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Humana Saves $4B Through Value-Based Care in Medicare Advantage in 2019


More Humana doctors are taking on full global risk under Medicare Advantage than are still using traditional fee-for-service.

Humana doctors in value-based care programs under Medicare Advantage (MA) saved an estimated $4 billion in medical expenses in 2019, according to the health care giant’s annual report on the impact of value-based care.

Humana’s MA members who saw physicians taking part in value-based care arrangements also spent 211,000 fewer days in the hospital and less time in the emergency department (ED) in 2019, compared with those Humana MA members whose doctors do not take part in value-based models.

While the report covered the year before the COVID-19 pandemic, Humana outlined how it is responding to physician needs through telehealth and other means, such as limiting social isolation and making sure members have enough food.

Value-based care models cover both tools and actionable data to give physicians “’an expanded view of patients’ health,” according to a Humana statement. These models allow physicians to focus their energies on more targeted monitoring and education on the patients who most need it. As interoperability increases, these models will become more effective, said William Shrank, MD, MPHS, Humana’s chief medical and corporate affairs officer.

“Value-based care underscores the need to take a holistic view to help members achieve their best health,” said Shrank. “Central to this is the ability for value-based physicians to have access to a full and complete picture of patients’ health, including their clinical, behavioral and social needs.”

More MA enrollees than ever. The news comes as enrollment in MA is reaching an all-time high. CMS announced recently that MA premium levels would reach their lowest levels since 2007, and that the agency expected 26 million people, or 42% of Medicare beneficiaries, to be enrolled in a MA plan in 2021. Officials said this would represent a 44% increase from 4 years ago.

Humana, which already has a huge MA footprint with 4.5 million subscribers, will be part of that growth as it plans to reach 39 more counties next year—up from 2670 to 2709.

As of the end of 2019, value-based care arrangements covered two-thirds (67%) of the 61,900 primary care physicians who work with Humana. There are 1000 agreements across 43 states and Puerto Rico.

Nearly all Humana MA members (91.2%) have at least 1 chronic condition and 85% have 2; the most common is hypertension (66.1%), followed by type 2 diabetes (30.6%), coronary artery disease (21.4%), and chronic kidney disease (20.8%). CKD will see a major shift in 2021 as CMS will allow more renal care to be covered through MA plans.

The report released today said that MA members are getting more value, with value-based agreements resulted in between 8% and 19% more colorectal screenings, diabetic eye exams, management of osteoporosis, and better glycemic control among Humana MA members who doctors take part in these arrangements.

More are taking on risk. According to the report, Humana MA physicians are increasing taking on more risk through a variety of arrangements, from 36% who take part in a FFS plus limited shared savings in Medicare A, B, and D, to 19% who take on “global risk,” or full responsibility in Medicare A, B, and D in monthly capitated payments. Outside of value-based care, only 14% of Humana physicians are in pure FFS, so a higher share are now in full global risk than FFS.

The report points out that taking on risk is ultimately good for the doctors who take the leap: those who do earn 2.5 times on average than Medicare’s fee schedule and those in the global risk category earn 4 times as much.

What it means for quality. The shift toward value-based care has brought successive increases in Healthcare Effectiveness Data and Information Set scores, with particularly stark differences that favor value-based care in pain screening, eye exams, blood sugar control, and reconciliation of medications after a hospital discharge. Adult body mass index assessment in value-based care is 97%.

Value-based care also brought higher scores for physician engagement, from getting necessary prescription drugs, to care coordination, to overall ratings of care.

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