Value-Based Care Benefits Patients and Physicians, New Report Shows

LOUISVILLE, Ky.--(BUSINESS WIRE)-- Value-based care is smarter healthcare that lowers costs and keeps Medicare Advantage members healthier, according to the tenth annual Value-Based Care Report released today from Humana Inc. (NYSE: HUM).

The 2023 report shows that Medicare Advantage (MA) patients receiving care under value-based arrangements spent more time with their primary care physician and were more likely to receive preventive care, with fewer hospitalizations. Meanwhile, physicians working under the value-based model are more empowered and better positioned to coordinate care while prioritizing outcomes over the quantity of services.

"The data are clear: Value-based care works," said Dr. Kate Goodrich, Chief Medical Officer at Humana. "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. At Humana, we are proud to lead the way on value-based care for our Medicare Advantage members, and we will continue to look for ways to expand this approach into other lines of business."

The Value-based care model (VBC) reimburses clinicians for the quality of care they provide with a focus on preventive care and better patient health outcomes. Clinicians often have smaller patient panels and more time to spend with patients. They are enabled by support teams and other resources to help them coordinate all aspects of care and address their patients’ needs holistically. This clinical model keeps the focus on ensuring patients remain healthy at home and minimizing the need for emergency room visits or hospitalization. In contrast, the traditional fee-for-service model (FFS) reimburses clinicians based on the number of individual services provided to a patient. Clinicians have larger panel sizes with shorter appointments – often just 10 -15 minutes – with no direct incentive to avoid hospitalization or the ER (Emergency Room).

For years, Humana has closely studied the efficacy and implications of the value-based care model to determine the best care practices for its members. This year marks a decade’s worth of Humana data, research, analysis, and patient, member and physician testimonials on VBC and how it compares to other care models.

Based on data from Humana’s report, VBC enables:

• A team-based holistic approach to patient care, quarterbacked by their physician with greater support from a multi-disciplinary team including nurses, medical assistants, pharmacists, social workers, and others.
• Coordination across transitions in care, such as after hospital discharge, and collaborating closely with patients and their care team to minimize the risk of ending up back in the hospital.
• Technology and data usage to help catch and eliminate “gaps in care,” and make sure patients’ needs do not fall through the cracks or get lost or forgotten.
• More resources and incentives to manage health-related social needs, such as transportation benefits and community support programs.

Other key findings from the report:

• Patients receiving health care under value-based care arrangements grew by 2.3 million over the past decade.
• 2022 showed a record 70% of Individual Medicare Advantage patients aligned with value-based care providers.
• Value-based care patients were less likely to spend time in the hospital. There were 30.1% fewer in-patient admissions for value-based care patients compared with Original Medicare beneficiaries in 2022.
• Value-based care patients were more likely to receive preventive care. Specifically, value-based care patients completed preventive screenings at a 14.6% higher rate than Medicare Advantage members not in a value-based care arrangement.
• Value-based care arrangements lead to cost savings for patients. In 2022, Humana Medicare Advantage Value-Based contractual arrangements saved 23.2% in medical costs compared to Original Medicare.
• Humana research found that patients cared for by VBC physicians had significantly lower acute care usage and potentially avoidable events.
• Humana invests cost savings into more member benefits, averaging $527 annually for members who see VBC providers.

Findings were not exclusive to Medicare Advantage. The 2023 report also highlights how value-based care factors intersect with Medicaid and how these arrangements positively impact patient outcomes and experience with Medicaid in Florida markets.

“Healthcare organizations are working together more and more, and now we’re starting to see aligned payment model benefits in Medicaid,” said George Renaudin, Humana’s President of Medicare and Medicaid. “We are at the dawn of the next era in value-based care. As we think about how to continue improving health outcomes for our members, we will determine ways to apply our successful care models beyond primary care and Medicare Advantage.”

“Humana continues to lead the way in value-based-care adoption and advocacy,” added Oraida Roman, Humana’s Senior Vice President of National Provider Strategies and Operations. “We couldn’t have done this without our value-based provider partners who take care of our members in such a way that they continue to be able to put health first.”

Throughout the last ten years, Humana has consistently found that value-based care arrangements contribute to better patient outcomes. Despite this model’s proven cost savings and better health management and outcomes for patients, members, and physicians, as shown in Humana’s report, less than half of primary care physicians in the U.S.reported receiving payments through VBC arrangements. Humana will share its findings across the industry to help increase promotion and adoption of a demonstrated improved approach to healthcare.

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.