Humana's Investment in Holistic, Value-Based Care Improves Care and Health of MA Members

Chronic diseases remain a significant challenge for older Americans, and Humana is using a holistic approach, leveraging value-based reimbursement models, to improve health outcomes and quality measures for the insurer’s Medicare Advantage (MA) members, according to a new Humana report, “The Intersection of Health + Care.”

The holistic approach to care that Humana implemented has the primary care physician coordinate patient care with specialists to treat the patient’s chronic conditions. The majority of Humana’s MA members (83%) have at least 2 chronic diseases.

“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,” Roy A. Beveridge, MD, Humana’s chief medical officer, said in a statement. “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.”

The report found that value-based agreements increased preventive measures and kept more patients out of the hospital. When physicians were in value-based agreements, MS members experienced 11% more preventive screenings for colorectal cancer and 10% more screenings for breast cancer compared with standard settings. In addition, when physicians were in value-based agreements, MA members had 7% fewer emergency department (ED) visits and 5% fewer hospital admissions per thousand.

Physicians in value-based agreements also performed better financially. Medical costs for patients attributed to physicians in value-based agreements were 15.6% lower compared with traditional Medicare fee-for-service and 1.0% lower compared with Humana MA fee-for-service.

The holistic approach that Humana is implementing also addresses social determinants of health that impact how well a patient can improve his or her well-being. Andrew Renda, MD, MPH, director of population health at Humana, wrote in the report that the insurer is working to address social isolation and loneliness, as well as food insecurity.

People with social isolation are at greater risk of developing dementia and Alzheimer disease and more likely to be rehospitalized within a year of discharge, according to Renda. “The senior population is particularly vulnerable” to being isolated, he wrote.

Food insecurity can have a significant impact on how well a patient can management a chronic disease. “If left unchecked, hunger and a lack of healthy food can undermine clinical efforts to improve patient health,” Renda wrote.

People who are food insecure have higher levels of diabetes, hypertension, coronary artery disease, and kidney disease; high rates of ED visits, hospital readmissions, and urgent care visits; and a higher probability of mental health issues.

“Looking ahead, Humana will continue to make investments in accelerating our integrated care delivery strategy, which encompasses supporting physician practices and care providers, making it easier for our members to engage at the intersection of health care and lifestyle, and leveraging technologies and clinical analytics that enhance our holistic health approach,” Beveridge wrote in the report.