Reimbursement News

Why Value-Based Care Yields Lower Cost, Higher Quality Care

"The value-based model supports the holistic approach to care that is necessary for effective population health management.”

By Jacqueline DiChiara

- Value-based care is in the lead compared to its fee-for-service competitor, according to Humana’s new Medicare Advantage population health results.

Medicare advantage population health value-based care

“Members treated under the care of providers in value-based reimbursement models with Humana experienced greater quality than those treated by providers in standard Medicare Advantage settings,” stated Humana in a press release.

“Members served by providers in value-based reimbursement models had more screenings and healthier outcomes than their counterparts served in standard Medicare Advantage settings.”

A key finding was Humana members under value-based relationships fared better than those under conventional fee-for-service models, as the former reportedly experienced better quality care and healthier overall results.

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  • More young adults have healthcare post-ACA implementation
  • Humana, comparing the quality and outcomes among nearly 1 million Medicare Advantage members, noted an 18 percent lower cost difference for those members treated by healthcare providers under value-based reimbursement models last year.

    “A strong supporter of the value-based reimbursement model, Humana has helped Medicare Advantage members across the industry experience better quality and healthier outcomes through partnerships with approximately 44,000 providers in value-based reimbursement models as of September 30, 2015,” Humana asserted.

    “The positive impact of the value-based model in Medicare Advantage also reflects Humana’s support of the goal of the Department of Health and Human Services of tying 50 percent of traditional, or fee-for-service, Medicare payments to quality or value by 2018.”

    6 key findings are about cost-reduction and quality

    According to Humana’s primary research results, the benefits of value-based care compared to fee-for-service are plentiful.

    Humana’s results confirmed the value-based reimbursement model produce better quality, more advanced healthcare outcomes, greater levels of savings, better managed chronic conditions, fewer trips to the emergency room, and advanced care for vulnerable patient populations.

    • Humana providers in value-based reimbursement relationships had 21 percent higher Healthcare Effectiveness Data and Information Set (HEDIS) Center for Medicare and Medicaid Services (CMS) Star scores as compared to providers in standard Medicare Advantage settings.
    • Humana Medicare Advantage members in value-based reimbursement model relationships experienced 7 percent fewer inpatient admissions per thousand. In addition, screening rates were higher for the following: colorectal cancer screening (+7 percent) and breast cancer screening (+6 percent).
    • By focusing on quality and health, Humana experienced 18 percent lower costs in total in 2014 for members who were treated by providers in a value-based reimbursement model setting versus original fee-for-service Medicare. When Medicare Advantage plans generate savings, costs are lowered for the government, as well as for plan members through reduced out-of-pocket costs, lower member premiums, and/or additional benefits.
    • For diabetes and osteoporosis compliance, the numbers of screenings for members in value-based reimbursement models were higher for each of the following: diabetes care – eye exam (+9 percent); diabetes care – blood sugar control (+12 percent); and osteoporosis management (+13 percent).
    • 6 percent fewer emergency room visits per thousand than those in standard Medicare Advantage settings.
    • Better management for older adults in vulnerable populations. Higher assessment rates for each of the following: functional status assessment (+15 percent); medication review (+11 percent); and pain screening (+12 percent).

    Humana: value-based care is necessary

    “Putting the physician/patient relationship at the center of care, combined with the transformative power of the value-based reimbursement model, is helping people with Medicare Advantage achieve their best health,” stated Bruce D. Broussard, Humana’s President and Chief Executive Officer. 

    “These results are evident of the strong, trusting agreements we have built with our provider partners and have also led to cost reductions.”

    “The provider community’s embrace of the value-based reimbursement model and continued dedication to patient care, combined with the population health capabilities from health plans, is proving to produce better outcomes for patients, physicians, health plans and society as a whole,” asserted Roy A. Beveridge, MD, Humana’s Chief Medical Officer.

    “As a physician who has practiced for more than 20 years, the value-based model supports the holistic approach to care that is necessary for effective population health management.”