value-based care

Humana was honored to be asked to participate in the 2019 International Consortium for Health Outcomes Measurement (ICHOM) in the Netherlands. With 1,200 healthcare leaders from across the globe, we were happy to participate as a healthcare company moving those we serve into better outcomes at lower costs by associating with physicians in successful value-based models of care.  

Roy Beveridge, MD, former Humana Chief Medical Officer and current advisor, moderated a panel of experts on the topic of Examples of Value Based Payment Models. More than 200 healthcare leaders attended to hear real-life examples from organizations at the beginning of the VBC journey and others who are farther along. Panelists included Ward Bijlsma, Mengis; Lili Brillstein, Blue Cross Blue Shield; Jeroen van der Wolk, Zilveren Kruis; Erik van Raaij, Erasmus University; and Eva de Boer, Erasmus University. The audience was very engaged, and the discussion was informative.

Dr. Beveridge also participated on a signature panel of thought leaders on the topics of Value Based Health Care. This panel was presented for all 1,200 conference attendees and was moderated by Herb Riband, Stanford University. Panelists included: Pall Jonsson, The National Institute for Health and Care Excellence; Nathalie Moll, European Federation of Pharmaceutical Industries and Associations; and Jan Kimpen, Philips.

One conference attendee called Humana “one of the most advanced insurance companies in the U.S.” based on our value-based care and social determinants work. Dr. Beveridge shared many insights, one of which was, “fee-for-service models are inherently wasteful and inhibit innovation; and most importantly, they don’t produce the best outcomes for patients. We have to push the boundaries and think of healthcare really differently. In some U.S. states, we have been working in value-based care models for 20 years; in others, we’re just getting started.”

Finally, on Friday, ICHOM and Humana will co-host a thought-leadership breakfast for a select group of 30 conference attendees to share thoughts on the importance of having a global population measure and propose that the CDC’s Healthy Days tool may be a good option. It’s a self-report measure that is critical in understanding the patient experience and while simple, is correlated with health outcomes. Highlights from this thought-leadership conversation will be captured as a white paper or issue brief for publication.

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Dr. Roy Beveridge, Humana’s chief medical officer, writes in Managed Healthcare Executive that “value-based care is proving its worth to both physicians and patients alike through improved care, greater reimbursement levels, and lower cost—delivering on the promise of the right care at the right time at the right cost.”

He notes that physicians in value-based arrangements can expect lower healthcare costs, more shared savings, and a higher percent of the overall healthcare dollar compared to the national average.

Read the full article here, and learn more from Humana’s latest Value-Based Care Report here.

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Humana’s value-based care report has shown how physician practices in value-based agreements are increasing preventive care, improving health outcomes and quality measures, and lowering overall health care costs for Humana Medicare Advantage (MA) members.

This video features a panel discussion of care professionals discussing the report.

Written by physicians, the report details the clinical and economic impact of integrated care delivery, examining patient care and the experience of physicians. The report, which can be accessed here, also details physician progress controlling blood sugar, blood pressure and medication adherence for people with diabetes.

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Forbes has taken note of Humana’s latest Value-Based Care Report, writing about how the shift from fee-for-service medicine to value-based payments for physicians is reducing costs and improving quality of care for seniors in Medicare Advantage plans.

Read the Forbes article here.

“Medical costs were nearly 16% lower for seniors enrolled in Humana Medicare Advantage plans that paid physicians via value-based models in 2017 compared to costs of those in traditional fee-for service Medicare,” Forbes said, citing the study.

“In the value-based approach, insurers reimburse providers for services plus additional pay if they meet quality measures, control costs and improve health outcomes of their patients. The traditional fee-for-service system pays for the volume of care delivered.”

The article quoted Dr. Laura Trunk, Humana medical director of provider development, who wrote in the report: “While we know that all physicians are committed to patient health, those in value-based care agreements have access to additional resources and capabilities to build the infrastructure they need to expand their reach outside the practice. Focusing on prevention and the whole health of their panel population allows physicians and their care teams to work more strategically to improve the care of their patients, thus keeping them home and out of the hospital and emergency room.”

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Dr. Roy Beveridge, Humana’s Chief Medical Officer, recently spoke with The Pulse, a healthcare journal associated with the Wharton Health Care Business Conference. Dr. Beveridge will be speaking at the conference later this month, on a panel titled “The Other 50% of Health: Bending the Health Care Cost Curve via Wellness & Behavioral Economics.”

The pulse noted these key takeaways from their conversation:

• Payment mechanisms will be the driver behind changes in how the healthcare system approaches basic wellness (e.g., diet, exercise, sleep, stress). As we shift towards value-based care, the whole system has more incentives to promote wellness.

• Payers need stability in the populations they are covering so that there is a financial return to investing in wellness. It’s hard to invest a lot of time and money into someone’s long-term wellness if you’re only insuring them for a couple of years.

• Basic social factors, like your ZIP code or education level, can determine a massive part of your health and wellness, and payers need to partner with civic leaders and community organizations to improve the health of socially-disadvantaged communities.

“I practiced medicine for over twenty years, and I recognize that the engagement of the physician is crucially important,” Dr. Beveridge told the publication. “The medical world has switched from the fee-for-service (FFS) mentality to value-based care (VBC), which means that doctors are no longer paid just for a treatment, but for outcomes. This creates a huge change in doctors’ treatment plans for their patients, including a big focus on educating the patient; for example, helping them understand why taking insulin is important. The payment mechanism is driving this behavior change, and this behavior change is making people healthier.”

Read the entire interview here.

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