Humana saves $ 4 billion with value-based care in Medicare Advantage in 2019

While the report covered the year before the COVID-19 pandemic, Humana outlined how it is responding to the needs of doctors through telemedicine and other means, such as its continued focus on limiting social isolation and making sure members have food to enough.

According to a Humana statement, models of care based on value on tools and data that can be used to provide physicians “a broader view of patients’ health”. These models allow clinicians to focus their energies on more targeted monitoring and education on the patients who need it most. 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,” Shrank said. “At the heart of this is the ability of value-based physicians to have access to a complete and comprehensive picture of patients’ health, including their clinical, behavioral and social needs.”

More subscribers BUT than ever. The news comes as enrollment in the Master is reaching an all-time high. CMS recently announced that MA award levels will reach their lowest levels since 2007 and that the agency expects 26 million people, or 42% of Medicare beneficiaries, to be enrolled in an MA plan in 2021. Officials have stated that 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 expects to reach 39 more counties next year, from 2670 to 2709.

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

Almost 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 heart disease (21.4%) and chronic kidney disease (20.8%). CKD will see a major shift in 2021 as CMS will allow more kidney care to be covered through MA plans.

The report released today states that AOS members are getting more value, with value-based deals that have resulted in between 8% and 19% more colorectal screening, diabetic eye exams, and osteoporosis and better glycemic control among members of Humana MA in which doctors take part in these provisions.

Others take risks. According to the report, Humana MA doctors are increasing their higher risk taking through a variety of deals, from 36% taking part in an FFS plus limited shared savings in Medicare A, B and D, to 19% taking on. ” global risk “or full liability in Medicare A, B and D in terms of monthly payments. Outside of value-based care, only 14% of Humana doctors are in pure SBB, so more are now at full global risk than SBB.

The report points out that taking risks is ultimately good for doctors who make the leap – those who earn an average of 2.5 times the Medicare rate card and those in the global risk category earn 4 times as much.

What does it mean by quality. The shift towards value-based care has led to successive increases Data sets and information on health care effectiveness scores, with particularly stark differences favoring value-based care in pain screening, eye exams, glycemic control, and drug reconciliation after hospital discharge. The BMI rating of adults in value-based care is 97%.

Value-based care also led to higher scores for physician involvement, from getting the prescription drugs needed, to coordinating care, to overall care assessments.


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