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Humana's Medicare Advantage Value-Based Care Success

A Closer Look at How Value-Based Care is Transforming Medicare Advantage Plans

November 28, 2023  – In a healthcare landscape that constantly evolves, Humana’s Medicare Advantage beneficiaries are experiencing improved health outcomes through value-based payment arrangements. Not only enhancing patient care, but these plans also achieved an impressive $8 billion in savings in 2022 states a report from the payer.

Kate Goodrich, MD, Humana’s Chief Medical Officer, highlights the effectiveness of this care model. ” “The data are clear: Value-based care works. As our report shows, this smarter healthcare 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.”

The Results: Medicare Advantage Plans Showing Improvement 

So how is Medicare Advantage helping beneficiaries and the healthcare industry in general? There are numerous benefits, including: 

1) More Preventative Care and Screenings: In 2022, a substantial 70% of Humana’s individual Medicare Advantage plan members were under the care of a value-based care provider. This led to a noticeable rise in preventive screenings, outpacing those not in such arrangements by 3 to 11%. In addition, for screenings requiring cross-provider coordination, the figures were even more impressive, showing an 8 to 11% increase.

These beneficiaries were not only more consistent in their medication adherence for conditions like diabetes and hypertension but also reported a more satisfactory healthcare experience. This is reflected in their Consumer Assessment of Healthcare Providers and Systems (CAHPS) score of 3.9, outshining the 3.3 score for non-value-based care providers.

A notable difference in patient behavior was observed in primary care visits, with 85% of value-based care beneficiaries seeing their primary care physicians, compared to 75% of those in non-value-based arrangements.

2) Significant Reductions in Hospitalizations and ER Visits: When compared to traditional Medicare, beneficiaries under value-based care plans witnessed a 30.1% reduction in inpatient admissions, equating to 214,000 fewer admissions in 2022. These plans also saw a 12.7% decrease in emergency room visits, translating to 146,000 fewer visits.

3) Curbing Unnecessary Medical Procedures: In terms of unnecessary medical interventions, value-based care beneficiaries under Medicare Advantage fared better than their traditional Medicare counterparts, with significant reductions in surgeries, diagnostic tests, imaging, pre-operative testing, and cardiovascular procedures.

4) The Financial Aspect: The cost-effectiveness of Humana’s value-based care is hard to overlook. With a 23.2% cost-saving compared to traditional Medicare, this translates into $8 billion in savings. These funds are reinvested into member benefits such as reduced premiums and additional services like home care and prescription delivery.

About half of the providers in Humana’s value-based care plans earned shared savings payments in 2022, showcasing the financial viability of this model. These providers receive a more significant share of healthcare dollars, earning 3.4 times the Medicare physician fee schedule, with advanced risk stages earning even more.

Proving Value-Based Care’s Impact on Medicaid

The report also sheds light on Humana’s Medicaid plans in Florida, where value-based care arrangements showed better compliance with HEDIS performance measures, indicative of enhanced health outcomes. These plans, with high value-based care penetration, recorded lower disparity scores, signaling greater health equity.

Humana’s pioneering steps in value-based care for Medicare Advantage beneficiaries underline the potential benefits for the broader healthcare community, including Medicaid populations. This approach not only elevates health outcomes but also ensures healthcare delivery is cost-effective and equitable.

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