Study: Value-based care lowers hospitalizations, ER visits in Medicare Advantage

Value-based care can drive down acute care episodes such as hospitalizations and emergency room visits among Medicare Advantage beneficiaries, a new study shows.

The research, published in JAMA Network Open and led by analysts at Humana and Harvard, found MA members treated by doctors in advanced value-based care models saw 5.6% fewer hospitalizations and 13.4% fewer emergency department visits compared to those treated in fee-for-service arrangements.

Value-based care models have been adopted in Medicare Advantage more rapidly than in traditional Medicare, Medicaid and commercial insurance.

"This is just more ammunition that value-based care works," said William Shrank, M.D., chief medical officer at Humana and one of the study's authors, in an interview with Fierce Healthcare.

Humana has seen notable success within its own member population through value-based care. In its most recent value-based care report, the insurer found that the members enrolled in its value-based care programs had a 60% lower risk of readmission after 30 days.

A majority (67%) of Humana members are cared for by a provider in a value-based care arrangement, according to the report.

Shrank said that while the insurer has tracked its own internal data for some time, Humana wanted to build the volume of evidence further with data that could be published in a peer-reviewed journal like JAMA. Participating in value-based care is not a simple or easy process for many providers, so having that database may make the pitch a bit easier, he said.

Having a rich collection of data can also be a valuable asset in continuing to iterate on existing models, making them work better for members, Shrank said.

"I hope that we as an industry, as a sector do a better job of evaluating and understanding the impact of value-based care on the member," he said.