Humana Report Shows Benefits of Value-Based Care for Patients, Physicians

Patients covered by Medicare Advantage (MA) who received care under value-based arrangements were more likely to receive preventive care, were hospitalized less frequently, and spent more time with their primary care physicians compared with patients receiving care in traditional fee-for-service models, according to a report released by Humana.¹ The 10th annual Value-Based Care Report also found that physicians were better able to prioritize outcomes vs quantity of services.

In value-based care (VBC) arrangements, clinicians are reimbursed based on care quality measures aimed at improving patient outcomes such as rates of hospitalization, in contrast with traditional fee-for-service reimbursement models that reimburse physicians based on the quantity of individual services provided. VBC places a focus on holistic health and preventing escalations such as emergency room visits or hospital admission.

According to the new report, the last decade has seen VBC grow by 2.3 million covered patients, and 70% of patients covered by MA aligned with value-based providers in 2022.

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In 2022, 85% of patients in value-based arrangements saw their primary care provider (PCP) at least once, whereas 75% of those not in VBC arrangements saw their PCP at least once. Regarding preventive care, value-based arrangements saw a 14.6% higher rate of completed preventive screenings compared with MA members who were not in value-based arrangements. Patients treated in VBC arrangements also saw 30.1% fewer in-patient admissions compared with Original Medicare beneficiaries.

"The data are clear: Value-based care works," Kate Goodrich, MD, PhD, MHS, chief medical officer at Humana, said in a statement. "As our report shows, this smarter health care model improves outcomes for Medicare Advantage members and allows primary care physicians to practice medicine at the top of their license and develop meaningful relationships with patients. At Humana, we are proud to lead the way on value-based care for our Medicare Advantage members, and we will continue to look for ways to expand this approach into other lines of business."

Based on the findings, VBC facilitates a more team-based approach to whole-patient care, with PCPs empowered by multidisciplinary teams to ensure patients receive high-quality, holistic care. A team-based approach to care transitions, such as follow-up post hospital discharge, helps minimize the risk of hospital readmission, according to the report. Overall, there was lower use of acute care or avoidable procedures among patients receiving care in VBC arrangements.

The report also noted cost-savings with VBC, which can be reinvested into member benefits. Another aim in VBC is to help provide resources to manage health-related social needs, such as provision of transportation or community support.

“Health care organizations are working together more and more, and now we’re starting to see aligned payment model benefits in Medicaid,” George Renaudin, president of Medicare and Medicaid at Humana, said. “We are at the dawn of the next era in value-based care. As we think about how to continue improving health outcomes for our members, we will determine ways to apply our successful care models beyond primary care and Medicare Advantage.”

References

1. Value-based care report. Humana. Accessed December 6, 2023. https://www.humana.com/provider/news/value-based-care/value-based-care-report

2. Value-based care benefits patients and physicians, new report shows. Press release. Humana. November 15, 2023. Accessed December 6, 2023. https://press.humana.com/news/news-details/2023/Value-Based-Care-Benefits-Patients-and-Physicians-New-Report-Shows/default.aspx#gsc.tab=0