Value-based models work: Humana report


Humana’s Medicare Advantage members show better quality, healthier outcomes and lower costs through value-based models.

The continued impact of the value-based reimbursement model shows better quality and healthier outcomes, with lower costs, for people with Medicare Advantage, according to Humana’s recently released 2014 population health results.

For the 2014 results, Humana compared quality and outcomes for approximately 1 million Medicare Advantage members who were treated by providers in value-based reimbursement model agreements with Humana versus members who were treated by providers in standard Medicare Advantage settings.

Beveridge“We found that when we worked with our providers, members had a 21% improvement in HEDIS [Healthcare Effectiveness Data and Information Set] and CMS [Center for Medicare and Medicaid Services] Star scores as compared to providers in standard Medicare Advantage settings,” says Roy A. Beveridge, MD, Humana’s chief medical officer, and MHE editorial advisory board member.

The positive impact of the value-based model in Medicare Advantage also reflects Humana’s support of the goal of the Department of Health and Human Services of tying 50% of traditional, or fee-for-service, Medicare payments to quality or value by 2018.

“This [report] is in direct correlation to what [CMS] is saying,” Beveridge says. “It’s remarkable that we are going through this change so quickly. The proof is in the pudding-if you manage a population, you get good results.”

Humana members also experienced 7% overall fewer inpatient admissions per thousand, in addition to 18% lower costs in total for this same member population treated by providers in value-based reimbursement models setting versus original fee-for-service Medicare.

“If you do more cancer screenings, more osteoporosis screenings, and diagnose patients with diabetes earlier, the cost for the population as a whole is reduced,” Beveridge says.

Currently, approximately 59% of Humana’s individual Medicare Advantage members have access to primary care physicians who are participating in value-based relationships. Humana’s goal is to continue growing its programs so that 75% of individual Medicare Advantage members are attributed to primary care physicians who are participating in value-based relationships by the end of 2017. Transitioning providers to value-based relationships is also a key part of Humana's 2020 goal, which is to improve the health of the communities it serves 20% by 2020.

“Our provider partners have access to all of the relevant data,” Beveridge says. “Data analytics can help the physician determine where the patient is-that Mrs. Smith hasn’t had her mammogram or filled her prescription for her diabetes medication.”

Beveridge offers these important tips when it comes to a value-based model:

  • Leverage claims data from health plans. This can provide a more complete view into patient populations.

  • Primary care centricity is important. If you don’t have it, it will be difficult.

  • Implement a member-friendly process. “If a patient needs to get to a specialist, get them in to see a specialist within 10 days,” Beveridge says. “If you don’t they will end up in the emergency department. Treat members well.”
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