Looking Back, Thinking Ahead

Dear Physicians and Health Care Providers:

As I talked with physicians at the American Academy of Family Physicians’ annual conference in Denver, one of the topics that came up time and again was the future of our health care system.

What will it look like 10 years from now? How will these newly formed partnerships between payers and physicians play out? And what will it mean for patients?

As a physician who practiced oncology for more than 20 years, I have seen for myself that the fee-for-service model — although still in wide use today — doesn’t support the holistic, customized approach physicians must take to help their patients achieve health in today’s consumer-driven world. Nor does it reward physicians for the value they bring to a patient’s life.

For the past couple of years, we’ve been comparing quality, outcomes and costs for one million people with our Medicare Advantage plans who are treated by physicians in outcomes-based reimbursement arrangements versus those treated by physicians in traditional, fee-for-service arrangements. We’re seeing consistent improvement in chronic condition management, reductions in ER visits and cost savings for patients treated by physicians in outcomes-based reimbursement arrangements.

  • On average, patients have better osteoporosis management and more functional assessments, medication reviews and pain screenings.
  • For people with diabetes, eye exams are up and blood sugar is better controlled.
  • In 2014, people treated by physicians in value-based reimbursement arrangements had 5.8 percent fewer ER visits per thousand than those in fee-for-service settings.

Given these results, physicians in outcomes-based arrangements received the following:

  • Higher HEDIS Star scores – 21 percent higher than their counterparts in fee-for-service.
  • More money – Last year, Humana paid $77.3 million to physicians who achieved quality outcomes. It was the most Humana has ever paid physicians in outcome-based relationships, and we’d like to do more.

With 10,000 people turning 65 every day, many of whom have multiple chronic conditions, the time has come to hasten this needed evolution.

Recently our Chief Executive Officer Bruce Broussard posted a commentary about how partnerships are key to transforming health care. He said: “Let’s be clear: A transaction is a negotiation. A relationship is a partnership. It’s about building stronger partnerships between health plans, providers and others that put the individual’s health as the summit we look to reach.”

Here’s to stronger partnerships with you in 2016 so you can practice medicine the way you want and know is best.


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