As the debate about how to cure our ailing health care system continues both on Capitol Hill and across the country, companies like Humana are demonstrating that Medicare Advantage has a number of structural solutions already in place to help improve patients’ health, make health care more affordable, and improve the overall consumer experience.
For example, right now, the majority of our health care system relies on a fee-for-service model where doctors are paid based on the quantity of services provided — not how much your health improves. As a health and well-being company, Humana believes that we need to transition away from this system so that payments to doctors are linked to improving health outcomes, rather than just for the services they provide.
Imagine going to the doctor’s office and knowing every aspect of your health and well-being are being taken into account. Imagine knowing that your doctor will help you make personalized decisions about your care, including issues not usually addressed in a doctor’s office — like how to access healthy food to keep your diabetes under control or how to connect you to reliable transportation so you can get to your medical appointments. Now, imagine getting this kind of quality, comprehensive care — all for often less money than traditional care.
That’s value-based care.
Today, more than two million Humana members are seeing doctors that operate within a value-based care model, an increase of more than 26,000 members since 2017. To explore how this transformative approach is helping deliver better health and lower costs, Humana released its sixth annual Value-Based Care Report.
Here are 6 ways Humana’s value-based care approach is helping drive better health for our members:
1. It emphasizes preventive care.
Today, health care’s fee-for-service model incentivizes treating patients after they’re sick — not preventing illnesses before they happen. This is a lose-lose situation. Not only do undetected conditions make people less healthy, they can leave people needing more treatment and with more bills to pay.
Because doctors in value-based care agreements are held accountable for their patient’s overall well-being, preventive care is a key part of helping patients identify chronic illnesses sooner to help avoid unnecessary costs.
At Humana, we know that annual wellness visits are the foundation for our members’ care over the following 12 months. Last year, our doctors in value-based care programs conducted nearly 10 percent more annual wellness visits than those in non-value-based programs. These visits give physicians the chance to have one-on-one discussions with their patients, dig deeper into patients’ lives outside of traditional health metrics, and develop a holistic picture of their patient’s health. They also help uncover and diagnose patient problems early. In 2018, our members received 21 percent more screenings to detect conditions like osteoporosis, diabetes, and colon cancer.
2. It helps lower health care costs.
Today, many older Americans struggle with spiraling medical bills. More than half — 53 percent — of seriously ill people with Medicare say they struggle to afford their prescription drugs and hospital bills.
By delivering more preventive screenings and helping patients better adhere to their medication, our approach helps to not only improve members’ health but also lower medical costs. In fact, Humana members in value-based care arrangements had 20% lower cost than traditional Medicare.This adds up to $3.5 billion in avoided covered medical expense that would have been incurred had they been enrolled in traditional Medicare.
3. It helps health care providers look beyond the doctor’s office walls.
Often social, economic, and environmental circumstances like food insecurity, social isolation or access to transportation are the root of why patients aren’t achieving their best health outcomes. For example, we know that seniors who are food-insecure are 50 percent more likely to have diabetes and seniors who are lonely are 64 percent more likely to develop dementia.
Humana’s value-based care approach means that we’re focused on what contributes to an individual’s whole health.
In Kentucky, physicians at the Mountain Comprehensive Health Corp, a non-profit funded by grants from the U.S. Department of Agriculture, Humana, and other community groups, are turning to the Letcher County Farmers Market, known as the Farmacy, to address widespread food insecurity throughout the community. Through this program, Mountain Comprehensive doctors can send patients at risk of food insecurity to the Farmacy with “prescriptions” for healthy doses of fresh fruits and vegetables. In addition to weight loss, the director of clinical affairs says that he has seen patients in the Farmacy program also experience notable drops in blood pressure, cholesterol, and A1C levels, changes that can slow the progression of diabetes.
4. It uses data to get ahead of chronic conditions and help prevent them from getting worse.
Data isn’t just important information, it’s the foundation for better health. Just take it from Dr. Kabir Harricharan Singh, a family practice physician at the University of Tennessee Medical Clinic: “Tom Brady can’t win the Super Bowl by himself. He has to have everybody there.”
With our value-based care approach, not only is patient data accessible and more centralized — but it can be analyzed and shared between doctors and patients. This helps physicians identify patients who may be at risk for ER visits or frequent hospital readmissions, helps coordinate care and treatment — especially when patients have multiple specialists treating their chronic conditions — and proactively alerts physicians to schedule wellness appointments and preventive screenings.
Physicians’ real-time access to medical history, health insights, and treatment options also helps save money. Prescribers who use the electronic health record platform that presents them with alternatives, select a more cost-effective treatment nearly 40 percent of the time.
5. It helps patients take their medication more regularly, which may improve their health.
While roughly two-thirds of Americans have a prescription, 50 percent do not take their medication, resulting in 125,000 premature deaths every year. Neglecting to take prescription medication presents a huge problem to public health. Since 90 percent of our members live with at least one chronic illness, we know keeping them healthy means helping make sure they keep up with their medication.
That’s why our value-based care relationships use a collaborative approach where providers, physicians, and pharmacists work together instead of in silos to ensure patients are managing their medication. The results speak for themselves.
By having Humana pharmacists check in with members regularly, speak directly with members’ doctors, and use data and analytics to identify missed prescription refills, Humana’s 90-day mail order pharmacy members have higher rates of medication adherence than retail pharmacies. For example, Humana members with hypertension boasted adherence rates 4.8 percentage points higher than those at retail pharmacies.
6. It helps keep patients out of hospitals and emergency rooms.
Hospital and emergency room visits are expensive — the average cost of a three-day hospital stay adds up to nearly $30,000. Between effective care management, increased prevention, and patient engagement efforts, our value-based care approach is delivering better outcomes for patients — helping keep them out of hospitals and emergency rooms. At Humana, members in value-based care arrangements were admitted to hospitals 27 percent less often and visited emergency rooms 14.6 percent less often when compared to patients in traditional Medicare.
If we want a health care system that treats the “whole” person, improves patients’ overall health, and lowers costs, it’s clear that value-based care needs to be at the center.
Humana’s approach to value-based care proves that this approach can deliver better health, lower costs, boost preventive care, encourage health data sharing, and treat patients’ whole health.