Value-based contracts led to better care quality, says Humana

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Looking at new data published on its Medicare Advantage members, major insurer Humana found that those MA patients receiving value-based care had better outcomes overall, along with lower costs and more preventative care.

The findings were published in Humana's annual value-based care report, which also found that 67% of its individual MA members seek care from primary care physicians in value-based agreements. That statistic is unsurprising, considering that, as of the end of last year, about 67,800 primary care physicians had value-based contracts with Humana. These affiliations span more than 1,000 agreements in 43 states and Puerto Rico. 

As of Dec. 31, 2020, Humana's total MA membership was approximately 4.6 million members, including roughly 3.96 million individual MA members and 613,200 group members.

Drilling down further into the numbers reveals that the vast majority of Humana MA members – almost 90% – have at least one chronic condition, while about 83% have at least two chronic conditions. Humana pointed to these statistics as evidence that value-based frameworks are appropriate for these populations, given that the care model is more focused on prevention.

WHAT'S THE IMPACT?

Care consistency is one of the major reasons why value-based models tend to result in better outcomes for MA members, Humana said. Despite the trend during the COVID-19 pandemic of deferring care, 86% of the insurer's MA members still saw their value-based primary care physicians at least once last year, compared to 78% among those in non-value-based arrangements. MA members also saw their primary care physicians more often.

This consistency, the numbers showed, reduced incidences of hospital admissions and emergency room visits during 2020 for value-based members – 7% and 12% lower, respectively – compared to those with non-value-based healthcare providers. Hospitalization avoidance fared even better – it was a whopping 22% less – when measured against original Medicare.

More MA members also use telehealth for behavioral healthcare than their non-MA counterparts, the data showed. MA members affiliated with value-based physicians took part in nearly 628,000 behavioral visits, representing roughly 21% of all telehealth visits in 2020. The usage rate per thousand among value-based members over non-value-based members hovered between 5% and 10% each month between May and December.

The availability of home healthcare to MA patients was highlighted as well. MA members affiliated with value-based physicians and receiving home health services had a 60% lower risk of readmission to a hospital within 30 days of discharge and a 45% lower readmission risk within 60 days, the numbers showed. And care of those members resulted in an 11% lower total 90-day healthcare cost, including costs associated with home healthcare.

Costs and finances are other reasons why Humana is touting value-based arrangements. To help solidify the financial footing at the pandemic's height in 2020, Humana accelerated value-based and quality-recognition payments, which reportedly reduced practices' fiscal concerns. Preventative care lowered the usage of acute care services, and value-based physicians reduced avoidable hospitalizations by 11% over their fee-for-service counterparts.

That, in turn, led to an estimated medical cost savings of 13.4% compared to original Medicare. That percentage amounts to a $3.1 billion reduction in medical costs that would have been incurred by value-based members during 2020 had they been enrolled in original Medicare, Humana found.

THE LARGER TREND

Insurers are expanding their Medicare Advantage offerings at a decent clip, with Humana announcing in October that it would debut a new Medicare Advantage PPO plan in 37 rural counties in North Carolina in response to market demand in the eastern part of the state.

Around the same time, UnitedHealthcare, which already has significant market control with its MA plans, said it will strengthen its foothold in the space by expanding its MA plans in 2022, adding a potential 3.1 million members and reaching 94% of Medicare-eligible consumers in the U.S.

For the third straight year, health insurer Cigna is expanding its Medicare Advantage plans, growing into 108 new counties and three new states – Connecticut, Oregon and Washington. The move will increase its geographic presence by nearly 30%.

Centene is also getting in on the act, expanding MA into 327 new counties and three new states – Massachusetts, Nebraska and Oklahoma. In all, this represents a 26% expansion of Centene's MA footprint, with the offering available to a potential 48 million beneficiaries across 36 states.

The Centers for Medicare and Medicaid Services said in late September that the average premium for Medicare Advantage plans will be lower in 2022, at $19 per month, compared with $21.22 in 2021. However, Part D coverage is rising to $33 per month, compared with $31.47 in 2021.

Enrollment in MA continues to increase, CMS said. In 2022, it's projected to reach 29.5 million people, compared with 26.9 million enrolled in a Medicare Advantage plan in 2021.
 

Twitter: @JELagasse
Email the writer: jeff.lagasse@himssmedia.com