business-critical

Results

Humana’s 2016 value-based care results

Humana compared quality metrics and prevention measures for calendar year 2016 for approximately 1.65 million Medicare Advantage members who were affiliated with providers in value-based reimbursement model agreements to 191,000 members who were affiliated with providers under standard Medicare Advantage settings1, which doesn’t offer added incentives to providers who meet quality or cost targets.

Humana also compared costs for calendar year 2016 for approximately 1.4 million Medicare Advantage members who were affiliated with providers in value-based reimbursement model agreements to original fee-for-service Medicare and also compared outcomes for those 1.4 million to 216,000 members who were affiliated with providers under standard Medicare Advantage settings.

Chronic Condition Management

Chronic conditions continue to adversely impact the Medicare and Medicare Advantage populations. Over six in 10 Medicare beneficiaries are living with more than one chronic condition, according to the Centers for Medicare & Medicaid Services.

In order to address the rising tide of chronic conditions and social determinants of health, Humana’s holistic approach to helping physicians, clinicians and other care professionals has centered on its integrated care delivery model. A key element of the integrated care delivery model is the primary care physician (PCP).

In a value-based reimbursement model agreement, Humana believes that it’s important for the PCP to have a centralized role to manage all aspects of the patient’s care, since the PCP is working to coordinate a number of specialists that care for a Medicare Advantage member’s multiple chronic conditions.

Improved Quality, Improved Health

Humana first disclosed Medicare Advantage value-based member results in 2013 and has done so each year since. The 2016 results, as with the previous results, cannot be directly compared due to multiple demographic changes in member population.

Humana’s core measurements, which follow the “triple aim” of population health, are as follows:

  • A Value-based Approach is Improving Quality Measures: Providers in value-based reimbursement model agreements with Humana had 26 percent higher Healthcare Effectiveness Data and Information Set (HEDIS®) scores compared to providers in standard Medicare Advantage settings based on an internal attribution method.
  • Humana Medicare Advantage Members are Benefiting from a Preventive, Holistic Approach in a Value-based Care Model: Humana Medicare Advantage members affiliated with providers in value-based reimbursement model agreements experienced 6 percent fewer hospital inpatient admissions and 7 percent fewer emergency department visits than members in standard Medicare Advantage settings.

    Patients treated by physicians in Humana Medicare Advantage (MA) value-based agreements had more preventive care screenings and better health outcomes compared to those in Humana MA fee-for-service agreements.

2016 VBC vs. FFS outcomes

Management and adherence

  • + 15% Eye exam
  • + 7% Blood sugar control
  • + 4% Adult BMI assessment
  • + 4% Rheumatoid arthritis
  • + 2% High blood pressure adherence
  • + 2% Statin adherence

Diabetes care

  • + 9% Eye exam
  • + 7% Blood sugar control
  • + 2% Diabetes renal disease controlled
  • + 2% Diabetes medication adherence

Care for older adults

  • + 8% Functional status assessment
  • + 8% Medication review
  • + 4% Pain screening

Cancer screenings

  • + 13% Colorectal screening
  • + 8% Breast cancer screening

Hospital care

  • 7% fewer Emergency department visits
  • 6% fewer Hospital inpatient admissions
  • Lower Costs Obtained Through Value-based Approach: Humana found that medical costs for Medicare Advantage members affiliated with providers in value-based reimbursement model agreements were 15 percent lower versus those affiliated with physicians under original fee-for-service Medicare. As previously stated, medical cost reductions such as these can benefit plan members through reduced out-of-pocket costs, lower member premiums, and/or additional benefits.

“Based on our experience, the value-based care model helps physicians spend more time with their patients, which builds stronger relationships between the physician and patient,” said Roy A. Beveridge, M.D., Humana’s Chief Medical Officer. “The result is a bond of trust, which serves as the foundation for changing unhealthy behaviors and addressing social determinants of health. As we’ve seen at Humana, supporting physicians with actionable data gives them a deeper understanding of their patient − and that can result in more preventive care, which leads to better chronic condition management.”

For more information, visit humana.com/valuebasedcare.