terms of care management, program support, social determinants of health and all of their options that are provided by the different payers. Right. So the primary care physicians focus on annual wellness on two things, preventative things and future visits and enrollment and case management program. So the support that they get from the MSO is seen as a huge benefit by our physicians and we also see that this actually impacts on patient satisfaction.

So the more the patients are seen by the physicians practices, the better it is that they are satisfied with their with their doctors. So that's one of the ways and I think I want to I you've probably will hear me repetitively on this presentation support and education know how we support them in terms of data, in terms of personnel, in terms of meetings, and then how we educate the doctors, not only the leadership, but also how the leadership shares their information and best practices through peer support and peer, the sharing of best practices and challenges.

So that's a constant, constant theme. You know, organization and I think we accomplish and we have goals. We have goals of at least seeing 85% of our members within the first six months. That is our goal that we have our physicians who have always focused on that and they try to accomplish those goals.

It's Dr. Bhansali.

So when it comes to she just specifically those quality metrics, this is something that as doctors the rest that we start focusing on day one, we have our own care management team. And so the patient population that we serve in general is a reasonably well insured population. So there aren't any specific incentives for them to get their follow up care, get their mammograms.

Colonoscopy is Category one system. But that being said, our patients are reasonably well engaged in their care. And so it is a proactive approach where we get patients in for annual wellness visits, we try to close as many quality gaps as we can in that visit and then ensure that they have appropriate follow up. And then as the year goes on, we have again similar to Doctor Fresh, figuring out which quality gaps are still open, engaging very heavily with our payers and having a proactive outreach either directly.

We have a text campaign that happens. And then the other big part is that we have physician compensation and incentive structures in place to ensure that everyone is on the same patient engaged in delivering this outcome. And candidly, this year it's been a little bit more challenging because of the change of the heat quality metrics. So patient experience and med adherence both being triple weighted.

It is and how you do on those specific quality metrics is hard to figure that out until the latter part of the year. So we are we have done exceptionally well in previous years and we expect to do that this year again. But the strategies for doing that are meaningfully different because it's a very heavy lift towards the end of the year when we really figure out what's going on with medication adherence because earlier part of the year that's just not as evident.

And so for organizations who are trying to perform well in at least in the meditators part, there probably needs to be a right sizing of staffs that happens towards the end of Q3 to ensure some of those quality metrics are met and those gaps are closed. But as we think about quality, I think Peterson starts to see reasonable measure for quality.

But there's so many other measures that are much more directly tied to patients and I was privileged enough to take some classes with Dr. Michael Porter, who helped me frame how value based care should be thought about. And he introduced me to an organization called the International Consortium of Health Outcomes Management and really focused on what are the outcomes that really matter to patients.

It's not getting a mammogram. It's to prevent a breast cancer. Right. And so as I frame quality for our organization, in addition to heaters starts, it's really how are we going to get patients to a better place of living life, whether it is aligning their goals with care? That is a key quality metric that we're going to measure next year.

But we've implemented the process of that. This year where in our AHA now there's an easy way to click and have that course of care conversation or specific utilization metrics that we know zero is not the right number. We also know that where we are is we can do better. So specific things like emergency room utilization and inpatient utilization, stent utilization.

Again, we know that lower doesn't necessarily mean better, but there are benchmarks out there such as measurement that we use to help gauge how those outcomes are going to align with patients, getting the right care in the right place and essentially staying healthy. So our quality and outside of heaters and stars is very heavily focused on how do we keep our patients happy, healthy and out of the hospital.

Prevention insights from our roundtable of physicians

Humana physicians discuss how prevention drives their value-based strategy.

Building on telemedicine

Telemedicine usage decreased last year, but positive effects from its expansion are still seen. The technology, infrastructure and practices can provide greater access to care while removing any barriers that prevent physicians from providing excellent care.

Wellness rewards as incentives

Providers and payers are finding new and innovative ways to encourage patients to play an active role in their health. Read about a record year for wellness in value-based care.

Solving transportation needs

Lack of transportation is the leading cause of patient no-shows. Learn how some healthcare practices are addressing care gaps due to by transportation issues facing Humana’s Medicare Advantage members.

CareMax is a primary care physician group. One of those issues that we found very early on was that seniors had a difficult time getting to their doctor appointments and getting to their clinics by providing transportation. We make it easy for them to get health care services in our medical centers.

This is a very good advantage for the people when they are in an age, that it isn't possible to drive. So I think the transportation, it's doing a very good job.

Our senior population is the largest segment of our population. We wanted to bring care out into the community so that our patients and residents here can get the early detection and screenings that they need. So we go all around our community here in Tammany Parish, and we are a senior friendly community. So it's a huge asset for that population.

Our algorithm has made it that we can in an equitable fashion, provide transportation to all patients in all our geographies.

They're just appreciative that we bring this to them. So we're reducing that barrier, making it a little bit easier to comply with the recommendations of having these screenings every year.

She was asking me if I would like to do that or go somewhere, and I travel rather, you know, for the bus to come here and I'll come here to maybe it's more convenient.

You know.

The range of uses for our transportation is varied, but the purpose of it is to facilitate that care. Max can create a relationship with its patients. We have all kinds of patients who use transportation. Some patients use transportation just to come to our wellness or activity centers. Our patients come and use transportation, obviously, for their clinical visits, whether it's a cardiologist or other specialty visit or their primary care visit.

I think by bringing the service to folks where they're already planning to be, it's a huge asset. It makes it so convenient. It can be difficult for patients to get from point A to point B. So bringing this service to them is huge and it can mean the difference between having your screening completed and maybe passing on it.

Like bladder cancer. So we'll make sure that stays under control and you know, I have COPD so that, you know, I like to keep controlled.

We tell you when I start here, when I study here, I have four seniors per hour in my knee. So our thanks to the therapist aerobic exercise and soon the class. So now today, I can say that I'm another person.

So primarily, we provide screening mammogram. That's our major focus point. But we also have a full clinical exam room where we can provide other screenings, other health services. We can do ultrasounds, we can do. We've done vaccination clinics on the bus. So during COVID and the peaks that we experienced during COVID, we had had vaccine clinics set up, all of us, to alleviate some of the pressure in our in-person clinics.

We've got over 50 vans within the medical centers. Those vans need to be staffed by more than one driver per van.

We launched our first mammogram on the bus was in August of 2021, and we've had five cancers diagnosed since then. So it's you know, it's just been a tremendous success story for our community.

Our purpose, which is providing seniors across the country with an avenue to get the best and highest quality health care available.

I think we are blessed because of no stress, no depression, no pain, everything. So that made it they feel a spiritually, spiritually and physically good.

Take the next step toward value-based care

Download our VBC report

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

Download a copy of our report, PDF

Connect with colleagues

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

Insights from outcomes and utilization

Keep reading to learn more about how value-based care improves outcomes-utilization.