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Providers see higher HEDIS scores in Humana value-based arrangements for Medicare Advantage

The value-based models resulted in 6 percent fewer hospital inpatient admissions and 7 percent fewer emergency department visits.

Susan Morse, Managing Editor

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Providers in value-based reimbursement agreements with Humana's Medicare Advantage plans had 26 percent higher Healthcare Effectiveness Data and Information Set, or HEDIS scores compared to providers in standard MA settings, according to a new Humana report.

Value-based reimbursement models in 2016 resulted in 6 percent fewer hospital inpatient admissions and 7 percent fewer emergency department visits than patients who got care with providers not in these agreements, according to Humana.

[Also: Humana selling long-term business, lays off 6% of workforce]

The number of preventive screenings was 8 percent higher for breast cancer and 13 percent higher for colorectal cancer.

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Physicians also had higher quality scores, and total costs were lower compared to traditional fee-for-service Medicare.

[Also: Humana profits drop 11% as insurer cuts 2,700 jobs]

Primary care physicians in these value-based agreements received 16.2 percent of the total payments Humana distributed to physicians in 2016, according to the insurer's new "Making Progress, Seeing Results" report. The national average is 6 percent for PCPs, Humana said citing an American Academy of Family Physicians report.

Medical costs were 15 percent lower versus those affiliated with physicians under original fee-for-service Medicare. This translates  as reduced out-of-pocket costs, lower premiums, and/or additional benefits for members.

Value-based contracts are shown to offer improvements in chronic condition management in controlling blood pressure, diabetes,  blood sugar and medication adherence.

Over six in 10 Medicare beneficiaries are living with more than one chronic condition, according to the Centers for Medicare and Medicaid Services.

Humana said its chronic condition approach centers on an integrated care delivery model and the role of the PCP in managing all aspects of the patient's care and in coordinating specialists.

"Our 2016 health and quality results reflect continued investment in our integrated care delivery model, such as enhanced data analytics to help providers identify and address unhealthy behaviors," said Humana CEO Bruce D. Broussard.

Humana's report also references the impact that social determinants of health -- such as food insecurity, loneliness and social isolation -- can have on an elderly Medicare Advantage member's health and well-being. For example, Humana's research has shown that an older adult who is lonely or socially isolated is four times more likely to be readmitted to a hospital within a year of discharge.

"Based on our experience, the value-based care model helps physicians spend more time with their patients, which builds stronger relationships between the physician and patient," said Roy A. Beveridge, M.D., Humana's CMO. "The result is a bond of trust, which serves as the foundation for changing unhealthy behaviors and addressing social determinants of health. As we've seen at Humana, supporting physicians with actionable data gives them a deeper understanding of their patient − and that can result in more preventive care, which leads to better chronic condition management."

Humana first disclosed Medicare Advantage value-based member results in 2013. The 2016 results, as with the previous results, cannot be directly compared due to multiple demographic changes in member population, Humana said.

Humana compared quality metrics and prevention measures for approximately 1.65 million Medicare Advantage members who were affiliated with providers in value-based reimbursement models to 191,000 members who saw providers which didn't have added incentives to meet quality or cost targets. The results were based on medical claims.

As of September 30, 2017, Humana has reached its calendar year goal of having approximately 66 percent of Humana individual Medicare Advantage members in value-based payment relationships.

Twitter: @SusanJMorse
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