Healthcare

At a time in which the health care industry is moving away from fee-for-service models – hundreds of industry professionals signed up for a webinar to learn more about Humana’s approach, best practices and success in value-based care agreements.

On December 6, Vice President Caraline Coats of Humana’s Provider Development Center of Excellence participated as a panelist in FierceHealthPayer’s “Best Practices for Value-Based Payment Arrangements.” Coats was joined by fellow panelist Tom Leyden, Director of Value Partnerships at Blue Cross Blue Shield of Michigan, with FierceMarkets senior editor Leslie Small serving as moderator.

Humana is proud to have been in the value-based space for more than 30 years. Coats, who leads Humana’s efforts in support of physicians and providers in value-based care relationships with the company, provided an overview of the company’s approach – how Humana helps providers as they move from volume to value, and how we’re meeting challenges inherent in the process:

•  The results tell the story. Patients treated by physicians in Humana value-based arrangements experience better health outcomes and lower costs than in traditional fee-for-service models.

•  Humana’s Integrated Care Delivery model brings simplicity and connectivity to the healthcare experience. Through best practices, Humana leverages people, process, and technology to facilitate successful partnerships.

•  Humana develops a long-term understanding of a provider’s needs and capabilities, and meet them along the way on the value-based continuum.

Humana does not believe in a “one-size-fits-all” agreement structure, and offers different relationship options to meet specific provide needs depending on infrastructure, capabilities, and level of commitment in moving from volume to value. This includes a range of possible Partnership Models that range in degree of equity investment.

Those who registered for the webinar come from a wide range of affiliations, representing hospitals, physician practices, pharmaceutical companies, insurers, universities, federal and local health care agencies, law firms, and other entities.

To view or listen to a recording of the webinar, click on this link to “post-register” for the webinar. You’ll then receive an email confirmation with a second link. When you click on that second link, you can view the slides and play the webinar audio.

And for additional information on Humana and value-based care – including services and support; payment models; and results – please visit https://www.humana.com/provider/support/vbc/.

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Fifty-four percent of family physicians indicate their practices participate in value-based payment models and half believe value-based payment models will encourage greater collaboration between primary care physicians and specialists, according to a recent study on physician acceptance of value-based payment. The results were shared by the American Academy of Family Physicians (AAFP) and Humana in a congressional briefing this week.

The results are from a follow-up study conducted by the AAFP and sponsored by Humana. The study found that more and more family physicians are embracing value-based payment models, which is reflected in IT, care coordination and other investments. According to the study, family physicians are:

  • Acknowledging a connection between quality and payment. Thirty-seven percent of value-based payments distributed within a family physician’s practice are based on achieving quality and/or outcome measures, an increase from 18 percent as reported in 2015.
  • Investing in care coordination as part of their approach to value-based payment models. Thirty-two percent of family physicians report that they provide ongoing care management/coordination services to all high-risk patients, an increase of 23 percent from 2015. Forty-three percent cite hiring/hired care management and care coordinators, compared to 33 percent in 2015.
  • Earmarking more practice resources for value-based payment. Fifty-four percent of family physicians are in a practice that is updating or adding health IT infrastructure for data management and analysis to participate in value-based payment.

But the same barriers to navigating and implementing value-based payment models that the AAFP and Humana identified two years ago are still prevalent:

  • Lack of staff time (90 percent).
  • Lack of transparency between payors and providers (78 percent).
  • Lack of standardization of performance measures (78 percent).
  • No uniform insurance company reports on performance (75 percent).

Additionally, only 8 percent of family physicians agree with the statement “quality expectations are easy to meet in VBP models,” down from 13 percent in 2015.

The 2017 Value-based Payment Study was sent to 5,000 active members of the AAFP. A total of 482 surveys were returned, and 386 were evaluated after a screening process. For a more detailed review, click here.

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Bruce BroussardIn a series of LinkedIn Influencer blog posts, Humana President and CEO Bruce Broussard shares insights and ideas about the future of health care and discusses the importance of working together to improve the health-care system as well as our own health and well-being. His latest — Who are the forgotten soldiers of health care? — is reprinted below. To see all of his blog posts, click here.

If I were to ask you about the forgotten soldiers of health care, you might think about hard-working nurses and clinicians, or the ER staff that works diligently through the night. While these professions are absolutely critical to our nation’s health care system, my thoughts go closer to home, to family.

Think about how difficult it is to care for someone who is over 65 and needs assistance at home. Whether it’s managing multiple medications or monitoring blood-sugar levels, in-home care for an older person living with chronic conditions takes a team approach.

Primary care physicians can quarterback care and coordinate among specialists, and nurses can make sure care is efficient and consistent.

But beyond the traditional doctor/patient relationship, there is a forgotten soldier. This person is not a doctor or a nurse or a licensed care professional. Many times the person does not work in the health care industry. But they have the most unbreakable bond with the patient: They are family. That person is the caregiver.

And this was reinforced for me during a recent visit to Houston.

Meet “George”

While I was in Houston, I was fortunate enough to participate in an in-home visit with one of our members, “George.” I also met his wife, “Mary,” their daughter, “Beth,” and several members of George’s clinical team.

George is 71 years old and is in a Medicare Advantage PPO plan. He lives with multiple chronic conditions, including coronary artery disease and hypertension, and he has undergone a coronary artery bypass.

Living with these multiple chronic conditions is not easy for George, and it also takes a toll on Mary and Beth. Treating these conditions requires a holistic approach.

For example, Humana and our partners — physicians, nurses and clinical care experts — help care for George in a number of ways. He receives occupational therapy to strengthen his upper extremities and fine motor muscles, and physical therapy, primarily for his lower extremities and gross motor muscles. Under the direction of a care professional, George also receives support for personal care and activities of daily living, like feeding, showering, dressing, etc.

The Sit Down

Both George’s nurse and his therapist led the visit. His wife and daughter were there, too.

From the start, it was evident that the nurse and therapist had a strong, personal bond with George, Mary and Beth. The nurse and therapist, both of whom I could see were an unofficial extension of the family, understood the critical care and emotional support that Mary and Beth provided to George.

At the end of the 30-minute visit, I asked George what was most important about the care he received. He said he appreciated help from people with a positive attitude; he liked the quality of the interaction and not being “rushed;” and he noted the dependability of the team members, who always show up and follow through.

The care team benefitted too, enhancing their already deep, holistic understanding of George and reinforcing the bond of trust. It was clear to me that this care team – family and clinical – had been making a difference in George’s life, and that he was thankful.

The Importance of Caregivers

November is National Family Caregivers Month, a time to recognize the critical care provided by approximately 43.5 million caregivers. Their work had an estimated economic value of $470 billion in unpaid services in 2013. And with the senior population growing, many of us are going to find ourselves in the shoes of Mary and Beth – as caregivers.

These forgotten soldiers of health care will help determine how well America copes with the rising tide of chronic conditions. I’m encouraged, having seen firsthand how Humana’s Caregivers Network Resource Group is providing resources for our employees caring for family members and other loved ones.

While George has a very strong clinical team and family support network, there are many members who are not as fortunate. They are socially isolated and don’t have family to turn to for care. Their children may live in different cities. They might not have close relatives or friends.

This is the challenge, and we must be prepared.

It’s only going to become more common

In the caregiving world, relationships matter. Technology can help, maybe by building caregiver networks to identify people who have the time to help. But it’s not going to change health.

Technology is not a substitute for trust between two people. Basic human interactions can’t be replaced with a robot, an app or some other form of technology. It’s the low-tech and human efforts that are most impactful.

Our front-line associates know they can have an impact on the health, well-being and experience of our members. They are in this together, and they know it takes a team built on trust, empathy and emotion to make life better.

Mary and Beth are the unsung heroes, the forgotten soldiers of health care. They have an amazing impact on the people they care for, and on our health care system. You may also get the call – as a wife, daughter, husband or son – to be a caregiver. We need to ensure that we’re all prepared to receive this call, and to act on it.

 

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Maria Hughes, Humana’s Chief Inclusion and Diversity Officer, joined other business leaders in Louisville this week to talk about growth, talent acquisition and opportunities for 2018.

The panel discussion was hosted by Louisville Business First as part of its Grow Louisville event.

Maria said “it is vital to create a stimulating environment where diverse workers can be themselves and feel like each voice is heard and respected,” the newspaper reported. She also noted that “it is vital to attract the right talent that can fit well within a team structure.”

“It’s not just the mix, but making the mix work,” she said. “It’s having the environment in which people feel they can thrive.”

Click here to read the full article in Louisville Business First (subscription required).

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Forbes.com has reported on Humana’s value-based care report, noting that “As Humana Moves Doctors To Value-Based Pay, Medicare Costs Fall.”

“Humana’s shift from fee-for-service medicine to value-based payments for doctors is reducing costs and improving quality of care for seniors enrolled in Medicare Advantage plans,” the story said, citing the study.

The study found that “medical costs were 15% lower in Humana Medicare Advantage plans that paid physicians via value-based models last year compared to costs of those in traditional fee-for service Medicare,” the story noted.

Other highlights of the study include the fact that providers in value-based reimbursement model agreements with Humana had 26 percent higher Healthcare Effectiveness Data and Information Set (HEDIS®) scores compared to providers in standard Medicare Advantage settings based on an internal attribution method. Also, Humana Medicare Advantage members affiliated with providers in value-based reimbursement model agreements experienced 6 percent fewer hospital inpatient admissions and 7 percent fewer emergency department visits than members in standard Medicare Advantage settings. The number of preventive screenings was 8 percent higher for breast cancer and 13 percent higher for colorectal cancer.

“The Humana study is the latest evidence of the potential value-based models have at slowing or reducing spending on Medicare,” Forbes wrote.

Read the full Forbes.com story here.

You can access the full value-based care report here.

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