Logo Courtesy of Humana

Humana Improves Health and Reduces $3.5 Billion in Health Care Costs through Medicare Advantage Value-Based Care Programs

Originally Published by Humana

Helping people living with multiple chronic conditions achieve their optimal whole-person health has been a strategic initiative for Humana Inc. (NYSE: HUM). Today, Humana announced that the company has lowered overall health care costs and helped deliver improved health outcomes for Humana’s Medicare Advantage beneficiaries affiliated with primary care physicians in value-based payment models, which represents 67% of Humana’s total individual MA plan beneficiaries in 2018.

The physician-authored annual Humana Value-based Care Report, which can be accessed by clicking here, details how Humana uses its holistic approach to help beneficiaries facing numerous medical and social health challenges. For example, 82.6% of Humana Medicare Advantage members have at least two chronic conditions.

The report examines how Humana is supporting those Medicare Advantage members impacted by social determinants of health, such as food insecurity and social isolation. The report also explores how physicians are engaging and supporting patients in promoting healthier behaviors such as medication adherence and meeting specified clinical goals.

This is the third year that the company has issued the annual report and the sixth for reporting on health, quality and costs results for its Medicare Advantage beneficiaries affiliated with physicians in value-based payment models.

“What excites us most about these results is what they say about how we’re helping seniors improve their health, while also helping them better afford the care they receive,” said Humana President and CEO Bruce Broussard. “Our members count on us every day to improve their overall health care experience, and we are doing that. At the same time, as these results demonstrate, we’re getting better at supporting doctors, nurses and other care providers in their work to help people live healthier lives. In 2020 and beyond, we will keep at this.”

The potential of the value-based payment model was cited in a Humana study that appeared in October in the Journal of the American Medical Association, which stated that value-based care could meaningfully reduce the $265.6 billion wasted annually that is attributed to administrative complexity, and facilitate the expansion of numerous integrated clinical models proven to improve care.

Improved health, lower costs and better quality

In the report, Humana detailed how its value-based payment model has led to lower costs, better health and improved quality for its Medicare Advantage members served by physicians in value-based agreements with the company. Listed below is a snapshot of the report’s key findings:

  • Medicare Advantage members have reduced cost of care. Humana Medicare Advantage members under the care of physicians in value-based agreements would have incurred an additional $3.5 billion in plan-covered medical expenses had they been under Original Medicare’s fee-for-service model. Prevention screenings, improved medication adherence and effective management of patient treatment plans all contributed to creating these reductions. These medical cost reductions can benefit plan members through reduced out-of-pocket costs — and, in future years, lower member premiums — and/or additional benefits.
  • Medicare Advantage members are visiting the hospital less. Humana Medicare Advantage members served by physicians/practices in value-based agreements had a 27 percent lower rate of hospital admission (131,200 fewer admissions) and visited emergency rooms 14.6 percent less often (110,700 fewer visits) compared with Original Medicare.
  • Physicians in Medicare Advantage value-based agreements are delivering better quality care. Physicians in value-based agreements with Humana from 2016 through 2018 had a 4.44 average Healthcare Effectiveness Data and Information Set (HEDIS) Star score at the end of 2018 based on 1.13 million Humana MA members compared to a 3.10 HEDIS Star score for physicians serving 454,000 members in non-value based agreements. HEDIS is a measurement tool developed by the National Committee for Quality Assurance (NCQA) to assess health plans’ performance on various dimensions of care and service.
  • Physicians provided more care that is preventive to Medicare Advantage members. Humana Medicare Advantage members affiliated with physicians in value-based agreements received screenings as much as 21% more often in categories such as colorectal cancer, osteoporosis and blood sugar control than those in an MA non-value-based setting.

“The Medicare Advantage plan serves as a rich laboratory for value-based care, as it allows for integrated and coordinated management of chronic conditions, and a holistic view of the patient,” said William Shrank, MD, MPHS, Humana’s Chief Medical and Corporate Affairs Officer. “Moving the industry forward with a focus on value is not something we can do alone. Our dialogue with physicians, community organizations and other health care providers is essential to developing a sustainable system that improves population health and reduces costs for everyone.”

Humana’s Report Methodology

The 2018 results, as with the previous results, cannot be directly compared year over year due to multiple demographic changes in Humana’s member population.

Humana compared quality metrics and prevention measures for calendar year 2018 for approximately 1.85 million Medicare Advantage members who were affiliated with providers in value-based reimbursement model agreements to approximately 848,000 members who were affiliated with providers under standard Medicare Advantage settings.

Humana also compared medical cost and utilization for calendar year 2018 for approximately 1.63 million Medicare Advantage members who were affiliated with providers in value-based reimbursement models to approximately 855,000 members who were affiliated with providers under standard Medicare Advantage settings as well as to Original fee-for-service Medicare.

Original Medicare costs, admission and emergency room estimates were derived using CMS Limited Data Set Files from 2017 and are subject to restatement with the availability of more current CMS data. As of Sept. 30, 2019, Humana’s total Medicare Advantage (individual and group) membership is more than 4.07 million members. For more information, visit humana.com/valuebasedcare.

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