Value-Based Care Simplifies Healthcare for Patients and Clinicians, New Report Finds
Humana Inc. (NYSE: HUM) released its annual Value-Based Care Report, demonstrating significant improvements in patient outcomes through value-based care (VBC) arrangements. The report shows that Medicare Advantage patients under VBC had 32.1% fewer inpatient admissions compared to Original Medicare, and experienced 11.6% fewer ER visits and 7.2% fewer admissions than non-VBC arrangements.
Key findings reveal VBC members had 10% more primary care visits in 2023, with a 90/100 satisfaction rate. The model achieved 25.8% savings in medical costs compared to Original Medicare, which Humana reinvests in member benefits. Black patients visited senior-focused primary care 39% more frequently, while low-income beneficiaries had 21% more visits versus Original Medicare. In specialty care, VBC nephrology programs showed 5% fewer unnecessary hospitalizations compared to fee-for-service models.
Humana Inc. (NYSE: HUM) ha pubblicato il suo rapporto annuale sulla Cura Basata sul Valore, dimostrando miglioramenti significativi negli esiti dei pazienti attraverso gli accordi di cura basata sul valore (VBC). Il rapporto mostra che i pazienti di Medicare Advantage sotto VBC hanno registrato il 32,1% di ricoveri ospedalieri in meno rispetto a Medicare Originale, e hanno vissuto l'11,6% di visitazioni al pronto soccorso in meno e il 7,2% di ricoveri in meno rispetto agli accordi non-VBC.
I risultati chiave rivelano che i membri VBC hanno effettuato il 10% di visite in più per la cura primaria nel 2023, con un tasso di soddisfazione di 90/100. Questo modello ha ottenuto risparmi del 25,8% nei costi medici rispetto a Medicare Originale, che Humana reinveste nei benefici per i membri. I pazienti neri hanno visitato le cure primarie focalizzate sugli anziani il 39% in più, mentre i beneficiari a basso reddito hanno avuto il 21% di visite in più rispetto a Medicare Originale. Nella cura specialistica, i programmi di nefrologia VBC hanno mostrato il 5% di ospedalizzazioni non necessarie in meno rispetto ai modelli basati sulle tariffe per servizio.
Humana Inc. (NYSE: HUM) publicó su informe anual sobre Atención Basada en el Valor, demostrando mejoras significativas en los resultados de los pacientes a través de los acuerdos de atención basada en el valor (VBC). El informe muestra que los pacientes de Medicare Advantage bajo VBC tuvieron un 32.1% menos de hospitalizaciones en comparación con Medicare Original, y experimentaron un 11.6% menos de visitas a urgencias y un 7.2% menos de ingresos que los acuerdos no-VBC.
Los hallazgos clave revelan que los miembros de VBC tuvieron un 10% más de visitas a la atención primaria en 2023, con una tasa de satisfacción de 90/100. Este modelo logró ahorros del 25.8% en costos médicos en comparación con Medicare Original, que Humana reinvierte en beneficios para los miembros. Los pacientes negros visitaron la atención primaria enfocada en personas mayores un 39% más frecuentemente, mientras que los beneficiarios de bajos ingresos tuvieron un 21% más de visitas en comparación con Medicare Original. En la atención especializada, los programas de nefrología VBC mostraron un 5% menos de hospitalizaciones innecesarias en comparación con los modelos de pago por servicio.
Humana Inc. (NYSE: HUM)는 연간 가치 기반 진료 보고서를 발표하며, 가치 기반 진료(VBC) 계약을 통해 환자 결과가 크게 개선되었음을 보여주었습니다. 보고서에 따르면 VBC에 속한 Medicare Advantage 환자는 기존 Medicare에 비해 32.1% 적은 입원율을 기록했으며, 11.6% 적은 응급실 방문과 7.2% 적은 입원을 경험했습니다.
주요 발견 사항에 따르면 VBC 회원들은 2023년에 10% 더 많은 기본 진료 방문을 했으며, 만족도는 90/100으로 나타났습니다. 이 모델은 기존 Medicare에 비해 의료 비용에서 25.8% 절감을 달성했으며, Humana는 이를 회원 혜택에 재투자합니다. 흑인 환자들은 노인 중심의 기본 진료를 39% 더 자주 방문했으며, 저소득 수혜자들은 기존 Medicare에 비해 21% 더 많은 방문을 했습니다. 전문 진료에서는 VBC 신장학 프로그램이 수가 청구 모델에 비해 5% 적은 불필요한 입원을 보여주었습니다.
Humana Inc. (NYSE: HUM) a publié son rapport annuel sur les soins basés sur la valeur, montrant des améliorations significatives dans les résultats des patients grâce aux accords de soins basés sur la valeur (VBC). Le rapport indique que les patients de Medicare Advantage sous VBC ont eu 32,1% d'hospitalisations en moins par rapport à Medicare Original, et ont connu 11,6% de visites aux urgences en moins et 7,2% d'admissions en moins par rapport aux accords non-VBC.
Les principales conclusions révèlent que les membres VBC ont eu 10% de visites de soins primaires en plus en 2023, avec un taux de satisfaction de 90/100. Ce modèle a réalisé 25,8% d'économies sur les coûts médicaux par rapport à Medicare Original, que Humana réinvestit dans les avantages des membres. Les patients noirs ont consulté des soins primaires axés sur les personnes âgées 39% plus souvent, tandis que les bénéficiaires à faible revenu ont eu 21% de visites en plus par rapport à Medicare Original. En matière de soins spécialisés, les programmes de néphrologie VBC ont montré 5% d'hospitalisations inutiles en moins par rapport aux modèles de paiement à l'acte.
Humana Inc. (NYSE: HUM) hat seinen jährlichen Bericht über wertorientierte Versorgung veröffentlicht, der signifikante Verbesserungen bei den Patientenergebnissen durch wertorientierte Versorgungs (VBC) - Vereinbarungen zeigt. Der Bericht zeigt, dass Medicare Advantage-Patienten unter VBC 32,1% weniger Krankenhausaufenthalte im Vergleich zu Original Medicare hatten und 11,6% weniger Notaufnahmebesuche sowie 7,2% weniger Aufnahmen als nicht-VBC-Vereinbarungen erlebten.
Wichtige Erkenntnisse zeigen, dass VBC-Mitglieder im Jahr 2023 10% mehr Hausarztbesuche hatten, bei einer Zufriedenheitsrate von 90/100. Dieses Modell erzielte 25,8% Einsparungen bei den Medizinkosten im Vergleich zu Original Medicare, das Humana in Mitgliedervorteile reinvestiert. Schwarze Patienten haben seniorenorientierte Hausarztbesuche 39% häufiger in Anspruch genommen, während einkommensschwache Leistungsempfänger 21% mehr Besuche im Vergleich zu Original Medicare hatten. In der Spezialversorgung zeigten die VBC-Nephrologieprogramme 5% weniger unnötige Krankenhauseinweisungen im Vergleich zu honorarärztlichen Modellen.
- 25.8% medical cost savings compared to Original Medicare
- 32.1% reduction in inpatient admissions vs Original Medicare
- 11.6% reduction in ER visits for VBC members
- 90/100 patient satisfaction rate with healthcare providers
- Improved access for underserved populations with 39% more visits for Black patients
- None.
Insights
Humana's comprehensive Value-Based Care (VBC) Report reveals compelling evidence of the model's success, with 25.8% medical cost savings compared to Original Medicare - a significant metric that directly impacts profitability. The demonstrated reduction in hospital admissions (32.1%) and ER visits (11.6%) represents substantial cost avoidance and improved resource utilization.
The report strategically positions Humana as a leader in healthcare transformation, particularly important as the industry shifts away from fee-for-service models. The company's investment in VBC infrastructure and decade-long data collection creates significant competitive barriers to entry. The successful outcomes in chronic disease management and preventive care screenings suggest lower long-term medical costs and improved member retention.
Most notably, the improvements in care access for Black patients and low-income beneficiaries (39% and 21% increased visits respectively) indicate strong execution in addressing healthcare equity - a critical factor for maintaining and expanding government contracts. The reinvestment of savings into enhanced member benefits creates a virtuous cycle, potentially driving membership growth and market share gains.
The expansion into specialty care, particularly the 5% reduction in unnecessary hospitalizations in nephrology programs, signals promising diversification opportunities. This multi-specialty approach could create additional revenue streams while further differentiating Humana's value proposition in the competitive Medicare Advantage market.
Over a decade of Humana’s research shows value-based care improves patient outcomes
Over a decade of Humana’s research shows value-based care improves patient outcomes. (Photo: Humana)
The report’s data shows that Medicare Advantage (MA) patients receiving care under value-based arrangements saw fewer emergency department visits, fewer inpatient hospitalizations, and received more preventive care screenings.
Clinicians under the traditional fee-for-service model are reimbursed based on the volume of patients and services provided, with no incentive to reduce costly or low-value interventions. The value-based model emphasizes preventive care and incentivizes health outcomes.
“Coordinated care that delivers the right care at the right time must become the standard,” said Dr. Kate Goodrich, Chief Medical Officer at Humana. “Our report paints a clear picture: value-based practices deliver better patient experiences and health outcomes. Patients spend more time with their primary care clinician, which means more preventive care and better management of chronic diseases, like diabetes and high blood pressure. Seniors in value-based care models receive the care they deserve with a clinician who holistically understands their care needs. At Humana, we are committed to advancing value-based care as the best model for improving health outcomes and the healthcare experience for seniors everywhere.”
A Smarter Healthcare Model
The need to accelerate value-based adoption is more imperative than ever. Clinicians are increasingly experiencing high levels of burnout, while patients struggle with a fragmented healthcare system characterized by disjointed appointments, and lack of coordinated care.
Value-based agreements range from financial rewards to full-risk reimbursement models allowing practices to choose what works best for them. Clinicians are incentivized to prioritize high-value, preventive care to keep patients healthy longer. As practices mature in value-based arrangements, care coordination becomes more effective across care teams, which results in more high value services and fewer unnecessary or duplicative services. With the alignment of financial incentives to delivery of high-quality care, care gaps close and patient engagement increases under an integrated clinical team.
Based on more than a decade of Humana’s data, value-based care advances:
- Patients spend more time with their primary care clinician and have fewer emergency department and hospital visits, in turn reducing costly, low-value care.
- A clinical team-based approach to care coordination - after a hospital stay, between primary care visits, or when beginning a new medication.
- A sustainable healthcare system, where patients, clinicians, and payers benefit from the financial stability and better outcomes of value-driven models.
- Technology integrations allow for real-time, actionable data at the fingertips of clinicians to eliminate gaps in care.
Key Findings from the report:
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Regular primary care appointments mean better prevention and healthcare maintenance. In 2023, value-based care members saw their primary care clinicians
10% more than non-value-based care patients. - VBC Medicare Advantage patients report 90 out of 100 satisfaction with their healthcare provider, per Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey data.
-
Less time spent in the hospital. VBC Medicare Advantage patients saw
32.1% fewer inpatient admissions in 2023 versus those enrolled in Original Medicare. -
Humana Medicare Advantage members treated by value-based clinicians experienced
11.6% fewer ER visits and7.2% fewer admissions than those not in a value-based arrangement. - Humana Medicare Advantage members receive more preventive screenings than those under non-value-based practices across these measures: annual wellness exam, colorectal screening, diabetes eye exam, and mammogram.
- Value-based care allows for better chronic disease management. Humana Medicare Advantage members were more likely to receive diabetes care eye exam screenings and to meet blood sugar control measures versus members not in a value-based care arrangement.
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Senior-focused primary care organizations (PCOs) combine a VBC model with a care delivery approach tailored for seniors. Black patients visited their senior-focused primary care clinician
39% more and low-income beneficiaries had21% more visits versus Original Medicare. -
Senior-focused primary care patients had
17% more primary care visits,6% fewer hospitalizations and11% fewer emergency department (ED) visits. -
Value-based arrangements allow for investments in benefits members value most at an affordable price. In 2023, Humana Medicare Advantage value-based arrangements saved
25.8% , in medical costs compared to Original Medicare. Humana invests these savings directly into more member benefits, such as lower premiums, home care, prescription delivery and healthy food cards.
Beyond Primary Care
The new report also spotlights how value-based arrangements in specialty practices positively impact patient outcomes. Humana MA patients aligned to value-based nephrology programs experienced
"We must unite to address clinicians’ pain points, creating a system where every stakeholder can prioritize health first,” said George Renaudin, Humana’s Insurance President. “Over a decade of our experience and research shows that providers navigating the shift to value achieve greater success with proactive support, an operational roadmap and actionable data. The path forward is clear: the value-based model is the future – we have seen it in action, and it’s the key to sustainable, patient-centered care.”
Humana offers a practical how-to-guide for successful value-driven operations. Real-time, integrated data systems are a first step for any practice in moving toward value. For a sustainable healthcare system, the value-based care model is a necessity for patients and clinicians.
Read Humana's Value-Based Care Report in full here.
About Humana
Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers, and our company. Through our Humana insurance services, and our CenterWell health care services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large. Learn more about what we offer at Humana.com and at CenterWell.com.
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Media Contact
Cait Crenshaw Whatley
Humana Corporate Communications
cwhatley@humana.com
Source: Humana Inc.
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