Humana’s 2015 value-based care results

Patients with Humana’s Medicare Advantage (MA) coverage treated by physicians in value-based care models experienced greater quality health care, more screenings and healthier outcomes than those treated in standard MA fee-for-service settings.

For 2015, Humana compared quality metrics and outcomes for approximately 1.2 million patients with Humana’s MA coverage who were affiliated with physicians in value-based care models to 170,000 patients who were affiliated with physicians under standard fee-for-service MA settings. Unlike value-based care models, standard MA fee-for-service models don’t offer additional compensation for physicians or other health care professionals who meet quality or cost targets. Our results speak volumes.

Physicians in Value-based Care Agreements Deliver Better Quality: Physicians in Humana value-based care relationships had 19 percent higher Healthcare Effectiveness Data and Information Set (HEDIS®) scores than those in standard MA settings. (Claim based on an internal attribution method.)

Patients on Average Continue to Experience Healthier Outcomes: Patients with Humana MA coverage served by physicians in value-based care agreements experienced 6 percent fewer emergency room visits than those in standard fee-for-service MA settings. Additionally, screening rates were higher for osteoporosis management in women (+13 percent), colorectal cancer screening (+8 percent) and breast cancer screening (+6 percent).

Humana also improved its management of older adults in vulnerable populations. Patients with special needs were assessed for pain and underwent medication reviews more often, by 5 and 10 percent, respectively, than those in original fee-for-service arrangements.

Humana Continues to Lower Costs through Value-based Care Agreements: By working differently with physicians on quality and health initiatives, Humana experienced a 20 percent drop in costs in 2015 for patients treated by physicians in a value-based care setting versus estimated costs for those treated by physicians under original fee-for-service Medicare arrangements. (Costs were estimated using CMS’ Limited Data Set Files.) Medical cost reductions such as these can reduce patients’ out-of-pocket costs, lower their premiums and help pay for additional benefits.

 Infographic: Humana's 2015 Value-Based Care Results