The country's second largest Medicare Advantage health plan provider reports that it has achieved better outcomes and lower costs through value-based reimbursement model agreements.
Humana's value-based Medicare Advantage (MA) program continues to produce better outcomes and lower costs with its reimbursement model when compared with standard fee-for-service healthcare, the company reports.
The proof is in the data: Physicians in the value-based MA program have racked up Healthcare Effectiveness Data and Information Set (HEDIS) scores 19% higher than average.
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The country's second largest Medicare Advantage health plan provider based on membership reports that patients treated by physicians in value-based agreements had better health outcomes compared to patients in standard MA settings, with
- 6% fewer emergency room visits
- 8% higher colorectal cancer screening rates
- 6% higher breast cancer screening rates
- 13% higher rates of osteoporosis management
Humana compared quality metrics and outcomes in 2015 for approximately 1.2 million MA members who were affiliated with providers in value-based reimbursement model agreements with metrics and outcomes from 170,000 members who were affiliated with providers under standard MA settings, which don't have additional incentives for providers who meet quality or cost targets. The results are consistent with the findings from the previous two years.
"Our integrated approach to partnering with providers enables us to improve the healthcare experience for consumers in multiple ways," Humana President and CEO Bruce D. Broussard said in a statement announcing the report.
"We're able to offer more affordable health plans, help people improve their health through comprehensive, holistic engagement with them, and also drive higher physician satisfaction."
Humana has 1.8 million individual Medicare Advantage members and 200,000 non-Medicare commercial members that are cared for by approximately 49,600 primary care physicians in more than 900 value-based relationships across 43 states and Puerto Rico.
As of September 30, 2016, approximately 63% of Humana individual MA members are seeing providers who are in value-based payment relationships with Humana. Humana's total MA membership is approximately 3.2 million members, which includes members affiliated with providers in value-based and standard MA settings.
Effect on Costs
Humana also continues to lower costs through value-based reimbursement model agreements, the report notes.
By working differently with providers on quality and health initiatives, Humana experienced 20% lower costs in total in 2015 for members who were affiliated with providers in a value-based reimbursement model setting versus an estimation of original fee-for-service Medicare costs using CMS Limited Data Set Files.
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Humana notes that cost reductions such as these can benefit plan members through reduced out-of-pocket costs, lower member premiums, and additional benefits.
Humana also achieved better management for older adults in vulnerable populations. For these members, assessment rates for pain screening and medication review were higher by 5% and 10%, respectively.
The value-based model holds Humana and providers jointly accountable for health outcomes. The report includes an endorsement from Griffin Myers, MD, of Chicago-based Oak Street Health, whose practice has recently transitioned to a value-based reimbursement model with Humana.
He says he has seen the opportunities firsthand about the impact of the model.
"In a value-based environment, Oak Street Health is held accountable on how we can quantifiably improve health outcomes," he says. "A value-based agreement drives our physicians to develop patient relationships where the goal is helping a patient reach his or her full health potential."
Gregory A. Freeman is a contributing writer for HealthLeaders.