Humana Shares 2020 Medicare Advantage Value-Based Care Results

Humana’s Medicare Advantage value-based care efforts helped improve hospitalization rates and preventive care during the coronavirus pandemic, the payer shared in its value-based care report.

“During a year of unprecedented disruptions, we are grateful for the dedication, care and ingenuity showed by physicians to continue providing high-quality care for our Medicare Advantage members,” said Bruce Broussard, president and chief executive officer of Humana, said in the press release. 

“As the population of Medicare Advantage beneficiaries continues to grow, we will continue to collaborate with providers and others on the best ways to address seniors’ critical needs and ensure a strong future for the Medicare guarantee made to our seniors.”

Humana shared the outcomes that their 2.65 million Medicare Advantage members experienced as a result of the payer’s value-based care approach. 

Over two-thirds of Humana’s Medicare Advantage members (67 percent) were covered under a value-based care model in 2020. More than a third of those in value-based care models (36 percent) were covered under a fee-for-service, bonus, and shared savings model. Another 20 percent were covered under global risk models.

Nine out of ten Humana Medicare Advantage members (89.1 percent) had one or more chronic conditions and 83 percent had two or more chronic conditions. Top chronic conditions among Humana’s Medicare Advantage members in 2020 included hypertension, type 2 diabetes, coronary artery disease, and chronic kidney disease.

Despite these conditions and the global pandemic in 2020, hospitalizations dropped in this population. Hospital admissions declined seven percent and emergency room visits dropping 12 percent among Medicare Advantage members covered under value-based contracts when compared to members in Medicare Advantage plans without value-based care agreements. 

The hospitalization rate was also 22 percent lower than what fee-for-service Medicare beneficiaries experienced. Emergency room visits were four percent lower in Medicare Advantage plans with value-based contracts, compared to fee-for-service Medicare. 

These results aligned with other studies that showed coronavirus-related hospitalizations were lower in Medicare Advantage than in fee-for-service Medicare in 2020.

The Humana report also indicated that Medicare Advantage members in value-based care contracts had 245,000 fewer days in the hospital than Medicare Advantage members who were not covered under value-based care contracts.

The results of value-based care were evident in primary care services as well. Nearly nine out of ten Medicare Advantage members (86 percent) saw their primary care physician who was in a value-based contract with Humana one time or more over the course of 2020. On average, these members saw their primary care provider 4.19 times.

In contrast, 78 percent of Medicare Advantage members who were not in value-based care agreements saw their primary care provider at least once in 2020. These members visited their primary care providers on average 3.97 times that year.

Value-based care also drove down costs, the Humana report found. The payer’s total Medicare costs for 2020 were 13.4 percent lower due to strong preventive care services and lower rates of hospitalization compared to fee-for-service Medicare.

Humana’s provider partners reaped the benefits of those lower costs, the payer stated. Providers who entered into value-based care contracts with Humana earned 17.5 percent of every healthcare dollar spent. Meanwhile, physicians whose payment was tied to fee-for-service reimbursement structures earned 6.7 cents for every healthcare dollar spent.

These results will have implications as payers back off of coronavirus-related waivers.

“Value-based providers had invested in the right infrastructure before COVID-19, allowing them to be more flexible and in a better position to leverage technology, drive more care to the home and be more sensitive to the emerging needs of their patients and communities,” William Shrank, MD, chief medical officer of Humana, said in the press release. 

“As we continue to navigate the uncertainties brought on by COVID-19, one thing is clear – the pandemic reaffirmed the imperative for value-based care.”