Humana’s Value-Based Care Plans Improved Health Outcomes for MA Members

Humana Medicare Advantage beneficiaries receiving care under value-based arrangements had better health outcomes, including fewer inpatient admissions and emergency room visits, a report from the payer indicated.

Humana’s tenth annual value-based care report shares how value-based care has improved the healthcare experience for beneficiaries and providers.

“The data are clear: Value-based care works,” Kate Goodrich, MD, chief medical officer at Humana, said in a press release. “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.”

In 2022, 70 percent of individual Medicare Advantage plan members were aligned with a value-based care provider. The rate of preventive screenings for these beneficiaries was between 3 percent and 11 percent higher than the rate for those not under value-based arrangements. For screenings that require care coordination across providers, the rate was between 8 percent and 11 percent higher for those in value-based arrangements.

Medicare Advantage beneficiaries receiving value-based care were also more likely to adhere to their medications for conditions like diabetes and hypertension.

Beneficiaries’ experience was better in value-based care, with providers receiving a Consumer Assessment of Healthcare Providers and Systems (CAHPS) score of 3.9, compared to 3.3 for non-value-based providers. This difference is likely related to providers having more time with patients and better care coordination efforts, the report noted.

Beneficiaries in value-based arrangements were more likely to visit their primary care physician in 2022 than non-value-based beneficiaries (85 percent versus 75 percent).

Compared to traditional Medicare, value-based care beneficiaries had 30.1 percent fewer inpatient admissions, saving 214,000 admissions in 2022. Compared to non-value-based care Medicare Advantage beneficiaries, there were 7.1 percent fewer admissions.

Additionally, Medicare Advantage beneficiaries under value-based arrangements had 12.7 percent fewer emergency room visits than non-value-based beneficiaries, saving 146,000 visits.

Medicare Advantage beneficiaries experienced less low-value care compared to those in traditional Medicare, including unnecessary surgeries (-30 percent), unnecessary diagnostic and preventive testing (-24 percent), unnecessary imaging (-10 percent), unnecessary pre-operative testing (-6 percent), and unnecessary cardiovascular testing and procedures (-5 percent).

In addition to improving health outcomes, Humana’s Medicare Advantage value-based care plan generated cost savings. The payer saved 23.2 percent in 2022 compared to traditional Medicare, translating to $8 billion in cost savings. Humana invests these savings into member benefits, such as lower premiums, home care, prescription delivery, and healthy food cards, according to the report.

Around half of the providers participating in Humana’s value-based care plan earned shared savings payments in 2022. Additionally, participating providers receive a greater share of the overall healthcare dollar in medical claims and capitation, bonus, and surplus payments than non-value-based providers (16 cents versus 6.5 cents).

Value-based care providers earned 3.4 times the Medicare physician fee schedule, with those in advanced stages of risk earning six times the fee schedule.

The report also touched on how value-based care impacted Humana’s Medicaid plans in Florida. Compliance with HEDIS performance measures was better in value-based care arrangements, including high blood pressure management, hemoglobin A1c control, cervical cancer screenings, and child and adolescent well-care visits.

Compared to Medicaid fee-for-service plans, Humana’s Medicaid plans, which have a high value-based care penetration, had a lower disparity score, signifying greater health equity.

While value-based care efforts have primarily been directed toward commercial and Medicare Advantage populations, underserved and vulnerable beneficiaries that make up Medicaid could benefit significantly, too.