Humana Value Report Shows Progress for Medicare Advantage Members Affiliated with Providers in Value-based Care Agreements

Business Wire

Fifth year of reporting value-based care reveals quality improvements and lower cost

LOUISVILLE, Ky.--(BUSINESS WIRE)-- For the fifth year in a row, Humana Inc. (NYSE: HUM) unveiled findings that detail how physician practices in value-based care agreements are increasing preventive care, improving health outcomes and quality measures, and lowering overall health care costs for Humana Medicare Advantage (MA) members.

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Written by physicians, Humana’s Value-based Care Report, titled “The Intersection of Health + Care,” details the clinical and economic impact of integrated care delivery, examining patient care and the experience of physicians. The report, which can be accessed by clicking here, also details physician progress controlling blood sugar, blood pressure and medication adherence for people with diabetes.

A holistic approach based inside and outside the clinical setting

While Humana’s Value-based Care Report details continued progress, chronic disease and other factors still represent significant challenges to America’s older adults. Humana’s report details how the company is using a holistic approach, leveraging value-based reimbursement models, to address the 83% of its 3.3 million Humana MA members, as of December 31, 2017, living with at least two chronic diseases.

This holistic approach centers around the primary care physician, who coordinates patient care in an environment where patients can have multiple specialists treating their chronic conditions. The approach also addresses how social determinants of health – like food insecurity, loneliness and social isolation – impact patients’ ability to improve their well-being.

“Humana is thankful to the countless physicians and other health care providers whose dedication to their patients is a major reason why value-based care is changing health care for the better,” said Bruce D. Broussard, Humana’s President and Chief Executive Officer. “As Humana continues to expand the functionality of our integrated care strategy with investments in home health and data analytics, we will employ those capabilities to become an even stronger supporter of physician practices as they navigate to value.”

Strong results from value

Below is a snapshot of Humana’s core results spanning quality, prevention, utilization and cost:

HEDIS scores reflected ongoing commitment to quality. Physicians in value-based agreements from 2014 through 2017 had a 4.21 average Healthcare Effectiveness Data and Information Set (HEDIS) Star score at the end of 2017 based on 672,000 Humana MA members. HEDIS is a measurement tool developed by the National Committee for Quality Assurance (NCQA) to assess health plans’ performance on various dimensions of care and service.*
More preventive measures were taken when physicians employed an integrated approach based on value. Humana MA members affiliated with physicians in value-based agreements experienced 11 percent more preventive screenings for colorectal cancer and 10 percent more breast cancer screenings compared with standard MA settings in 2017.
Value-based models helped physicians keep more of their patients out of the hospital. Humana MA members affiliated with physicians in value-based agreements experienced 7 percent fewer emergency room visits and 5 percent fewer hospital admissions per thousand compared with standard MA settings in 2017.
Costs were lower under the holistic approach based in value. Medical costs for patients who are affiliated with physicians in Humana MA value-based agreements were 15.6 percent lower than original Medicare FFS. These medical cost reductions can benefit plan members through reduced out-of-pocket costs -- and, in future years, lower member premiums -- and/or additional benefits. In addition, 10 percent more physician groups experienced shared savings in 2017 vs. 2016.

“Practicing value-based care works to address the nation’s chronic disease epidemic by giving physicians the support and data they need to focus more on prevention and reduce acute care episodes,” said Roy A. Beveridge, M.D., Humana’s Chief Medical Officer. “This model allows physicians to focus time and energy on those patients who need the most support to stay well at home, and out of the hospital. Physicians are clearly seeing the benefit of improved patient outcomes and more shared savings.”

Humana’s Report Methodology and Value-based Stats

The 2017 results, as with the previous results, cannot be directly compared year over year due to multiple demographic changes in Humana’s member population.

Humana compared quality metrics and prevention measures for calendar year 2017 for approximately 1.74 million Medicare Advantage members who were affiliated with providers in value-based reimbursement model agreements to approximately 130,000 members who were affiliated with providers under standard Medicare Advantage settings, which doesn’t offer added incentives to providers who meet quality or cost targets.

*Humana has a model for attributing HEDIS ratings to practices by using member results to each HEDIS measure issued by the NCQA. The member results to each HEDIS measures are then compared to thresholds published by CMS in order to calculate the HEDIS Star score.

Humana also compared medical cost and utilization for calendar year 2017 for approximately 1.5 million Medicare Advantage members who were affiliated with providers in value-based reimbursement models to approximately 146,000 members who were affiliated with providers under standard Medicare Advantage settings as well as to original fee-for-service Medicare. Original fee-for-service Medicare cost, admission and emergency room estimates were derived using CMS Limited Data Set Files from 2016 and are subject to restatement with the availability of more current CMS data.

As of Sept. 30, 2018, Humana’s total Medicare Advantage membership is more than 3.5 million members, which includes members affiliated with providers in value-based and standard Medicare Advantage settings. For more information, visit humana.com/valuebasedcare.

About Humana

Humana Inc. is committed to helping our millions of medical and specialty members achieve their best health. Our successful history in care delivery and health plan administration is helping us create a new kind of integrated care with the power to improve health and well-being and lower costs. Our efforts are leading to a better quality of life for people with Medicare, families, individuals, military service personnel, and communities at large.

To accomplish that, we support physicians and other health care professionals as they work to deliver the right care in the right place for their patients, our members. Our range of clinical capabilities, resources and tools – such as in-home care, behavioral health, pharmacy services, data analytics and wellness solutions – combine to produce a simplified experience that makes health care easier to navigate and more effective.

More information regarding Humana is available to investors via the Investor Relations page of the company’s web site at www.humana.com, including copies of:

Annual reports to stockholders
Securities and Exchange Commission filings
Most recent investor conference presentations
Quarterly earnings news releases and conference calls
Calendar of events
Corporate Governance information

Additional Information

Humana is a Medicare Advantage HMO and PPO organization with a Medicare contract. Enrollment in any Humana plan depends on contract renewal. Other providers are available in our network.

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