Humana Value Based Care 2019 Highlights

Humana Value Based Care 2019 Highlights


I’d like to thank you all for joining us for
today’s event: The Future of Primary Care. Humana sponsored, and POLITICO organized,
an event to take a deep-dive into primary care and the changing landscape in primary
care. Humana was very excited to be able to release
our sixth annual Value-based Care Report today. Value-based care is a model where instead
of reimbursing providers on a fee-for-service basis that encourages volume, we pay them
for the value of the care that they provide with a focus on improving health outcomes
and preventative measures. We’re seeing better quality scores for patients
that are in value-based arrangements, fewer visits to the emergency room – 14.6% lower
than in traditional Medicare. 27% lower admissions to the hospital and overall,
about a 20% reduction in total healthcare costs. The value-based model provides additional
resources for physicians. They keep more of the health care dollar than
any traditional fee-for-service model. It gives them the opportunity to spend more
time with their patients, get to know some of the other things that may be going on with
those patients and really, help improve their health. Value-based care has produced a laboratory
of true care transformation. We’re talking about somewhere between three
quarters and $1 trillion a year that’s being wasted in healthcare. There are proven interventions that if scaled,
could reduce that waste by approximately 50%. We’ve seen incredible progress over the
last five years with respect to decreasing complexity required of our physicians to report
on quality measures. We’ve also seen a movement from check-the-box
quality measurement more towards quality measures that really matter, that incentivize outcomes
in patient health – like blood pressure control, diabetes control hospitalizations, readmissions
and emergency room utilization. The context of a person’s life has a huge
impact on their health. If they’re socially isolated, if they have
housing instability, food instability, difficulties with transportation – these factors all are
highly correlated with the patient’s health outcomes and their health care costs. Hopefully, we’re encouraging more physicians
to get engaged in those conversations around social determinants and other barriers to
patients actually carrying out a healthcare delivery plan. It’s more important than ever to have involvement
with our community centers, expand the team for primary care – including pharmacists,
social workers, dietitians – who all need to work together to manage patients with chronic
care. That’s where a real partnership with a health
plan, a real partnership in a value-based arrangement with a payer – can help fill in
the gaps. If we can leverage the physician relationship
to help bring access, we can create more capacity in that patient’s life – so that they will
actually carry out the healthcare behavior you want them to, get healthier and keep them
out of the hospital. And then, it becomes this virtuous cycle that
there’s more dollars in the healthcare delivery system because we’re not spending it on acute
care that we can put back into program services, better integration, better data aggregation
for the membership. You need to change that confrontational relationship
between a payer and provider to one that’s more aligned. A health plan may create administrative barriers
– like prior authorization – for a provider to reduce the waste of too much of a specific
type of procedure. The provider experiences just more administrative
complexity, time spent that does not provide value for a patient. Sometimes there’s a conflict between certain
portions of the healthcare delivery system that are volume-based and still are moving
toward increasing volume, which would increase costs and others that want to work in a value-based
setting, which does not emphasize volume. It is really important because it builds this
important foundation to manage and work with patients to improve their health, and that
is critical, that partnership. We’re going to be looking to primary care
docs to say, How can we do better? Because the more we roll up our sleeves together,
the more we figure out how to partner together to really solve this problem of delivering
the best care, the most integrated care, the most effective care, the most coordinated
care for our members and reduce as much waste as possible. That is how we’re going to solve some of the
biggest problems we have in healthcare today.

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About the Author: Oren Garnes

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