Humana Medicare Advantage Members Benefit From Improved Health Outcomes, Preventive Care and an Estimated $4 Billion in Reduced Costs Through Value-Based Care
Humana Inc. (NYSE: HUM) released its annual Value-based Care Report, highlighting that 2.41 million individual Medicare Advantage members experienced improved health outcomes and reduced costs due to value-based payment models. In comparison to fee-for-service models, Humana members received preventive screenings 8% to 19% more frequently and spent 211,000 fewer days in hospitals. The report indicated that $4 billion in medical expenses were avoided by members under these agreements. The findings underscore the effectiveness of value-based care in enhancing patient health and lowering healthcare costs.
- Humana Medicare Advantage members received 8% to 19% more preventive screenings.
- Collectively, members spent 211,000 fewer days as hospital inpatients.
- Estimated savings of $4 billion in plan-covered medical expenses compared to Original Medicare.
- None.
LOUISVILLLE, Ky.--(BUSINESS WIRE)--Humana Inc. (NYSE: HUM) unveiled today its annual Value-based Care Report, detailing that 2.41 million Humana individual Medicare Advantage beneficiaries receiving care from primary care physicians in value-based payment models experienced, on average, better health outcomes, lower costs and more preventive care, as opposed to fee-for-service models. Results reflect data collected during calendar year 2019.
Value-based care, a key priority in the Medicare Advantage program, rewards quality and effectiveness of care rather than quantity of care. By aligning incentives with providers and, most importantly, with members, we foster deeper collaboration, more proactive and preventive care, and a more profound commitment to the experiences and outcomes of our members. Incorporating integrated care delivery and social determinants of health screenings can provide value-based providers with a clearer of a patient’s personal experience and to deliver the best services to help them achieve their best health.
Report Details
The report details how Humana’s holistic approach helped its Medicare Advantage members,
Humana President and CEO Bruce Broussard said he believes that, in a value-based care model, providers caring for Medicare Advantage members have reinforced a broader view of caring for people living with multiple chronic conditions.
“The premise of human care – where we listen to and address the specific physical health, behavioral health and health-related social needs of our members and their care teams – is amplified in value-based care agreements,” said Broussard. “Our collaboration with primary care physicians and their care teams is helping to deliver simpler and more convenient care and reducing avoidable hospitalizations.”
Key Findings
Listed below is a snapshot of the report’s key findings:
- Humana individual Medicare Advantage members benefitted from preventive screenings. Humana MA members seeking care from physicians in value-based agreements received screenings between 8 percent and 19 percent more often for colorectal screenings, diabetic eye exams, osteoporosis management and controlling blood sugar than those Humana MA members who received care from physicians in MA non-value-based arrangements.
- More Humana MA members stayed in their homes, not the hospital. Humana MA members receiving care from physicians in value-based care arrangements with Humana collectively spent 211,000 fewer days as hospital inpatients and less time seeking care in emergency rooms in 2019, compared to those Humana MA members receiving care from physicians in non-value-based care models. More broadly, Humana MA members served by physicians/practices in value-based agreements visited emergency rooms 10.3 percent less often (90,500 fewer visits) and had a 29.2 percent lower rate of hospital admission (165,000 fewer admissions) compared with Original Medicare.
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Care costs are lower for Humana Medicare Advantage members. An estimated
$4 billion in plan-covered medical expenses would have been incurred by Humana Medicare Advantage members if they had they been under Original Medicare’s fee-for-service model instead of in value-based agreements.
A strategic advantage of the value-based model is that it equips physicians with tools, actionable data and resources that provide an expanded view of patients’ health to assist in developing a more holistic approach to care. In turn, physicians can provide more targeted education, monitoring and coordinated, longitudinal care to their patients. William Shrank, MD, MPHS, Humana’s chief medical and corporate affairs officer, said he believes that value-based care models will become even more effective as we foster even greater interoperability in data and systems, facilitating improved visibility and coordination.
“Value-based care underscores the need to take a holistic view to help members achieve their best health,” said Dr. Shrank. “Central to this is the ability for value-based physicians to have access to a full and complete picture of patients’ health - including their clinical, behavioral and social needs. The COVID-19 pandemic further emphasizes the need to address barriers to social isolation, food insecurity, and transportation among seniors. Addressing social determinants of health is the right thing to do, and we believe helps our members spend more Healthy Days at home.”
The 2019 results, as with the previous results, cannot be directly compared year-over-year due to multiple demographic changes in Humana’s member population. This is the fourth year that the company has issued the annual report and the seventh for reporting on health, quality and costs results for its Medicare Advantage beneficiaries seeking care from physicians in value-based payment models.
Report Methodology
Humana compared calendar year 2019 prevention measures for approximately 2.1 million Medicare Advantage members seeking care from providers in a value-based arrangement to approximately 873,800 members who sought care from providers under standard Medicare Advantage settings.
Humana also compared medical cost and utilization for calendar year 2019 for approximately 1.9 million Medicare Advantage members who sought care from providers practicing value-based care to approximately 900,000 members seeking care from providers under standard Medicare Advantage settings, as well as to Original fee-for-service Medicare.
As of June 30, 2020, Humana’s total Medicare Advantage (individual and group) membership was approximately 4.5 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
