Humana Expands Value-Based Care to Medicare Advantage Members in OR

January 04, 2022 - Humana has partnered with Vancouver Clinic to expand value-based primary care services to Medicare Advantage members in Oregon.

The primary care practice, Enliven by Vancouver Clinic, will be available to residents in Gresham, Oregon and will accept Humana Medicare Advantage health maintenance organization (HMO) and preferred provider organization (PPO) plans that are offered in the state.

“We are grateful for the opportunity to bring Enliven to Gresham, which will improve access to quality care,” Jesse Gamez, president of Medicare in the intermountain region for Humana, said in the press release.

“By combining Humana’s strong focus on improved member experience and clinical outcomes and Vancouver Clinic’s long-standing commitment to patient care, we are able to offer primary care that is dedicated to helping our members achieve their best health.

The partnership will help increase access to care for older individuals in Oregon by providing Medicare Advantage members with a number of healthcare services, according to the payer.

“We know access to healthcare is critically important to good health. We think it’s important to provide care close to where patients live,” Mark Mantel, chief executive officer of Vancouver Clinic, stated in the press release.

The practice, which is located in Gresham, will offer integrated care teams consisting of doctors, nurses, nutritionists, health coaches, and nutritionists to Humana Medicare Advantage members.

Additionally, the care team can provide medication management and social services resources to help members navigate the health system and ensure holistic care, the press release stated.

The clinic aims to foster positive patient-provider relationships by offering physical and mental healthcare services and routine health and wellness classes.

Enliven builds on the past value-based care relationship between Humana and Vancouver Clinic. In November 2020, the organizations opened Evergreen Place in Vancouver, Washington. The neighborhood clinic offers patient-centered care to Humana Medicare Advantage HMO and PPO plan members and dual eligible members on a Humana Dual Eligible Special Needs Plan.

As of September 2021, the payer serves more than 3.1 million Medicare Advantage and commercial members across 44 states and Puerto Rico. Its value-based care network consists of more than 72,000 primary care providers. Including members in value-based and standard Medicare Advantage plans, Humana serves around five million Medicare Advantage members.

The new Enliven offering is not the first time Humana has worked to expand value-based care to Medicare Advantage members.

In November 2021, the payer announced a value-based contract with Allina Health that aimed to increase access to value-based care for Medicare Advantage members in Minnesota starting January 1, 2022.

The payer’s Medicare Advantage value-based care models led to positive member health outcomes during 2020, according to a value-based care report that Humana released.

For example, hospital admissions among Medicare Advantage members in value-based care contracts dropped by seven percent and emergency room visits fell by 12 percent compared to Medicare Advantage members in plans without value-based care models.

Additionally, Medicare Advantage members in plans with value-based care agreements had 245,000 fewer days in the hospital than their counterparts in a plan without a value-based care agreement.

Value-based care contracts also led to higher utilization of primary care services among Medicare Advantage members, the report indicated.

Humana is also a part of a value-based contracting model for traditional Medicare plans in which it planned to partner with providers to improve care coordination for traditional Medicare beneficiaries.