Humana report shows continued progress, benefits in shift to value-based care

young doctor
Humana's latest metrics on value-based care suggest new models have only scratched the surface when it comes to savings and satisfaction. (Getty/nortonrsx)

Humana’s annual assessment of value-based care portrays continued progress and growing promise for outcomes-based payment methodologies.

Improving outcomes, lower costs for patients and greater reimbursement for primary care physicians marked steady progress among value-based care practitioners, according to Humana’s fifth annual Value-based Care Report (PDF). As providers become more familiar with value-based payment incentives, physicians, hospitals and healthcare plans appear to be tuning into more efficient models of care coordination, particularly where they can extend their reach beyond the examination room and into patients’ homes.

The report highlights improved preventive measures such as cancer and diabetes screening programs, which patients under value-based payment methodologies received more frequently than those under fee-for-service systems. Value-based agreements also produced higher scores across HEDIS Star quality measures than other methodologies.

Conference

2019 Drug Pricing and Reimbursement Stakeholder Summit

Given federal and state pricing requirements arising, press releases from industry leading pharma companies, and the new Drug Transparency Act, it is important to stay ahead of news headlines and anticipated requirements in order to hit company profit targets, maintain value to patients and promote strong, multi-beneficial relationships with manufacturers, providers, payers, and all other stakeholders within the pricing landscape. This conference will provide a platform to encourage a dialogue among such stakeholders in the pricing and reimbursement space so that they can receive a current state of the union regarding regulatory changes while providing actionable insights in anticipation of the future.

In 2018, Humana had 62 bundled payment agreements with providers, up from 12 just two years ago. Two-thirds of Humana's 2.9 million Medicare Advantage members are affiliated with a primary care physician enrolled in a value-based care arrangement.

RELATED: Continued push to value-based care the key to lower healthcare costs, experts tell legislators

Despite the steady progress captured in the metrics, Roy Beveridge, M.D., Humana’s chief medical officer, believes the industry has only scratched the surface when it comes to the potential benefits value-based care plans may unlock.

“I think when this all started five years ago in terms of value-based care, some clinicians thought there would be an improvement of 5%, 10%, 15%, and that would be the maximum you could get to,” he told FierceHealthcare. “I think this shows that with continued efficiency, continued attention to quality, the numbers are just going to improve.”

That high ceiling stems in part from the way value-based programs appear to be pushing providers toward a sweet spot where all stakeholders recognize benefits. When physicians began dealing with the first-order problem of reducing emergency room visits in a bid to bring down overall healthcare costs, that inevitably produced a stronger relationship between physicians and patients, according to Dr. Beveridge. That improved relationship leads to better patient engagement, but it requires more time and energy per patient from physicians, and a more coordinated and integrated plan for patient care.

RELATED: 3 reasons to let go of fee-for-service payment models

On that front, Dr. Beveridge pointed to the rise in compensation among Humana’s physicians operating under value-based care agreements, who received 16.8% of every healthcare dollar earned last year, per the report. That compares to an average of 6% on the fee-for-service side, according to the American Academy of Family Physicians.

“That speaks to the importance of the family practitioner and all the work that they’re doing,” said Beveridge, noting that family practitioners have traditionally been underpaid compared to their specialist peers. Primary care physicians expected to spend the extra time and energy with a senior population under an accountable quality payment system also wind up seeing fewer patients, which suggests potential for improved physician satisfaction over time as well.

As value-based care continues to mature, Beveridge says he’s keeping an eye on its potential to help address physician burnout by aligning clinicians’ activities more closely with the reasons they entered medicine in the first place.

“The corollary to all of this should be an improvement in physician satisfaction, because they’re being paid more and because they’re doing what they were trained to do and they’re at the top of their license," he said. "That will be an interesting thing for us to investigate more in years to come."

Suggested Articles

Health insurers’ financial performance is on a continuing upward trend, but political and legal risks could pose a threat to that growth.

Senate lawmakers released a draft package of legislation Thursday aimed at curbing health care costs they said they believe they can pass on a bipartisan basis…

Attorneys general seeking to defend the ACA argue that their opponents—including the DOJ—have poor legal standing to challenge the law.