The Value of Value-based Care

This is Humana’s ninth year of releasing its annual value-based care results. This year’s report spotlights the progress value-based care physicians make in achieving better outcomes for their patients. The report found that 68% of Humana individual Medicare Advantage (MA) beneficiaries, or slightly over 3 million members, who received care from primary care physicians in value-based payment models experienced, on average, better health outcomes, lower costs and more preventive care, compared to those in non-value-based settings and to Original Medicare.

Value-based care is team-based interdisciplinary care, quarterbacked by primary care physicians, that breaks down clinical silos. In Humana’s work on value-based care initiatives, we have deployed a continuum that is designed to meet and support primary care physicians where they are and equips physicians with tools, data and resources to assist in developing a more holistic approach to care.

The report, comprised of data collected during 2021, reflects the outcomes and experiences of 74,100 primary care physicians with value-based relationships with Humana. Those affiliations included more than 1,100 agreements in 44 states and Puerto Rico.

This year’s report details four key areas—prevention, outcomes and utilization, patient-physician experience and costs and payments:

Promoting more preventive screenings:

• All preventive screenings and adherence measures were better among value-based physicians as compared to those in non-value-based agreements.
• Preventive screenings for colorectal cancer and breast cancer, post-discharge medication reconciliations, osteoporosis management and diabetic eye exams were between 6% and 10% higher for members whose physicians were in value-based agreements vs. non-value-based physicians.

Enabling better health outcomes for patients:

• MA members seeking care from value-based physicians compared to those seeking care with non-value-based physicians collectively spent 251,000 fewer days as hospital inpatients.
• MA members who see value-based physicians compared to members who see non-value-based physicians had 9%, or 90,000 fewer emergency room visits. MA members who see value-based physicians had 1%, or 15,000 fewer ER visits than Original Medicare members.

Helping create a better patient and physician experience:

• Practices in value-based arrangements focus much of their efforts not just on how their patients feel physically, but also on how they feel about all that encompasses a visit to their primary care physician.
• A 2021 internal Humana survey similar to the Consumer Assessment of Healthcare Providers and Systems (CAHPS), a key Stars patient experience metric, showed members rated value-based physicians about 25% higher than non-value-based physicians (3.9 Stars vs. 3.1 Stars) in each of eight categories. They appreciated the level of care coordination and overall care provided categories.

Creating better value for patients and better financial stability for providers:

• Better outcomes at lower costs translate to improved health plan benefits for members. Humana invests savings from value-based care into better health plan benefits—such as home care, prescription delivery and healthy food cards—and lower premiums. Those additional benefits on average amount to roughly $500 annually (per member) for members associated with value-based physicians.
• Physicians in value-based arrangements with Humana received 14.3 cents of every dollar spent on primary care for Humana MA members, compared to 6.4 cents per dollar for physicians in non-value-based arrangements.

Overall, Humana and its clinical partners are collaborating in new ways thanks to value-based arrangements and driving results aligned with our missions and a sense of passion. Together, we are minimizing unnecessary and costly hospital admissions, helping seniors get more engaged in their health and well-being, and making healthcare more accessible – for everyone.