Humana: Value-based contracts led to better care, outcomes during COVID-19

Home health senior nurse
While value-based care existed before COVID-19, its success in quality of care and outcomes in 2020 revealed to many why it is preferable, Humana's chief medical officer William Shrank, M.D., told Fierce Healthcare. (KatarzynaBialasiewicz/Getty)

Humana Medicare Advantage members receiving value-based care had more preventive care, lower costs and better outcomes in 2020 compared to those in traditional Medicare, according to Humana’s latest annual value-based care report.

The majority of Humana’s MA members (67%) receive care from physicians in value-based agreements. These patients had fewer hospital admissions and emergency room visits than others. Among those who received care at home, they also had lower (60%) risk of readmission within 30 days following a hospital discharge and decreased healthcare costs, the report found.

“We will never go back to where we were,” David Moulton, M.D., of the State of Franklin Healthcare Associates, was quoted as saying in the report. “We have embraced a team approach to care and not an individual provider. The paradigm change of the provider becoming accountable for patient care has resulted in improved systems and resources to help patients.” 

“The pandemic was a real accelerant in the transformation of the healthcare system,” Humana’s chief medical officer William Shrank, M.D., told Fierce Healthcare. It highlighted the strengths, challenges and areas of improvement. Value-based care served as what Shrank termed a “source of resilience” and an “accountable model.” While it had existed prior to the onset of COVID-19, its success in 2020 showed many why it is preferable, he noted. 

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Humana’s report found that despite delays in care during the pandemic, value-based care physicians fared far better in terms of quality than those in non-value-based models across every care category. For instance, in 2020, 86% of MA members saw their value-based physician at least once, compared to 78% of those in non-value-based agreements.

Value-based physicians were also more adaptable during the rapidly changing healthcare landscape that year, able to implement tech like telehealth quicker and sustain use for longer. The reason for this, Shrank explained, is they already had the infrastructure and a “rich system of interaction and routine check-ins” in place prior to COVID-19. What may have also helped, the report noted, was accountability for cost, quality and disease management.

These physicians also leveraged Humana’s wellness program to entice qualifying Humana MA members to get screened and maintain healthy behaviors. (Members can earn gift cards per screening.) These patients also reported greater satisfaction with their physicians.  

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The physicians benefited as well, the report found: Those in value-based contracts received more of the overall healthcare dollar, earning 17.5 cents of every dollar spent compared to 6.7 cents for non-value-based physicians. They also had a steady revenue stream, the lack of which affected so many providers and businesses during the pandemic. Humana accelerated value-based quality recognition payments to value-based providers largely in April 2020, up to three months earlier than normal, the report said. It also ultimately moved more than 95,000 Humana MA members under value-based contracts. As for specialty physicians, bundled payments were a solid approach, the report noted, driving better outcomes in areas like complication rates and wound infection rates. 

Going forward, Shrank believes there is an opportunity for the entire industry to make it easier to participate in value-based care, particularly for providers working with multiple insurers. It’s also critical for providers and payers to stay aligned in both financial and quality outcomes to provide maximally impactful, patient-centric care.