Humana reports successful outcomes from ACO

Louisville, Ky.-based health insurance company Humana reported accountable care programs produced positive, measurable results in 2013 for quality of care and lower costs for one million Medicare Advantage beneficiaries.

Humana reported the following results for its accountable care continuum, as compared to traditional fee-for-service settings:

  • Accountable care providers received a Healthcare Effectiveness Data and Information Set Star score average of 4.25, compared to the 3.65 average score of providers in traditional settings. HEDIS Star scores measure managed care performance.
  • Emergency room visits decreased 7 percent per thousand for accountable care beneficiaries.
  • Inpatient admissions decreased 4 percent per thousand.
  • Among Medicare Advantage beneficiaries with diabetes, there was a 7 percent increase in screening compliance for cholesterol, eye exam and blood sugar.
  • Cholesterol screening compliance for cardiovascular care increased 5 percent.
  • BMI screening compliance increased 5 percent.
  • Colorectal cancer screening compliance increased 7 percent.
  • Humana's costs improved 19 percent in 2013 in total in accountable care treatment settings compared to traditional Medicare settings.

Findings are based on results from 1 million members in 2013, and 800,000 members for cost, emergency room and inpatient admissions data.


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