Humana's value-based contracts shrunk medical costs 16%: 5 notes

Humana released its annual value-based care report detailing how tying payment to performance outcomes affected Medicare Advantage patients and their providers.

The physician-written report, titled "The Intersection of Health + Care," considers quality metrics and prevention measures for 2017. About 1.74 million Medicare Advantage members who see physicians under value-based reimbursement models were included in the survey. Their data was compared to about 130,000 members affiliated with providers paid under fee-for-service Medicare Advantage models.

"Results show that patients affiliated with physicians in Humana MA value-based agreements had more favorable outcomes in all Healthcare Effectiveness Data and Information Set Star measures," Kathryn Lueken, MD, Humana's corporate medical director for medical market clinical integration, wrote in the report. HEDIS, created by the National Committee for Quality Assurance, measures how health plans perform across various metrics.

Here are five findings from the report:

1. Humana covered 3.3 million Medicare Advantage members as of Dec. 31, 2017. Of those members, 1.9 million were affiliated with 52,000 primary care physicians under more than 1,000 value-based care agreements. Those agreements spanned 43 states.

2. The report revealed Medicare Advantage members who received care from a provider through a value-based agreement saw increases in two key primary care services: an 11 percent increase in colorectal cancer screenings and a 10 percent increase in breast cancer screenings.

3. Notably, a 7 percent decrease in emergency room visits and a 5 percent decline in hospital admissions were recorded among Medicare Advantage patients receiving care from providers under value-based arrangements.

4. Physician payment also improved, according to Humana. In 2017, 70 percent of physicians in eligible Medicare Advantage value-based agreements earned shared savings. That's up from 60 percent in 2016. In 2017, 16.8 percent of every dollar spent on medical service went to primary care physicians in value-based agreements.

5. Overall, when compared to original fee-for-service Medicare, Humana said medical costs for patients receiving care from physicians in value-based contracts was 15.6 percent lower.

"The goal of taking costs out of the system and creating more value for the care received is showing results," Dr.  Lueken wrote. "Thus, value-based care is achieving the goal of creating higher quality medical care for lower cost."

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