Humana: Providers achieve better cost, quality results under Medicare Advantage value-based arrangements

Humana continues to see better cost and quality results from providers involved in its Medicare Advantage value-based payment models compared to those in other Medicare payment arrangements.

In 2016, medical costs for MA members affiliated with providers in value-based reimbursement agreements were 15% lower compared to those affiliated with physicians under fee-for-service Medicare, according to the insurer’s annual report (PDF) on the state of its value-based care initiatives.

Further, compared to members whose providers were in standard Medicare Advantage settings, MA members whose providers were in value-based payment models:

  • Experienced 6% fewer hospital inpatient admissions and 7% fewer emergency department visits.
  • Underwent 8% more breast cancer screenings and 13% more colorectal cancer screenings.
  • Were treated by providers with 26% higher Healthcare Effectiveness Data and Information Set scores.

“Our 2016 health and quality results reflect continued investment in our integrated care delivery model, such as enhanced data analytics to help providers identify and address unhealthy behaviors,” Humana President and CEO Bruce Broussard said in a statement.

RELATED: Humana touts success of value-based Medicare Advantage reimbursement models

Part of why the insurer’s value-based initiatives have made such progress is that many physicians have embraced them, he noted. Indeed, the report highlighted the fact that primary care physicians in Humana value-based reimbursement model agreements received 16.2% of the total payments that the distributed to doctors in 2016—compared to a national average of 6%.

Overall, the insurer said 1.9 million out of its 2.8 million individual Medicare Advantage members are aligned with physicians in value-based care arrangements.

Humana’s new report underscores the insurer’s overall strategy of strengthening its Medicare Advantage products and capabilities to respond to what it has acknowledged is increased competition in MA markets. In fact, the company announced in its third-quarter earnings report that it would trim its workforce by 5.7% in order to fund critical initiatives and advance its growth objectives.

Meanwhile, major competitor UnitedHealth is also invested in Medicare Advantage. The insurer announced Wednesday that it has started a health navigator program designed to coordinate care for MA members with complex and chronic conditions.