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    One insurer proves that value-based reimbursement works in practice


    Healthcare payment changes are moving full-speed ahead, with payers reporting that they are 58% along the flow toward full value-based reimbursement, a 10% jump since 2014.

    Case in point, Humana’s value-based reimbursement model with physicians has helped to improve care quality and health outcomes for its Medicare Advantage (MA) program members for the third year in a row.

    Humana’s 2015 value-based care results compared physicians and members under value-based agreements with Humana versus those in traditional fee-for-service settings


    “At a high level, we found three things,” says Humana Chief Medical Officer Roy Beveridge, MD, Managed Healthcare Executive editorial advisor. “First, that physicians in value-based reimbursement agreements with Humana delivered higher quality care. They had 19% higher Healthcare Effectiveness Data and Information Set [HEDIS] scores compared to physicians in standard MA settings based on an internal attribution model. Second, members cared for by physicians in value-based reimbursement agreements had healthier outcomes than in standard MA settings.”

    Among members under value-based care, Humana saw higher screening rates for colorectal cancer (up by 8%), breast cancer (up by 6%), and osteoporosis management (up by 13%). These members also experienced 6% fewer emergency room visits. And, for older adults with special needs, we increased the assessment rate by 5% for pain screening and 10% for medication reviews.

    Third, Humana saw a 20% reduction in medical costs for members cared for by physicians in value-based reimbursement agreements versus an estimation of original fee-for-service Medicare costs.

    “These cost reductions may benefit members in a number of ways, including future reductions in out-of-pocket costs and lower premiums,” Beveridge says.

    “We hope these results are encouraging to managed care executives as they look for ways they can drive quality and cost improvements in the near term,” he adds. “It’s especially timely, considering that our government has set forth ambitious targets that tie more care to quality metrics and value-based reimbursement. The 2015 results show that value-based reimbursement models do work in practice, not just in theory.”

    For the 2015 results, Humana compared two data sets. First, they looked at quality metrics and outcomes for approximately 1.2 million MA members affiliated with physicians in value-based reimbursement agreements with Humana. Then, that data set was compared to quality metrics and outcomes for 170,000 members cared for in standard MA settings.

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