Humana Improves Health and Reduces $3.5 Billion in Health Care Costs through Medicare Advantage Value-Based Care Programs
22 November 2019 - 12:35AM
Business Wire
- Humana’s annual Value-Based Care Report details 27 percent
fewer hospital admissions and 14.6 percent fewer emergency rooms
visits, compared with Original Medicare
- Nine percent more breast cancer screenings for Humana Medicare
Advantage members served by primary care physicians in value-based
agreements with Humana
Helping people living with multiple chronic conditions achieve
their optimal whole-person health has been a strategic initiative
for Humana Inc. (NYSE: HUM). Today, Humana announced that the
company has lowered overall health care costs and helped deliver
improved health outcomes for Humana’s Medicare Advantage
beneficiaries affiliated with primary care physicians in
value-based payment models, which represents 67% of Humana’s total
individual MA plan beneficiaries in 2018.
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The physician-authored annual Humana Value-based Care Report,
which can be accessed by clicking here, details how Humana uses its
holistic approach to help beneficiaries facing numerous medical and
social health challenges. For example, 82.6% of Humana Medicare
Advantage members have at least two chronic conditions.
The report examines how Humana is supporting those Medicare
Advantage members impacted by social determinants of health, such
as food insecurity and social isolation. The report also explores
how physicians are engaging and supporting patients in promoting
healthier behaviors such as medication adherence and meeting
specified clinical goals.
This is the third year that the company has issued the annual
report and the sixth for reporting on health, quality and costs
results for its Medicare Advantage beneficiaries affiliated with
physicians in value-based payment models.
“What excites us most about these results is what they say about
how we’re helping seniors improve their health, while also helping
them better afford the care they receive,” said Humana President
and CEO Bruce Broussard. “Our members count on us every day to
improve their overall health care experience, and we are doing
that. At the same time, as these results demonstrate, we’re getting
better at supporting doctors, nurses and other care providers in
their work to help people live healthier lives. In 2020 and beyond,
we will keep at this.”
The potential of the value-based payment model was cited in a
Humana study that appeared in October in the Journal of the
American Medical Association, which stated that value-based care
could meaningfully reduce the $265.6 billion wasted annually that
is attributed to administrative complexity, and facilitate the
expansion of numerous integrated clinical models proven to improve
care.
Improved health, lower costs and better quality
In the report, Humana detailed how its value-based payment model
has led to lower costs, better health and improved quality for its
Medicare Advantage members served by physicians in value-based
agreements with the company. Listed below is a snapshot of the
report’s key findings:
- Medicare Advantage members have reduced cost of care.
Humana Medicare Advantage members under the care of physicians in
value-based agreements would have incurred an additional $3.5
billion in plan-covered medical expenses had they been under
Original Medicare’s fee-for-service model. Prevention screenings,
improved medication adherence and effective management of patient
treatment plans all contributed to creating these reductions. These
medical cost reductions can benefit plan members through reduced
out-of-pocket costs -- and, in future years, lower member premiums
-- and/or additional benefits.
- Medicare Advantage members are visiting the hospital
less. Humana Medicare Advantage members served by
physicians/practices in value-based agreements had a 27 percent
lower rate of hospital admission (131,200 fewer admissions) and
visited emergency rooms 14.6 percent less often (110,700 fewer
visits) compared with Original Medicare.
- Physicians in Medicare Advantage value-based agreements are
delivering better quality care. Physicians in value-based
agreements with Humana from 2016 through 2018 had a 4.44 average
Healthcare Effectiveness Data and Information Set (HEDIS) Star
score at the end of 2018 based on 1.13 million Humana MA members
compared to a 3.10 HEDIS Star score for physicians serving 454,000
members in non-value based agreements. HEDIS is a measurement tool
developed by the National Committee for Quality Assurance (NCQA) to
assess health plans’ performance on various dimensions of care and
service.
- Physicians provided more care that is preventive to Medicare
Advantage members. Humana Medicare Advantage members affiliated
with physicians in value-based agreements received screenings as
much as 21% more often in categories such as colorectal cancer,
osteoporosis and blood sugar control than those in an MA
non-value-based setting.
“The Medicare Advantage plan serves as a rich laboratory for
value-based care, as it allows for integrated and coordinated
management of chronic conditions, and a holistic view of the
patient,” said William Shrank, MD, MPHS, Humana’s Chief Medical and
Corporate Affairs Officer. “Moving the industry forward with a
focus on value is not something we can do alone. Our dialogue with
physicians, community organizations and other health care providers
is essential to developing a sustainable system that improves
population health and reduces costs for everyone.”
Humana’s Report Methodology
The 2018 results, as with the previous results, cannot be
directly compared year over year due to multiple demographic
changes in Humana’s member population.
Humana compared quality metrics and prevention measures for
calendar year 2018 for approximately 1.85 million Medicare
Advantage members who were affiliated with providers in value-based
reimbursement model agreements to approximately 848,000 members who
were affiliated with providers under standard Medicare Advantage
settings.
Humana also compared medical cost and utilization for calendar
year 2018 for approximately 1.63 million Medicare Advantage members
who were affiliated with providers in value-based reimbursement
models to approximately 855,000 members who were affiliated with
providers under standard Medicare Advantage settings as well as to
Original fee-for-service Medicare.
Original Medicare costs, admission and emergency room estimates
were derived using CMS Limited Data Set Files from 2017 and are
subject to restatement with the availability of more current CMS
data. As of Sept. 30, 2019, Humana’s total Medicare Advantage
(individual and group) membership is more than 4.07 million
members. For more information, visit humana.com/valuebasedcare.
About Humana
Humana Inc. is committed to helping our millions of medical and
specialty members achieve their best health. Our successful history
in care delivery and health plan administration is helping us
create a new kind of integrated care with the power to improve
health and well-being and lower costs. Our efforts are leading to a
better quality of life for people with Medicare, families,
individuals, military service personnel, and communities at
large.
To accomplish that, we support physicians and other health care
professionals as they work to deliver the right care in the right
place for their patients, our members. Our range of clinical
capabilities, resources and tools – such as in-home care,
behavioral health, pharmacy services, data analytics and wellness
solutions – combine to produce a simplified experience that makes
health care easier to navigate and more effective.
More information regarding Humana is available to investors via
the Investor Relations page of the company’s web site at
www.humana.com, including copies of:
- Annual reports to stockholders
- Securities and Exchange Commission filings
- Most recent investor conference presentations
- Quarterly earnings news releases and conference calls
- Calendar of events
- Corporate Governance information
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version on businesswire.com: https://www.businesswire.com/news/home/20191121005313/en/
Alex J. Kepnes Humana Corporate Communications 502-580-2990
akepnes@humana.com
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