Roy Beveridge, MD

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There’s not a lot of peer-reviewed research that proves paying physician practices for positive patient outcomes is better than paying for services only. Certainly, anecdotal evidence exists that shows patients are benefitting from practices getting into value-based care. But what can practices expect?

For 30 years, Humana has been entering into some form of value-based care arrangements through its Medicare plans, but it wasn’t until five years ago that we began releasing results on Medicare Advantage plans. For the past two years, this has taken the form of the “

,” which features physician practices and the progress they’re making.

Humana MA members totaled 3.3 million at the end of 2017 (the latest year of processed data). Among them, 91% had at least one medical condition (like congestive heart failure or depression), and 83% had at least two.

Highlights include some of what you might expect from a patient perspective: preventive screenings were up for patients affiliated with value-based care practices. For patients with diabetes, those increased condition-specific screenings led to better medication adherence and better management of their blood glucose levels. The same was true for people with hypertension and their ability to better manage their blood pressure.

Emergency department visits and admissions to the hospital were down for patients affiliated with value-based practices. Also, patients affiliated with value-based practices had a 20% higher average HEDIS Star score compared to those affiliated with fee-for-service practices.

But what’s most striking may be the answer to the question: what can primary care practices expect from value-based care?

Medical costs for patients attributed to PCP practices in Humana MA value-based care settings were nearly 16% lower vs. original fee-for-service Medicare.

In 2017, across all value-based models, 10% more practices experienced shared savings than in 2016 (70% vs. 60%).

Higher percent of the overall healthcare dollar compared to the national average. 

The American Academy of Family Physicians calculates PCPs, in general, receive about 6% of the total payments made to providers for a patient’s care

 PCPs practices in a Humana MA value-based care arrangement are receiving nearly 17%.

These results would not be possible without leaders forging the way in value-based care and showing us what’s possible. Below are just a few examples from the report.

Jeff Galles, DO, is chief medical officer at Utica Park Clinic, a 150 PCP practice in Oklahoma with 4,000+ Humana MA patients. Galles writes in the “Value-based Care Report” that, in 2017, the clinic increased the number of patients with two or more PCP visits per year to 80%, leading to a decrease in hospital readmission rates.

David Hatfield, DO, is CEO and lead physician at Hatfield Medical Group, a 15 PCP practice with nearly 1,000 Humana MA patients. Hatfield cites value-based care as the reason he is more fulfilled and happier as a physician today because of the time he spends with patients and, as a result, the ability to affect outcomes.

Larry Blosser, MD, is outpatient medical director for Central Ohio Primary Care, a 370+ PCP practice with more than 3,500 Humana MA patients. Blosser writes how quickly the group saw results in its transition to value-based care, going from a 3-star to a 4-star practice in a year. In 2017, each of the physicians caring for adults received a 20% shared savings bonus.

Value-based care is proving its worth to both physicians and patients alike through improved care, greater reimbursement levels, and lower cost-delivering on the promise of the right care at the right time at the right cost. I invite you to check out our full report 

 editorial advisor and Humana’s chief medical officer.

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A new report from Humana shows the benefits of value-based care for patients and providers.

Real-World Benefits of Value-Based Care

A change is occurring, and it’s not the type of change we typically talk about in the shifting healthcare landscape. It is a change requiring us, as healthcare leaders, to acquire new skills, talents, and capabilities as we lead new and expanded teams of people in the treatment of patients.

Physician leaders, in particular, are trained well to do many things. We perform highly technical skills and complicated procedures. We manage multiple needs at the same time. We take an unstructured human narrative, break it down into individual components, and develop an entire care plan-determining if and when others are needed. We are trained well for one-to-one interactions with our patients. This training has made us very good at a certain type of leadership-one that is based on hierarchy and a top-down approach.

Unfortunately, this team dynamic and leadership style is not effective in a value-based reimbursement model, where better health outcomes for chronically-ill patients is the measure of success.

As physicians, we intellectually understand a team-based approach is needed. We recognize the need for an array of skills and capabilities like cardiology, physical therapy, behavioral health, social work, nutrition, etc., but we have not successfully incorporated these skills and capabilities into a better process to care for populations of people. We have generally not integrated social determinants of health or social workers, or recognized the true need of behavioral health as part of physical health.

Over the past decades, we’ve expanded whom we work with, but we haven’t fundamentally changed how the team functions to best support the care of the chronically ill. For people to work together differently, we need a different style of leadership.

Research from the NHS Institute for Innovation and Improvement shows that clinicians want to be led by clinicians. If physicians want to lead in the value-based world, we need to get a team working together to achieve something that’s superior to what we would have achieved on our own. How do we do that?

Encourage collaboration. We must do more than identify contributors. We need to get better at bringing people together to work not just alongside each other, but with each other. This is a table stake. Care for a population requires the cross-pollination of multiple people with intersecting expertise.

Increase transparency. In the joint decision-making process, we must be willing to have difficult conversations with our peers and influential people within our organizations, realizing they may not be happy with us.

Practice humility. Assume other providers know more than we do on a large number of topics.

Be curious. Recognize the team has expertise; ask good questions and listen to what they are telling us.

Provide inspiration and motivation. How our team feels matters. They need to feel heard and that they have a purpose. Help them see the bigger picture and connect to meaning in their work.

Ultimately, the goals of healthcare are still the same. Our job is to improve health outcomes and help people achieve their best health. To do that, we must work together in new ways and, as leaders, we must change the way we lead.

 editorial advisor and Humana’s chief medical officer. Meredith Williams, MD, MBA, is lead medical director

Value-based reimbursement models require different leadership to align the practice and move it forward around a team-based model of care.

Author | Roy Beveridge, MD

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