Humana’s MA accountable care models save money and improve health outcomes

December 15, 2014

Medicare Advantage (MA) members in Humana’s accountable care programs in 2013 had 7% fewer emergency room visits and 4% fewer inpatient hospital admissions than members in traditional, fee-for-service settings.

Medicare Advantage (MA) members in Humana’s accountable care programs in 2013 had 7% fewer emergency room visits and 4% fewer inpatient hospital admissions than members in traditional, fee-for-service settings.

In addition, Humana experienced a 19% cost improvement, and providers earned an average 4.25 Healthcare Effectiveness Data and Information Set (HEDIS) Star score average compared to providers outside of accountable care settings, who earned an average 3.65 score. HEDIS is used by more than 90% of America's health plans to measure performance on defined dimensions of care and service.

The results show that accountable care is having a “measurable impact” on the quality of care experienced by Humana’s MA members, according to the company.

“Humana’s accountable care approach is effective in obtaining results that help patients manage their health, which leads to improved outcomes for patients and is reflective of our intent to serve as a health partner to our members,” said Bruce Broussard, Humana’s President and Chief Executive Officer. “Humana is committed to improving the overall health of our members, and we are pleased to see that our Continuum of programs is working to encourage and support primary care physicians to become successful population health managers.”

“With 75% of our health care dollars in the United States going to treatment of chronic conditions1, helping patients effectively manage these conditions is critical,” said Roy Beveridge, MD, Humana’s Chief Medical Officer. “With an accountable, value-based model, our results show that doctors are successfully improving quality, managing population health and keeping patients healthier and out of the hospital.”

MA members also experienced improved clinical management and increased screening compliance, including a:

  • 16% increase in osteoporosis management in women with a fracture;

  • 7% increase in colorectal cancer screening;

  • 5% increase in adult BMI assessments.

Humana’s investment in accountable care is part of a shift away from fee for service and towards value-based care, says Beveridge. “So many people look at quality as (something) that you have to spend more money for,” he notes. But a value-based, accountable care model often lowers costs because it’s focused on keeping people healthy. Better health benefits the patient and Humana, says Beveridge. “That’s what the value is really about…It’s a beautiful synergy.”

Humana is the nation’s number two MA insurer. It currently has more than 900 MA accountable care relationships with providers in 43 states and Puerto Rico, according to the company.