VALUE-BASED CARE REPORT - Physician progress and patient outcomes based on calendar year 2020 data - Humana Investor relations
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VALUE-BASED CARE REPORT Physician progress and patient outcomes based on calendar year 2020 data
Physicians see the value, patients experience the care
This report details three key areas of focus—prevention, outcomes and utilization, and costs
and payments—for Humana individual Medicare Advantage (MA) members seeking care from
primary care physicians in value-based agreements. A new section focuses on the experience of
patients and physicians within value-based care (VBC).
Humana shares these results annually to spotlight progress and highlight how the company supports
physicians in helping their patients achieve their best health. As with the previous seven years
of results, the 2020 statistics cannot be directly compared year over year due to multiple demographic
changes in Humana’s member population.
ValueBasedCare.Humana.com
Table of contents
Introduction Patient–physician experience
01. A care model primed for agility, stability and equitable health 14. Value-based care contributes to satisfaction
03. Outlining the path to value 16. Home care helps value-based PCPs manage care and improve outcomes
18. Physician perspective: How does your experience in value-based care differ
from a fee-for-service model?
Prevention
19. Building on home healthcare capabilities
05. Value-based care has strong showing in prevention and adherence
20. Turning data into a clear picture
07. A pandemic lifeline: Telemedicine solidifies its place in primary care
08. Driving innovation and efficiency during COVID-19 and beyond
Costs and payments
09. More than medicine: Value-based care helps with food insecurity
21. The financial strengths of value-based care
10. Wellness rewards: A tool for VBC physicians to boost patient health
23. During the pandemic, value-based care helps keep doors open
24. Proactive pharmacy outreach with VBC: Better medication adherence, lower costs
Outcomes and utilization
25. Bundled payments offer a value-based approach for specialty physicians
11. Insights from outcomes: Prevention, personalization and connections matter
12. The lasting appeal of behavioral telehealth
Conclusion
13. From patient care to value-based payments: What we’re learning
27. What value-based care’s future may hold
USING THE INTERACTIVE TOOLS
Look for the plus sign icon, then click to read extended stories
Look for the video icon, then click to see videos related to select
stories in the report
INTRODUCTION
A care model primed for agility, stability and equitable health
COVID-19, by many accounts, served as Ultimately, we have to address the basics— but what you’ll see is that value-based
a wake-up call for how we approach care the context in which people live. It’s hard physicians were agile and maintained
delivery and our healthcare system as for one to manage his or her diabetes or critical connections with patients while
a whole. We’ve had to be nimble and congestive heart failure without a safe, maintaining a consistent cash flow.
flexible, to leverage technology in new ways stable home environment.
and to further orient to the very personal Going forward, we need to continue to
William Shrank, Moreover, the pandemic didn’t create build on the fabric of team-based care,
needs of our members and patients.
M.D., MSHS disparities. It exposed them. And we all have sealing off clinical silos. Team-based
Chief Medical Officer As we continue to navigate the a role to play in addressing those problems. interdisciplinary care, quarterbacked
uncertainties of the pandemic, we are by primary care physicians, will be a
Dr. Shrank is dedicated thinking to the future and trying to best Value-based care has offered the business differentiator in that effort. Continuing to
to putting integrated understand what we can learn from the context for payers and healthcare providers work with physicians will help dig deeper to
care delivery strategy lessons of the last 18 months. One thing to align incentives and to consistently focus uncover truths about what a person needs,
into action. His work is clear—the pandemic reaffirmed the on what is most important for patients and then deliver it to them.
emphasizes consumer- imperative for value-based care. throughout the pandemic. Value-based
friendly, evidence- providers had invested in infrastructure Every person deserves to live their best
based, technology- The pandemic required us to take a different before COVID-19 that allowed them to be life, and we, along with physicians and
enabled approaches approach in how we interact with members more flexible, enabling those practices to healthcare professionals, want to facilitate
to personalized health and be far more proactive. We called leverage technology, drive more care to that. Because we’re a global community,
improvement. A former members at the outset and talked to them the home and to be more sensitive to the an individual’s lack of well-being should be
practicing physician and about their chronic conditions. Many told us emerging needs of the people they serve. everybody’s concern.
Harvard Medical School they hadn’t left the house and didn’t have
assistant professor, ways to get food, or that they were depressed Data reflected in this annual report is
his research has because they hadn’t seen their children. influenced greatly by the pandemic,
focused on the use and
effectiveness of chronic-
care medications.
Click the video icon for an
introduction to this year’s Value-based
Care Report by Dr. William Shrank.
01 INTRODUCTION VALUE-BASED CARE REPORT
Humana’s total MA membership Value-based practices
Individual MA members include the greater share
3.96 million
of Humana MA members
As of Dec. 31, 2020, 67,800 primary care physicians
(PCPs) have value-based relationships with Humana.
Those affiliations include more than 1,000 agreements
in 43 states and Puerto Rico.
As of Dec. 31, 2020, Humana’s total MA membership Of Humana’s individual MA
was approximately 4.6 million members, including membership, 67%, or 2.65
roughly 3.96 million individual MA members and million, seek care from
613,200 group members.1
primary care physicians in
Group MA members value-based agreements.
613,200
A different kind of care
for chronic conditions
89.1% Common chronic conditions
among Humana MA members 1
of Humana MA Hypertension | 3,312,072: 67%
Most Humana MA members are living every members have at least Type 2 diabetes | 1,386,857: 28%
day with a chronic condition—and often,
more than one. A high-touch, preventive- one chronic condition.11 Coronary artery disease | 1,141,290: 23%
focused care model is well-suited to meet
these patients’ needs.
Chronic kidney disease | 1,089,913: 22%
COPD | 788,267: 16%
82.8 %
The figures to the right show common
conditions that existed among all Humana Congestive heart failure | 676,414: 14%
MA members during calendar year 2020
Depression | 549,074: 11%
and the percentage of members with those
of Humana MA
specific conditions. Figures include both Osteoporosis | 370,831: 7%
partial- and full-year health plan members. members have at least
The numbers exceed the total Humana MA Prostate cancer | 126,150: 3%
two chronic conditions.1
membership due to co-morbidities. Breast cancer | 93,004: 2%
3
INTRODUCTION VALUE-BASED CARE REPORT 02
INTRODUCTION
Case studies Outlining the path
How three practices put
value-based care into action
to value
As of 2020, 67%, or two-thirds, of Humana’s
There is no singular path to success
individual MA members seek care from primary
in value-based care. Every practice faces
care physicians participating in some form of
its own unique set of challenges
value-based care agreement with Humana.
and opportunities. These case studies
feature organizations from across the
To support value-based care, Humana
country and of varying size sharing how
developed a continuum of programs that offers
a value-based approach has shaped their
financial rewards to primary care physicians for
clinical and operational models.
improvements in quality, outcomes and costs.
Incentives increase along with the level of risk.
Humana’s value-based primary care continuum
shows the broad spectrum of segments under
Mankato Clinic which physicians can benefit from the quality
Mankato, Minnesota care they provide.
50 13 402 Of importance, the continuum is not designed
PCPs Locations Humana to advance all primary care physicians to global
MA members2 value (or full accountability), but rather to meet
and support them where they are on the path to
value. Segments of the continuum are designed
Paxton Medical around a physician or practice’s readiness to
Seminole, Florida accommodate varying levels of accountability.
As value-based care becomes more prominent, The primary care
32 12 7,084 the number of Humana individual MA members continuum shows the
PCPs Locations Humana receiving care from physicians in value-based care
MA members3
arrangements has grown with the addition of a
broad spectrum of
little more than 1 million individuals since the segments under which
beginning of 2016. physicians can benefit
Intermountain from the quality care
Healthcare they provide.
Las Vegas, Nevada
1,800 63 51,457
PCPs Locations Humana
MA members4
03 INTRODUCTION VALUE-BASED CARE REPORT
Evolving primary care payment models1
Value-based care The percentages below represent Humana individual MA members Non-value-based (NVB) care
67 33
seeking care from physicians in each category of the continuum.
% 70 %
of individual MA members in VBC model of individual MA members in NVB model
60
20%
Percentage of Humana membership
Global risk – 788,875 FFS Plus – 734,446
F ull responsibility for Medicare Parts FFS + additional compensation
50
A, B and D through monthly capitated for meeting quality measures
payments 4%
FFS – 578,241
Full risk – 165,295 40
7%
Pays for the services a patient receives
Fee-for-service (FFS) + 100% responsible
for Medicare Part B expenses and sharing
of Part A (may have shared savings or 30
complete responsibility for Part D)
18%
Limited risk – 277,681
FFS + bonus + care coordination payment 20
+ higher portion than bonus + shared 36%
savings in Medicare Parts A, B and D
10
Bonus + shared – 1,418,162 15%
F FS + bonus + potential for limited shared
savings (upside only) in Medicare Parts A, B 0
and D
VBC NVBC
Rapid growth
1,016,913
Value-based individual
Value-based care physicians have seen members gained between
significant member growth year over year. Jan. 1 2016– Dec. 31, 2020
INTRODUCTION VALUE-BASED CARE REPORT 04
PREVENTION
Value-based care has strong showing in prevention and adherence
Despite pandemic public health refills by members, who filled roughly healthcare leaders say the technology will be
precautions that led to deferring 400,000 through June 2020. a permanent part of their approach
in-person medical care through much going forward.
The prevention and adherence figures led
of 2020, physicians in value-based to overall Stars Ratings and average HEDIS Although in-person medical visits rose in
agreements found ways to overcome Stars Ratings for preventive screenings both the latter part of 2020, a resurgence in
J. Nwando Olayiwola,
those medical-distancing hurdles by being a half-star higher for value-based COVID-19 transmissions has pushed some
M.D., MPH, FAAFP
Senior VP and Chief
capitalizing on telemedicine and other physicians than for non-value-based—a practices to reduce physical interactions
Health Equity Officer innovative approaches to improve 15% difference.1 as many patients express concerns with
health outcomes. visiting physicians’ offices. That has
Why it matters: Prevention is the foundation prompted practices to rely again on those
Dr. Olayiwola is for member well-being and the effectiveness
Increased access resulted in MA members alternative approaches to care delivery.
responsible for creating of value-based care. In the face of the
affiliated with value-based physicians Only this time, they’re employing tactics
and implementing a pandemic, medical distancing emerged as
outperforming those in non-value-based that are proven and refined.
strategy to achieve a challenge. But value-based physicians
health equity across settings in all Healthcare Effectiveness
Data and Information Set (HEDIS®) focused on whole-person health quickly Effective use, though, will only happen with a
all lines of business,
preventive screenings and adherence found new and innovative ways to increase lens toward health equity, working to improve
including care delivery,
measures. Screenings were between 8% patient access to care. access to all modalities of care patients need,
giving all communities
and 20% higher for the value-based cohort which also requires understanding their
and groups of people a Virtual visits proved to be a viable platform
fair and just opportunity compared to non-value-based for colorectal unique needs and barriers to care. Telehealth
for physicians for everyday treatment and is only successful if patients have all the tools
to be as healthy as screenings, diabetic eye exams, osteoporosis
some screenings. Additionally, Humana sent necessary for digital health engagement—
possible. management and controlling blood sugar.1
more than 1 million kits to MA members—at stable broadband connectivity, connected
Value-based members with certain chronic no cost to them—so they could be tested devices, digital literacy and health literacy. It
conditions routinely showed more screenings for colorectal cancer, diabetes control and is imperative that medical and social services
and better control than those non-value- nephropathy without having to go to a communities recognize their intricate
based. For example, value-based members clinic or lab. Of the kits returned, 10% of connections to empowering the full health of
with diabetes not only had their blood sugar the screenings identified members with each and every patient cared for.
levels under control but adhered to their unfavorable results.
medication regimens more frequently.1
Those members were notified and clinical
Patient safety related to medication follow-ups recommended. If no follow-up Preventive screenings:
was noted via a claim within 120 days,
adherence among members affiliated with Value-based PCPs compared to
value-based physicians earned a HEDIS Stars Humana’s outreach team contacted the
member and assisted in scheduling an
non-value-based physicians1
4-Star Rating and outpaced those affiliated
with non-value-based clinicians. appointment for him or her.
8% more screenings conducted overall
The consistency of medication use among The way forward: Nontraditional approaches
value-based members for diabetes, to care delivery are quickly becoming 19% more colorectal screenings and
diabetic eye exams
hypertension and statins was as high as 89%. regularly used methods, primarily in
Data analysts attribute those rates in part to the virtual space. The increased use of
telemedicine provided a vital connection
22% more post-discharge medication
reconciliations
actions taken at the outset of the pandemic
allowing for early and extended prescription between physicians and their patients, and
05 PREVENTION VALUE-BASED CARE REPORT
PREVENTION
Overall HEDIS Stars score
Ratings show better patient 5.0
2018
NVB: 3.70
engagement for those in
Engagement rate (out of 5)
4.0 VBC: 4.50
value-based practices 3.0
2019
Across every care category, physicians in value-based care 2.0 NVB: 3.90
arrangements have scored higher than those in non-value- VBC: 4.30
1.0
based (NVB) models, based on HEDIS scores.1 The chart
below shows the results for select measures among 2020 0.0 2020
continuously enrolled Humana MA members, of which 2018 2019 2020
NVB: 3.40
914,785 were in non-value-based physician agreements NVB = Non-value-based VBC = Value-based care VBC: 3.90
vs. 2,358,808 in value-based physician agreements.
To the right are overall HEDIS Stars results for MA patients
continuously enrolled during 2018, 2019 and 2020. For
consistency, scores reflect Humana’s administrative data
only, as the Centers for Medicare & Medicaid Services (CMS)
NVB VBC
advised health plans to not collect hybrid data in 2019 due
HEDIS and patient safety
to the COVID-19 pandemic.
97 98
100 96 96
94 93
89 88
90 87 87
85 85 86 85 86
(by percentage of members screened)
82 82
78 81
80 77 77
76 76
74 73
70
Engagement rate
70 67
60 56
50 46
38
0
Eye Blood sugar Nephropathy Osteoporosis Rheumatoid Breast Medication Statin therapy Colorectal Medication Pain Statin use in Hypertension Diabetes Statins
exam controlled management arthritis cancer reconciliation cardiovascular cancer review screening persons with
management screening post discharge disease screening diabetes
DIABETES CARE CARE FOR OLDER MED ADHERENCE
ADULTS
PREVENTION VALUE-BASED CARE REPORT 06
PREVENTION
A pandemic lifeline: Telemedicine solidifies its place in primary care
Primary care telemedicine use in 2020 based organizations focused on quality and Mercy Health in Missouri, looking to
rose faster and reached higher levels continuity over quantity of care. capitalize on convenience for patients and
among Humana MA patients affiliated enhance the customer experience, built
The way forward: Though the study period the ExpressCare platform. Though being
with value-based organizations
examined telemedicine use between piloted, the tool, accessible via an app,
compared with those in non-value- January and September, the trend among
Kathy Driscoll, enables users to fill out a brief questionnaire.
based arrangements. value-based practices continued through the
MSN, RN, CCM Those answers prompt a personalized
Senior VP and rest of the year. It remains a vital connection escalation path that connects them to the
Accountability for cost, quality and disease
Chief Nursing Officer tool for physicians as some patients remain proper provider.
management under value-based payment
leery of in-person contact or prefer the
models may have been a stronger catalyst
Ms. Driscoll oversees platform’s convenience. “It breaks that boundary of time and space,”
for telemedicine adoption than recouping
Humana’s strategy said Michael Michetti, Mercy’s senior vice
revenue from deferred in-person visits, Physicians interviewed for the study said
of improving the president of clinical operations. “Even
a study of health maintenance organization they believe telehealth is here to stay. While
experiences of the telehealth is bound by the time there is
(HMO) members from March 1–Sept. 30 by continuing to use it, a number of physicians are
company’s 10,000 a person on video and structured by a
nurses, care managers Humana Healthcare Research suggests. changing their approach. Some are no longer schedule. This platform lets patients be
and social workers. Within the shared-savings categories of writing prescriptions for certain conditions until asynchronous. Whenever they want to
Her efforts focus on the value-based primary care continuum, patients are seen physically. Others are using start the encounter, they can start
promoting a culture adoption happened at an even quicker pace the momentum of telemedicine’s acceptance that conversation.”
that engages, values among physicians at the greatest risk level, to expand virtual offerings.
and inspires clinical according to the research.
professionals while
impacting health In late April, at the peak of use, value-based
outcomes. physicians used the technology at a rate of 2020 Humana MA HMO telemedicine visits1
50.1 telehealth visits per 1,000 members per 50.1
week compared to 9.3 visits per 1,000 within
the non-value-based space.1 35
Number of visits per 1,000 members
Additionally, many value-based practices 30
were helped by infrastructure, technology 25.6
and management systems in place at the 25 22.4
start of the COVID-19 outbreak, interviews 20
with study participants revealed.
15
Why it matters: Patterns of outpatient care 9.3
shifted drastically during the early stages 10
of the COVID-19 pandemic, with deferred 5.0
3.4
5
in-person care leading to substantial
revenue losses for many non-value-based 0
primary care organizations. The shift created 0-4 5-8 9-12 13-16 17-20 21-24 25-28 29-32 33-36 37- 39
a strong financial incentive to move to NVB VBC
Weeks
telemedicine visits, especially among value- Note: Study period concluded Sept. 30
07 PREVENTION VALUE-BASED CARE REPORTPREVENTION
Driving innovation and efficiency during
COVID-19 and beyond
Ingenuity and adaptability defined how most Some physicians and their staffs helped their patients
healthcare practices operated—and continue to obtain food and medication. Some made calls to
operate—during the COVID-19 pandemic. Staring at patients to warn of COVID-related scams to help
vacant waiting rooms, physicians, administrators and protect their financial health along with their
their staff members enlisted alternative measures to physical health.
maintain critical connections with those they serve.
As many patients who stayed home in 2020
That meant seeing patients virtually, finding inventive struggled to adjust to new technology platforms,
ways to meet patients at a safe distance—such some physicians found themselves playing multiple
as outside the office building—or devising other roles: healthcare provider, technical support agent
strategies to provide care. and coach.
With quality metrics and the financial model within A year of challenge became a prescription for
value-based care agreements driven by patient well- change—now and into the future. The video below
being, proactive approaches among those physicians in features a trio of practices that connected with patients
navigating unprecedented obstacles helped them treat in non-traditional fashion and, at the same time,
general illness, manage chronic conditions, evaluate ushered in new ways of doing business they anticipate
medication adherence and assess mental health. will lead to more effective and efficient care.
Amid physicians’ struggle
with new challenges caring
for patients, Humana
helped support their efforts
by eliminating some
administrative requirements
for providers involving
Humana members
with COVID-19.
Click the video icon for more information
PREVENTION VALUE-BASED CARE REPORT 08PREVENTION
More than medicine: Value-based care helps
with food insecurity
have limited or uncertain access to enough
Lack of healthy food and lower
food to live a healthy, active life.7
nutrient intake can lead to myriad
physical and mental health Evidence suggests that alleviating stress
complications, new research shows.6 and anxiety over access to food is
Food insecure seniors are 65% considered a beneficial health outcome.
Andrew Renda,
more likely to be diabetic, 19% more And as the number of adults age 65 and
M.D., MPH
likely to have high blood pressure older is expected to rise to more than 73
VP, Bold Goal
and Population and 2.3 times more likely to suffer million by 2030,8 it is likely the number of
Health Strategy from depression compared to food- seniors living in food-insecure households
will also rise substantially without effective
secure seniors.5
and sustained interventions in place.
Dr. Renda’s work
includes leading Furthermore, food insecure Medicare
Tackling food insecurity, including
population health work beneficiaries incur $5,527 more a year in
addressing root causes, is a challenge
streams, including healthcare costs than those who are food
insights, informatics, many payers and healthcare providers
secure,6 according to the study published
strategy and execution, have shifted focus to in recent years.
in the Journal of the American Medical
business integration, This is because food insecurity often forces
Association titled “Interventions to Address
and community individuals to make difficult tradeoffs,
Food Insecurity Among Adults in Canada
engagement. He is a such as choosing between purchasing
and the U.S.”
published researcher and food or purchasing medications or seeking
speaker in the fields of medical care. Food insecurity is particularly high among
The focus on social determinants of
population health, social MA members with dual-eligible special
health (SDOH), such as food insecurity,
determinants of health The way forward: Humana has worked needs plans (D-SNP). That is why Humana
and how they affect a person’s physical,
and chronic disease. with healthcare providers and community leveraged the Medicare Advantage value-
social and mental well-being highlights
organizations to address food insecurity based insurance design (VBID) model in
the critical role value-based care plays in
within its MA population. 2020 to offer the healthy food card benefit
population health management. When
to qualifying members in several states.
healthcare providers and payers leverage When the COVID-19 pandemic hit, The benefit can be used to purchase healthy
an infrastructure that can access real- the company created the Basic Needs groceries at various national retailers and
time data, technology and appropriate Team, which leverages resources and comes in the form of a wallet card loaded
care management, they can see a more emergency flexibilities granted by CMS each month with funds.
holistic picture of a person’s health, identify to screen MA members for food insecurity
unmet needs and determine effective and coordinate with national vendors Having access to critical data and screening
interventions, researchers said. to deliver meals to members’ homes. tools allows clinicians, payers and policy
The program served 77,863 members makers to continue to search
Why it matters: Millions of seniors
and delivered more than 1.1 million for opportunities and interventions that
nationwide face food insecurity, making
meals in 2020, and is continuing the address the negative implications of health-
it one of the country’s leading health and
effort in 2021. related social needs within patients and
nutrition issues. In fact, nearly 5.3 million
whole populations.
09 PREVENTION VALUE-BASED CARE REPORTPREVENTION
Wellness rewards: A tool for VBC physicians to boost patient health
With preventive care paramount patients who are Humana members with The way forward: Value-based partner
to patient long-term well-being, Go365 on their plans to earn rewards for agilon health experienced an uptick in
value-based physicians in 2020 eligible activities like routine cancer and member engagement in wellness and
took advantage of incentives from biometrics screenings. Members earn prevention activity through the incentives
$10–$30 gift cards—per screening—to a provided by Go365. Heavy promotion of
Humana’s wellness program, Go365®,
Minoti Parab, variety of national retailers. the program and its wellness benefits by
to help entice Humana MA members
M.D., FAAFP agilon was a top goal of its communications
with Go365 on their plans to obtain Why it matters: Healthy behaviors and
Lead Medical Director campaign composed of welcome emails for
preventive screenings and maintain prevention are critical to identifying new members and a quarterly e-newsletter.
Dr. Parab is a lead
healthy behaviors. Value-based problems early and potentially preventing
medical director for healthcare providers focus on achieving severe illness and unnecessary medical MA members associated with agilon who
Medicare in the Mid- gap–closure goals. costs. By Humana rewarding members for visited Humana’s website for wellness
Atlantic region. With a healthy behaviors and annual screenings, information had an 83% gap-closure rate.
background in outpatient Members associated with value-based primary care physicians are better able to
family medicine and physicians accounted for roughly 83% of all close clinical gaps in care so their patients— “The success of this program really
telemedicine, her Go365 rewards-qualifying activity in 2020.1 and their practices—can achieve better highlights the power of engaging
passion drives her work health outcomes. our patients as true partners in their
in physician wellness Additionally, these members received over healthcare,” said Dr. Ben Kornitzer, agilon
and engagement 7.4 million preventive screenings, completed Annual wellness exams and preventive health’s chief medical officer. “As a primary
internally through nearly 1.4 million fitness activities and screenings are key to promoting better care physician, it is incredibly gratifying
leadership development participated in almost 400,000 social and health outcomes. A patient who has at least to see how thoughtfully designed health
and externally through health education activities. one annual wellness visit per year is 122% plan incentives can really help move the
hospital-provider
more likely to have a colonoscopy and 75% needle on the quality programs that value-
communication and Go365 is promoted regularly to value-based more likely to have a mammogram9— based physicians are working toward with
improved processes. healthcare providers to encourage their two essential methods of cancer screening. their patients.”
Promoting wellness with rewards1
2020 Go365 Number of reward- Earned amount by MA 2020 total MA 2020 total MA
rewardable activity for qualifying events by members with reward-qualifying earned amount
VBC providers VB members VB physicians events
Social/health 395,740 $1,985,700 460,904 $2,304,520
education activities
Preventive screenings 7,473,195 $113,325,587 9,106,236 $180,587,215
Fitness/workouts 1,388,371 $6,931,458 1,572,941 $7,864,705
Grand total 9,257,306 $122,242,745 11,140,081 $190,756,440
PREVENTION VALUE-BASED CARE REPORT 10OUTCOMES AND UTILIZATION Value-based providers helped keep
patients out of the hospital
Insights from outcomes: Prevention, personalization Humana MA members who sought care
from physicians in value-based care
and connections matter arrangements during 2020 experienced fewer
hospital admissions and ER visits, both when
compared to patients in Original Medicare
Critical to keeping members well in 2020 me care for our patients to where there was models and patients in Humana MA
no delay in their care. It makes a difference, non-value-based arrangements.10
were already-persistent focuses on
whole-person well-being and care access
that were amplified by the pandemic.
and it showed during the pandemic.”
245,000 fewer
days
Why it matters: Physicians continually as hospital inpatients for Humana individual MA
stress the importance of primary care members seeking care from physicians in
In fact, despite widespread care aversion
Bryan Loy, M.D. intervention first, freeing up space for true VBC arrangements compared to those seeking
nationally, 86% of Humana MA members care from NVB physicians10
Corporate Medical emergencies and helping control costs
Director
still saw their value-based primary care
without unnecessary visits to high-cost Hospital admissions
physicians at least one time last year,
acute care facilities. This message, which (VBC arrangements compared to)
compared to 78% among non-value-based Original Humana MA NVB
Dr. Loy is an industry- physicians emphasized even more during
members. Those value-based members saw Medicare models arrangements
recognized physician the pandemic, appeared to resonate.
their primary care physicians an average of
executive serving as 22% less 7% less
4.19 times during the year vs. 3.97 times Members personally gave high ratings for
corporate medical or 121,000 or 39,000
director for Humana. among non-value-based. the outcomes they experienced directly as a fewer admissions fewer admissions
Board certified in result of the care they received from value- Emergency room visits
That consistency of care sharply reduced
anatomic and clinical based clinicians.
incidences of hospital admissions and (VBC arrangements compared to)
pathology and
hematology, he leads emergency room visits during 2020 for Internal Humana surveys designed to
Original Humana MA NVB
Medicare models arrangements
many of Humana’s value-based members—7% and 12% mimic the Health Outcomes Survey that
cancer care initiatives. lower, respectively—compared to those polled members remaining with the same 4% less 12% less
with Humana non-value-based healthcare physician during the last two years showed or 28,000 or 93,000
providers. Hospitalization avoidances were value-based physicians spent more time
fewer admissions fewer admissions
even better—a whopping 22% less—when discussing general health issues, monitoring Data derived from Humana 2020 value-based
measured against Original Medicare.10 physical activity and working with their membership of 2,113,382 and non-value-based
membership of 949,657.
patients to reduce their risk of falls than
Value-based practices such as AMA Medical
non-value-based physicians did.
Group never closed during the emergency,
While in-person visits have become more
recognizing the need to facilitate in-person The way forward: Deferred care, of frequent in the second year of the pandemic,
visits for those needing them. The Dunedin, widespread concern across the industry, it’s unclear what impact deferred care will
Florida facility implemented stringent did not appear to translate into new or have on the healthcare system moving
protocols that entailed installing special air worsening medical conditions requiring forward. Meanwhile, a number of physicians
filters, removing furniture in waiting and acute attention or inpatient treatment are modifying their reliance on distanced
exam rooms to force social distancing and among Humana MA members by the end of care methods such as telemedicine. They’re
only allowing patients inside one at a time. 2020. High-frequency outreach—in person, pushing for less medical separation by
virtually and telephonically—closed well- requiring chronically ill patients and those
“When you’re a value-based provider, you
being gaps in care and allowed physicians with other outstanding conditions to receive
focus on the well-being of your patients and
to continue assessing conditions and tests that cannot be administered virtually.
prevention. An ounce of prevention is worth
administering treatment as necessary, even They want to see patients physically so care
a pound of cure,” said Dr. Cruz Fana-Souchet,
from a distance. regimens can be adequately adjusted.
AMA founder. “Value-based medicine helped
11 OUTCOMES AND UTILIZATION VALUE-BASED CARE REPORTOUTCOMES AND UTILIZATION
The lasting appeal of behavioral telehealth
As it did for primary care, telemedicine director for behavioral health. “This platform to expand services during the pandemic,
became vital connective tissue between is critical in providing value, delivering greater helped as well by state and federal changes
specialists and those seeking care for value and supporting the clinical model.” enabling providers to bill for behavioral
their mental well-being. telehealth visits, including telephone visits,
The way forward: Primary care physicians in which were previously not allowed for
Behavioral telehealth trend lines paralleled value-based arrangements have recognized psychologists and social workers.
Taft Parsons, M.D. the impact of behavioral health issues on
those of general telemedicine at the outset
Corporate Medical physical well-being, and many have begun A TriHealth survey of its affiliated primary
Director of the pandemic, taking off during the
spring and early summer. As virtual clinical incorporating behavioral specialists into their care physicians showed that the integration
medicine as a whole tapered off months into practices. That way, when a patient presents is making a difference for patients and
Dr. Parsons is a with potential psychological and emotional providers. Some 97% of physicians
psychiatrist who is the outbreak, behavioral telehealth visits
remained relatively steady. concerns, there can be an immediate, expressed satisfaction with the behavioral
applying his expertise to
smooth handoff. health services, 95% said the integration
address the integrated
MA members affiliated with value-based somewhat or significantly improved their
needs of Humana’s
physicians took part in nearly 628,000 “The setup lends itself perfectly to integration, ability to manage patient needs, and 92%
membership and to
behavioral visits, representing roughly 21% especially in regard to timeliness,” Ruble said. reported somewhat or significantly improved
guide the enterprise’s
strategy for behavioral of all telemedicine visits in 2020. The usage job satisfaction. Meanwhile, TriHealth
TriHealth in Cincinnati began piloting
health. rate per thousand among value-based patients surveyed at the end of each visit
integrated behavioral health in primary
members over non-value-based hovered about its helpfulness rated them an average
care practices in late 2016. The health
between 5% and 10% each month between of more than 9 on a 10-point scale.
system piggybacked on that infrastructure
May and December.1
Experts and practices incorporating
behavioral telehealth attribute the Monthly trend of 2020 behavioral telehealth visits
consistent use to convenience to both
patients and practitioners and the ability 30 28.30
for those needing assistance to obtain help
Number of visits per 1,000 members
more privately. 28.12
23.70
Why it matters: The coronavirus pandemic 21.84
took an obvious physical toll on Americans.
20
Prolonged restrictions and lockdowns that
came with it exacerbated other kinds of pain
and struggle within behavioral health.
Anxiety. Depression. Substance abuse.
“There are many barriers to getting to the 0
front door and a stigma with behavioral March April May June July Aug. Sept. Oct. Nov. Dec.
health. Telehealth does away with that,” NVB VBC
Notes: Behavioral health was identified based on primary diagnosis
said Dr. Matt Ruble, Humana’s lead medical
OUTCOMES AND UTILIZATION VALUE-BASED CARE REPORT 12OUTCOMES AND UTILIZATION
From patient care to value-based payments:
What we’re learning
As the healthcare industry continues to shift Evaluation of home health
away from quantity of care toward quality Inpatients (IP) eligible for the post-acute
of care, recent research helps illustrate the transfer program who received additional
value of value-based care. Those studies services in their homes after a hospital
show how physicians use the approach to discharge experienced lower risks of
Debbie Peikes,
drive better patient outcomes. readmission and decreased healthcare costs.
Ph.D., MPA
Deferred care Humana Healthcare Research (HHR)
VP, Humana
Healthcare Research As pandemic social distancing widened to researchers evaluated the effectiveness
include medical distancing—significantly of discharge to home health compared
Dr. Peikes is a nationally reducing office visits for routine and sick to home for patients discharged from an
recognized health- care early in 2020—healthcare leaders inpatient stay for a set of diagnostic related
services researcher with used a broad range of communications groups that met the criteria for post-acute
decades of experience and operational tactics to ensure patients transfer as defined by CMS.
leading rigorous mixed- received proper care amid a COVID-19 surge,
methods studies of according to a report by the Medical Group MA members affiliated with value-based
innovative payment and physicians and receiving home health
Management Association (MGMA)
care delivery models. services had a 60% lower risk of readmission
and Humana.
She has an extensive to a hospital within 30 days of discharge
record of publications and avoidable IP admissions in a cohort
The publication, “No Time to Waste: and a 45% lower readmission risk within 60
and presentations of newly eligible MA enrollees over a
Deferred Care and Pandemic Recovery,” days, compared to those members with non-
sharing insights about 30-month period.
refining and spreading
found that during the COVID-19 pandemic, value-based physicians. Additionally, care
effective models. 97% of practices polled reported a drop in of those members resulted in an 11% lower At the end of that period, the average
patient visits by early April 2020.11 A lack total 90-day healthcare cost, including costs annualized PCP visit rate was significantly
of reliable internet connection for patients associated with home healthcare.1 greater—3,408 visits per 1,000 members vs.
in rural areas, older patients not being as 2,712 per 1,000—for the group of members
tech savvy when attempting telehealth Changing patient patterns
affiliated with value-based care physicians
services and vulnerable populations having Value-based payment, particularly when compared to the group affiliated with
trouble connecting to platforms such as downside financial risk is involved, may non-value-based physicians.1
Zoom, FaceTime and Hangouts all posed be associated with reduced use of the
challenges to accessing care in 2020. emergency department (ED) and greater use The 30-month average annualized ED visit
of primary care, according to a study by HHR. rate was lower for members whose PCPs were
Continuing to engage patients in their in value-based payment arrangements—
health, ensuring they are willing to seek and Researchers assessed the association 194 visits per 1,000 members—compared
receive care as needed, face-to-face or via a of primary care physician payment to those whose physicians were in non-value-
computer screen, is vital for medical practice arrangements with PCP visits, emergency based arrangements—209 visits per
growth in the year ahead, researchers said. department visits, inpatient admissions 1,000 members.1
13 OUTCOMES AND UTILIZATION VALUE-BASED CARE REPORTPATIENT-PHYSICIAN EXPERIENCE
Value-based care contributes to satisfaction
Humana MA members cared for by Satisfaction is also critical because it
physicians in value-based arrangements directly translates to retention. Some 93%
reported significantly higher levels of of Humana MA members remained with
patient satisfaction compared with their value-based primary care physicians
in 2020, compared to 91% with non-value
those associated with non-value-
based providers.1
Alex Ding, based clinicians.
M.D., MS, MBA Why it matters: The healthcare experience
Physician Executive, In a 2020 internal Humana survey similar
tends to be defined as much by quality
Clinical Strategy to the Consumer Assessment of Healthcare
interactions as quality of care. Experience
Providers and Systems (CAHPS), value-based
can outshine—and certainly overshadow—
Dr. Ding is a board- physicians rated 10% higher than non-
the total care delivery system. Patient
certified practicing value-based physicians (3.1 stars vs. 2.9
satisfaction leads to stronger trust in their
diagnostic and stars) in each of the eight categories of the
clinicians, which, in turn, develops greater
interventional CAHPS. The largest differences between the
long-term therapeutic relationships.
radiologist with two provider groups was in the overall rating
experience in practice of the health plan and the overall rating of The way forward: Within the value-based
Physician satisfaction is just as pivotal,
management, drug coverage, with value-based physicians leading Humana to remove prior space, support is a minimum expectation.
academic and private scoring 1.4% and 1.2% higher, respectively.1 authorization approvals during much of Members and healthcare providers serving
practice, and health
2020 to help remove obstacles potentially in as a focus have driven several initiatives to
system leadership. He CAHPS percentages are significant for
the way of patient care. help make navigating the healthcare system
is a physician champion three reasons:
and patient advocate, easier and the experience in a complex
• A difference of one point can represent Beyond the pandemic, a value-based design system more pleasant.
and focuses on clinician
engagement, health as much as a 1-star difference in equips physicians with tools, data and
technology deployment performance on these measures. resources to assist in developing a more Data-driven research plays a critical role
and clinical innovation. holistic approach to care. The creation of in helping payers like Humana build a
• CAHPS makes up 24% of the overall foundation for identifying clinical programs
platforms, such as Humana’s Population
Stars Rating. that advance its human care commitment
Insights Compass, efficiently informs
• CAHPS data is member-reported, coming primary care physicians about their patients’ to identify members’ most important needs
directly from the perspectives of those lives and medical histories outside the office and address them.
being treated. in a way that is both easily understandable
and actionable. Work continues to expand home-based
Humana collaborates with and supports offerings to complement physicians’
its community of healthcare professionals The tool houses supporting data beyond treatment in making care more accessible
through extended coverage. Emphases the direct medical and clinical, and also and targeted, and in bringing about
include SDOH, removing financial barriers provides insights into social needs for increased interoperability. Streamlined,
to treatment and helping keep members a more holistic picture of the patient. interoperable patient data, available to
safe, particularly during the pandemic, Compass allows physicians to look out for clinicians and members, can help enhance
by sending them safety kits that included their whole panel of patients and determine both the patient and physician experience
masks. This support of members who needs more attention and resources, for more efficient and effective care while
and their doctors also contributes to such as enabling practices to follow up on a reducing administrative hurdles and
member satisfaction. missed wellness exam or check-up. increasing technology usability.
PATIENT-PHYSICIAN EXPERIENCE VALUE-BASED CARE REPORT 14PATIENT-PHYSICIAN EXPERIENCE
Members experience the value-based care difference
Members clearly recognized physicians’ efforts in care
Initiatives aim to enhance patient experience
coordination and effective care management. In 2020, Providing care when and how a patient The platform offers both members and
continuously enrolled Humana MA members with physicians needs it most, especially in unprecedented healthcare providers direct access to a
in value-based agreements (53,625) rated their physician higher times such as a pandemic, is crucial to one’s “navigator” to address their unique needs.
(3.1 stars out of 5) than those 19,239 surveyed who were with health and well-being. Recent investments Members can connect one-on-one with
physicians in Humana MA non-value-based agreements in value-based programs and technology by a care coordinator for non-clinical advice
(2.9 stars out of 5).1 The results are from internal patient Humana are designed to support physicians and benefit questions, while providers
experience surveys similar to the Consumer Assessment in providing personalized attention and help have access to assistance resolving prior
of Healthcare Providers and Systems, but not the official CAHPS improve members’ healthcare experience. authorizations and checking the status
results. Official CAHPS results do not provide member-level data. of claims.
A difference of one point is important and, in general, represents Humana Care Support
as much as a 1-star difference in performance on Creating a personalized experience aimed Author has been launched in five South
these measures. at addressing members’ unique needs is the Carolina Humana MA plans, supporting about
goal of Humana Care Support—a technology- 13,500 members, with plans to scale into
Engagement measures NVB VBC enabled chronic care management platform. additional markets in the future.
(percentage rating)
By leveraging data analytics and existing
Remote patient monitoring
0 80 81 82 83 84 85 86 87 88 89 90 value-based agreements, the platform
provides Humana MA members living with Philips Lifeline medical alert service has
87.4 congestive heart failure and diabetes, along partnered with Humana to provide telehealth
Overall rating of
drug coverage with other chronic conditions, access to kits to select MA members living with
88.6
nurses, pharmacists, social workers and congestive heart failure (CHF). Kits include
Overall rating of 86.5 a weight scale, blood pressure monitor and
behavioral health specialists.
healthcare 87.1 pulse oximeter. The wireless devices all
In addition to serving the clinical needs of synch to an interactive tablet, also provided
Overall rating of 86.9
members, Humana Care Support addresses in the kit, to allow members to monitor their
health plan 88.3
the social determinants of health that might daily health while sharing real-time data
84.7
be present in a member’s home, such as food with care managers.
Ratings areas
Care
insecurity. And because 61% of older adults
coordination 85.4
prefer to age in their own home,1 having It is estimated that CHF accounts for
77.7 access to a multidisciplinary clinical team more than $30 billion in direct medical
Getting care
quickly 78.1 provides members access to care at home costs annually.2 The goal of the program
instead of being transferred to a facility. is to identify members most at risk for
82.0 readmission within 30 days after a hospital
Getting
needed care 82.3 The platform is available to MA members in discharge. Monitoring the health of high-
Kentucky, Pennsylvania and West Virginia, risk members allows Humana to help
Getting needed 87.1
with plans to expand to additional states physicians make informed and proactive care
prescription drugs 87.8 through 2021. decisions and provide interventions to help
81.1
reduce unnecessary readmissions and keep
Health plan Personalized healthcare through Author
customer service members at home longer.
82.0
Author by Humana is designed to meet
the emerging expectations of digital-savvy
seniors aging into Medicare.
15 PATIENT-PHYSICIAN EXPERIENCE VALUE-BASED CARE REPORTPATIENT-PHYSICIAN EXPERIENCE
Home care helps value-based PCPs manage
care and improve outcomes
The increasing emergence of in-home DispatchHealth offers advanced urgent
services satisfies two critical needs care in 38 cities. The organization focuses
within value-based care: Providing care on treating medical conditions—COPD,
heart failure, cellulitis and others—that
for patients where they want and need
require urgent intervention, but not
it most, and supporting physicians’ necessarily hospitalization.
Greg Sheff, M.D.
care plans when patients cannot—
Senior VP and Chief
Medical Officer, or will not, due to fear of COVID-19 Why it matters: Dispatching clinicians
Home Solutions transmission—visit their office. directly to a patient’s home overcomes
many of the barriers that tend to prevent
Much of the recent focus in creating home- some from seeing their physicians, such
Dr. Sheff’s background
care opportunities has centered on primary as a lack of transportation and now, amid
includes two decades
care—the foundation of the value-based the pandemic, a desire to limit exposure to
in healthcare as a
practicing physician
model—but has evolved recently to include groups of other people. It also adds to the
and healthcare advanced urgent care. The aim of the patient experience.
executive. He is approaches is to drive improved access,
experience, outcomes and quality of life. “Home-based care can be a partner
currently responsible
for advancing
and support system to help PCPs
Humana’s vision to
Humana research has determined that 20% and other physicians take the best care
of its Medicare Advantage expenditures can of their patients,” said Andrew Lynch,
transform the home
into the center of be addressed via home-care services, vice president of Home Solutions for Home care delivery
care delivery. Prior to and an even higher percentage in some Humana. “Whether it’s Medicare home continues to evolve
Humana, he served areas such as prevention, care coordination, care, advanced urgent care, hospital at
in leadership roles care management and assessments. home, etc., we believe all of these can help 20% of Humana’s MA
at multispecialty value-based physicians better manage their expenditures can be addressed via
physician groups, New partnerships with organizations patients and improve outcomes.”
focused on primary and urgent care home- home care services.1
health systems and
home-based care based clinical visits provide complementary The way forward: Dr. Barron Taylor, a
companies. access points for care to members. practitioner with Heal, says the ability DispatchHealth performs advanced
These options are particularly suited for to be present in a patient’s home gives urgent care visits at 80% less
members where traditional primary care valuable insight to an individual’s well- cost than a traditional ER visit.12
clinics are out-of-reach because of an being he otherwise might never receive in a
inability to find a local physician practice traditional physician’s office. He can use that
Humana MA members who
or home-bound status. information to pinpoint physical and mental
health issues and develop care strategies. received home health from Kindred
Heal, one option, provides primary care at Home saw 11% fewer
services by way of house calls, telehealth “How can you truly make an evaluation if readmissions than those supported
and remote monitoring to patients in eight you’re not in the patient’s house?” Taylor by other home health providers.1
states. The company also works with health asked. “That interaction and connection
plans to assist in closing gaps in care. solidifies the patient-provider bond. That’s
where the difference is being made.”
PATIENT-PHYSICIAN EXPERIENCE VALUE-BASED CARE REPORT 16PATIENT-PHYSICIAN EXPERIENCE
Building on home healthcare capabilities
Recent acquisitions continue to advance the evolution that improves outcomes and trims costs, said Susan Fully acquiring Kindred—the nation’s largest home
of value-based care for Humana MA members by Diamond, Humana’s chief financial officer who was health and hospice provider, of which Humana already
emphasizing home-based treatment, with the benefit president of home solutions during the transactions. owned 40%—further advances home-based clinical
of care continuity and improved outcomes. efforts. The companies collaborated over the last
OneHome, focusing on the MA population, uses a year to prove home-based care models’ impact on
Purchases of Kindred at Home (KAH) and One value-based model to provide post-acute at-home preventable events and assemble supporting clinical
Homecare Solutions (OneHome) by Humana add services, including infusion care, nursing, occupational capabilities ranging from preventive to higher acuity,
to the patient experience and are designed to offer therapy and physical therapy. It also offers durable emergent, hospital-level care.
care where members want it most—at home, where medical equipment at patients’ homes and sites-
the need increased during the pandemic amid of-care placement through skilled nursing facility The work resulted in the development of a platform
lockdowns and restricted access. Just as significant, at-home programs. to share and analyze information between the health
the transactions further integrate primary care with plan and home health agency, facilitating the delivery
home care to help improve outcomes and satisfaction The acquisition of OneHome helps further value-based of proactive and individual care plans. The approach
for patients and providers and drive greater value for home care capabilities on a national scale. OneHome delivers personalized, more comprehensive whole-
health plan partners. serves roughly 1 million members—many of whom are person care and supports care continuity by engaging
Humana MA members—through its plan partners, and in-home physicians and urgent care resources when
The integration of the companies makes value-based can provide an estimated 20% in savings through its a patient does not have immediate access to
home services available to more members nationwide care-delivery approach, according to OneHome. a primary care physician or if symptoms need
while further developing a quality-focused model immediate escalation.
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