Physician-Payer Collaboration Matters in Value-based Care

To get the most from value-based care, payers and physicians must align their objectives to make the transformation easier. Success in this new paradigm rests with us all, and payers need to get behind physicians and help them make this shift.

In the beginning of the transition to value-based care, Humana, like many payers, emphasized the process versus the outcome. This inadvertently resulted in more paperwork for physician practices and less information about how better tracking and preventive screenings can improve patient health and satisfaction, and reduce costs for everyone. Now, we understand that we need to focus on taking a more integrated approach, expanding clinical services, and simplifying the experience for our physicians and their patients.

More specifically, we are working to improve the transition to value-based care in three ways:

  • Aligning around quality metrics.
  • Assessing and maximizing all our capabilities.
  • Co-creating a plan for the transition to value-based care.

For now, I’d like to discuss the second objective, but look for more to come on quality metrics and co-creating a plan in the October edition of Humana’s Your Practice.

Working together to assess and maximize your capabilities and ours means we meet you where you are on the value-based care journey. For example, we know independent research supports the premise that certain specialists consistently have improved clinical outcomes, higher quality of care and lower costs.1,2,3 In response, we developed and can share specialist referral information based on efficiency and effectiveness4 through our Care Decision Insights tool. You may find this information helpful as you make care decisions for your patients.

Another capability is our web-enabled reporting platform, Carebook, which aids physicians in value-based care relationships to run a wide range of clinical and financial reports. Additionally, our market provider engagement team can work hand-in-hand with you and your clinical staff to review patient panel and population health information, work together to improve patient outcomes and build relationships for successful value-based contracting.

Our peer-reviewed research on medication adherence, tells us that many factors may contribute to low adherence rates, including things like food insecurity and the lack of synchronization of medication refills. Our Humana Pharmacy Solutions program is designed to support you and your patients by improving medication safety and adherence, and by reducing medication-related complications.

Our capabilities are available to you to make it easier to improve the health of your patients. See all of Humana’s capabilities.

Please take a moment to learn about how Humana can help you in your value-based care transition.

Roy Beveridge, M.D. Senior Vice President and Chief Medical Officer

1“The Productivity of Physician Specialization; Evidence from the Medicare Program,” Baicker and Chandra.
2“Medicare Payments to Providers in 2012,” Centers for Medicare & Medicaid Services.
3Humana proprietary internal analysis, 2014.
4When developed and available for Care Decision Insights.