Humana’s value-based agreements with physicians grew in 2018

Humana has released the findings of its latest value-based care report, detailing how the company is continuing to move away from fee-for-service when it comes to their Medicare Advantage population.

Humana is one of the nation’s largest MA plan providers, with 3.06 million individual members in 2018 and 3.56 million total members. In 2018, 67% of Humana’s total individual MA plan beneficiaries were affiliated with primary care physicians in value-based payment models. That’s about 2.04 million members engaged with 53,400 primary care physicians in value-based care relationships with Humana. Of MA group members, 36% were with value-based physicians.

By comparison, Humana reported 2.9 million individual MA members in 2017, 1.9 million of which were affiliated with physicians in value-based care agreements. However, Humana noted its most recent statistics cannot be directly compared to past reports because the member population sees demographic changes year over year.

Humana’s MA population also has health challenges, with 82.6% of the company’s MA members having at least two chronic conditions and 90.5% reporting at least one chronic condition. The most common chronic condition of the population is hypertension, which affected 2.5 million members in 2018, followed by type 2 diabetes and chronic kidney disease.

Humana has established a financial reward system to push its physician relationships toward value-based care, including additional compensation for meeting quality measures under fee-for-service agreements. Under value-based care agreements, Humana offers FFS plus a bonus plus the opportunity for limited shared savings in Medicare Parts A, B and D. This is an upside only agreement that makes up 36% of its VBC agreements. There is also: a limited value offering (FFS + bonus + care coordination payment + higher portion of shared savings in Medicare Parts A, B and D), full value (FFS + 100% responsible for Medicare Part B expenses and sharing of Part A (may have shared savings or complete responsibility for Part D), and global value (full responsibility for Medicare Parts A, B and D through monthly capitated payments).

MA members were more engaged in their health, with higher rates of care for chronic conditions, more screenings and better medication adherence.

“Because physicians in value-based agreements are held accountable for patient well-being, the annual wellness visit is a valuable tool for them, and they are conducted nearly 10% more frequently than for their Humana non-value-based colleagues,” Todd Prewitt, MD, corporate medical director at Humana, wrote in the report.

However, patient readmissions of both “MA value-based and MA non-value based arrangements, implementing strategic post-discharge care plans and completing immediate follow-ups” were 8%. MA members with VBC physicians did have better outcomes, admitted to the hospital 27% less and visiting emergency rooms 14.6% less frequently. These findings can contribute to lower overall healthcare costs. However, VBC MA members do utilize more healthcare services upfront in visits that can prevent more catastrophic care down the road