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Humana’s Value-Based Care Platform Decreased Costs by 20%

Humana uses a value-based care platform for its Medicare Advantage members to improve patient outcomes and reduce spending.

By Vera Gruessner

The health payer Humana released positive results within its Medicare Advantage program for the third year in a row, according to a company press release. The value-based care platform used at Humana indicated 19 percent higher HEDIS scores among its provider network when compared to fee-for-service Medicare Advantage programs.

Medicare Advantage Population

The results come from 1.2 million Medicare Advantage members enrolled in coverage last year. The value-based care platform used led to better patient health outcomes across the board.

The Humana value-based care platform also showed better patient outcomes with a 6 percent decrease in emergency room visits, 8 percent rise in the colorectal screening rate, a 13 percent increase in osteoporosis management, and a 6 percent growth in breast cancer screening rates. Pain screening and medication review also saw an improvement of 5 and 6 percent.

“Since many chronic conditions are the result of long-term behavioral decisions, it’s essential that health plans and physicians are in complete alignment,” said Roy A. Beveridge, MD, Humana’s Chief Medical Officer. “At Humana, we’re deeply focused on working with physicians and within communities to make it easier for people to achieve their best health. That means addressing the clinical and behavioral aspects of a person’s health. Our population health results clearly reflect this holistic approach.”

Additionally, Humana found a 20 percent reduction in cost among providers who utilized a value-based care payment strategy. The press release also outlines that significant reductions in spending for payers leads to lower premiums, better benefits, and a decrease in out-of-pocket costs for Medicare Advantage beneficiaries.

“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.”

Humana was able to better manage populations with chronic diseases and align itself with the goals of the Centers for Medicare & Medicaid Services to transition from fee-for-service to a value-based care platform. Provider networks moving forward with payers like Humana and embracing value-based care are seeing better results in terms of patient health outcomes.

“In a value-based environment, Oak Street Health is held accountable on how we can quantifiably improve health outcomes,” Dr. Griffin Myers from Oak Street Health explained how his practice transitioned to value-based care under Humana’s leadership. “A value-based agreement drives our physicians to develop patient relationships where the goal is helping a patient reach his or her full health potential.”

The payer uses a pay-for-performance guideline that has reduced spending and improved clinical outcomes among its Medicare Advantage member population. Humana serves 1.8 million Medicare Advantage members and 200,000 non-Medicare commercial policyholders across the United States with about 63 percent of this population managed under a value-based care platform.

Results from a Premier survey exhibit that health payers have been slow to implement alternative payment models linked to value-based care. Healthcare payers will need to look to the example of Humana and implement value-based care payment models as they move into the future of healthcare reform.


Dig Deeper:

How Payers Should Prepare for Value-Based Reimbursement

How to Overcome the Challenges of Bundled Payment Models


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