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Humana Advances Population Health Management, Value-Based Care

Humana has achieved better health outcomes by investing in population health management and value-based care reimbursement.

Source: Thinkstock

By Vera Gruessner

- The health insurer Humana has been progressing with population health management and value-based care by partnering with the population health company FullWell in December 2016, according to a company press release. The partnership creates a more wellness-centered medical care approach with a focus on preventive services.

Through the value-based care reimbursement structure, physicians in the FullWell network will be financially incentivized to provide better quality of care. Humana Medicare members within the FullWell’s Colorado Health Neighborhoods Network will be served through this value-based care approach. The members will have access to more than 150 FullWell primary care physicians across Denver, Colorado.

“FullWell’s mission and vision is to enable physicians to succeed in the transition to value-based health care. In a time of change, uncertainty, and increasing administrative burden, FullWell provides population health capabilities that help providers offer high quality, affordable care to their patients and transform their practices,” said Dr. Creagh Milford, FullWell’s Chief Executive Officer.

Healthcare providers who lack the resources needed to enter value-based care payment arrangements could work with Humana and FullWell to receive the support necessary to invest in alternative payment models. Multiple services would be available to providers to advance their value-based care platform.

FullWell and Humana will strive to reduce healthcare spending and boost their population health management as part of the new agreement. Physician practices participating in the Humana and FullWell value-based care program will use population health management tools to find and decrease gaps in care, increase medication adherence, and identify at-risk patients to provide the right care and reduce emergency room visits.

“Our new agreement with FullWell is bolstering the future of health care right here to Colorado. We are proud to support FullWell in building upon what is already a well-integrated care delivery system by providing Humana’s care management support to the relationship,” said Mark Iorio, Central West Region Medicare President for Humana.

“FullWell’s care teams are focused on coordinating care around each patient’s unique health needs,” he continued. “By working with Humana, we are helping to strengthen FullWell’s team-based approach to care delivery, providing useful information, incentives, and resources to help those teams operate at their very best.”

The focus on population health management and value-based care reimbursement has brought better patient health outcomes for Humana’s Medicare Advantage members. In 2015, Humana Medicare Advantage beneficiaries saw improved cancer screening rates with an 8 percent rise in colorectal screening and a 6 percent rise in breast cancer testing as well as 6 percent fewer emergency room visits.

Medicare Advantage members treated in value-based care reimbursement programs had better health outcomes when compared to standard fee-for-service healthcare settings.

The transition to value-based care reimbursement from the more traditional fee-for-service payment structure at Humana represents a greater focus on disease prevention and patient wellness. Instead of paying physicians for the number of medical services performed, value-based care reimbursement rewards doctors for improving patient health outcomes.

By September 30, 2016, about 63 percent of Humana Medicare Advantage members were being served in value-based care reimbursement arrangements. Humana plans to expand and serve 75 percent of their Medicare Advantage beneficiaries in value-based care payment structures by the end of 2017.

Humana’s value-based care partnerships have shown 19 percent higher Healthcare Effectiveness Data and Information Set (HEDIS) scores in 2015 when compared to standard Medicare Advantage settings, according to a Humana press release. Additionally, the health insurance company was able to reduce costs by 20 percent in 2015 for patients treated through value-based care payment arrangements. Pain screening and medication review for older adults treated through value-based care also grew by 5 and 10 percent, respectively.

“Our integrated approach to partnering with providers enables us to improve the health care experience for consumers in multiple ways,” said Bruce D. Broussard, Humana’s President and Chief Executive Officer. “We’re able to offer more affordable health plans, help people improve their health through comprehensive, holistic engagement with them, and also drive higher physician satisfaction.”

The type of value-based care arrangements Humana pursued in 2015 include population health management and accountable care programs across the states of New York, Indiana, and Pennsylvania. For example, the New York-based provider North Shore-LIJ Health System transitioned from fee-for-service to a value-based care payment strategy with Humana. This shows how Humana has been advancing both population health management and value-based care across their provider networks for multiple years.

National health insurance companies like Humana are likely to continue expanding their value-based care partnerships in the coming years. Small-to-medium-sized payers will need to follow in their footsteps in order to compete effectively in the health insurance market.


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