Value-Based Care is the Answer for Humana

Preventative Care Measures Improved Under Value-Based Care Contracts

In 2021, Humana released an extensive report highlighting the success of their Value-Based Care Program. The report showed that Medicare Advantage (MA) members who went to physicians participating in value-based contracting arrangements had better health outcomes than patients who saw physicians in traditional fee-for-service contracts.

Humana’s value-based care (VBC) program accomplishments reaffirm the need to transition away from outdated fee-for-service (FFS) models. In 2020, Humana’s MA members who were associated with physicians in value-based care contracts:

  • Received over 7.4 million preventative screenings, completed almost 1.4 million fitness activities, and were highly engaged in social/health education opportunities
  • Had 7% fewer hospital admissions and 12% fewer emergency room compared to patients seeing non-VBC providers
  • Experienced a 60% lower risk of readmission within 30 days of a procedure
  • Filled more prescriptions at decreased costs compared to members utilizing non-value-based providers

Healthcare Costs Decreased Under Value-Based Care Contracts

As healthcare costs in the U.S. continue to follow an upward trend into unsustainable territory, value-based care models have been able to slow this trend by reducing costs in some of the most crucial areas of healthcare. Humana’s report produced significant evidence that VBC programs can lower overall healthcare expenditures while reimbursing physicians at higher rates as a reward for improved health outcomes.

  • Humana’s VBC agreements helped reduce total medical costs by an estimated 13.4% or $3.1 billion
  • Physicians in value-based contracts with Humana earned 17.5 cents of every dollar spent compared to 6.7 cents for non-value-based physicians
  • During the pandemic, many value-based practices were protected from the instability caused by COVID-19 because of the long-term financial steadiness and payer collaboration VBC arrangements provide

Quality of Care Increased Under Value-Based Care Contracts

In an ever-changing landscape, providers must be agile and adaptable to successfully provide the highest quality care. The need for innovation and technology to provide care was critical during the pandemic. Tools like telehealth became a driving force in accessing care. Humana’s report details how VBC providers outpaced others in adopting new technology for care delivery.

  • During the initial wave of COVID cases, providers in VBC contracts used telehealth at a rate of 50.1 visits per 1,000 members per week – non-value-based providers used telehealth at a rate of 9.3 visits per 1,000 members per week
  • Across all HEDIS categories, VBC physicians scored higher than non-VBC physicians
  • Value-based contracting arrangements helped Humana serve MA members over 1.1 million meals during the pandemic to combat food insecurity

Humana’s success in the value-based space continues to prove that moving away from fee-for service payment models can radically transform healthcare for all who are involved. Value-based contracting can create an improved healthcare model because of its ability to incentivize providers for providing high-quality, low-cost care for their patients. And when that happens, everyone wins.


Analysis of Value-Based Payment and Acute Care Use Among Medicare Advantage Beneficiaries

Value-Based Payment Models Associated with Lower Acute Care Use

Humana Value-Based Care Report

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