Humana Inc.: Humana Announces its Inaugural Medicare Advantage Value-based Care Report

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LOUISVILLE, Ky.--(BUSINESS WIRE)--Humana Inc. (NYSE: HUM) today unveiled its inaugural 'Making Progress, Seeing Results' value-based care report, which details the company's 2016 results for Humana Medicare Advantage members affiliated with providers in Humana value-based reimbursement model agreements. The report can be accessed by clicking here.

Humana compared quality metrics and prevention measures for calendar year 2016 for approximately 1.65 million Medicare Advantage members who were affiliated with providers in value-based reimbursement model agreements to 191,000 members who were affiliated with providers under standard Medicare Advantage settings, which doesn't offer added incentives to providers who meet quality or cost targets.

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Humana also compared costs for calendar year 2016 for approximately 1.4 million Medicare Advantage members who were affiliated with providers in value-based reimbursement model agreements to original fee-for-service Medicare and also compared outcomes for those 1.4 million to 216,000 members who were affiliated with providers under standard Medicare Advantage settings.

Chronic Condition Management

Chronic conditions continue to adversely impact the Medicare and Medicare Advantage populations. Over six in 10 Medicare beneficiaries are living with more than one chronic condition, according to the Centers for Medicare & Medicaid Services.

Humana's report also references the impact that social determinants of health -- such as food insecurity, loneliness and social isolation -- can have on an elderly Medicare Advantage member's health and well-being. For example, Humana's research has shown that an older adult who is lonely or socially isolated is four times more likely to be readmitted to a hospital within a year of discharge.

In order to address the rising tide of chronic conditions and these social determinants of health, Humana's holistic approach to helping physicians, clinicians and other care professionals has centered on its integrated care delivery model. A key element of the integrated care delivery model is the primary care physician (PCP).

In a value-based reimbursement model agreement, Humana believes that it's important for the PCP to have a centralized role to manage all aspects of the patient's care, since the PCP is working to coordinate a number of specialists that care for a Medicare Advantage member's multiple chronic conditions.

PCPs in Humana value-based reimbursement model agreements received 16.2 percent of the total payments Humana distributed to physicians in 2016. According to the American Academy of Family Physicians, the national average is 6 percent for PCPs.

'Humana is privileged to have built strong relationships with our providers, many of whom have embraced the transformative power of the value-based reimbursement model and have made these results possible,' said Bruce D. Broussard, Humana's President and Chief Executive Officer. 'Our 2016 health and quality results reflect continued investment in our integrated care delivery model, such as enhanced data analytics to help providers identify and address unhealthy behaviors.'

Improved Quality, Improved Health

Humana first disclosed Medicare Advantage value-based member results in 2013 and has done so each year since. The 2016 results, as with the previous results, cannot be directly compared due to multiple demographic changes in member population.

Humana's core measurements, which follow the 'triple aim' of population health, are as follows:

  • A Value-based Approach is Improving Quality Measures: Providers in value-based reimbursement model agreements with Humana had 26 percent higherHealthcare Effectiveness Data and Information Set (HEDIS®)scorescompared to providers in standard Medicare Advantage settings based on an internal attribution method.
  • Humana Medicare Advantage Members are Benefiting from a Preventive, Holistic Approach in a Value-based Care Model: 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.
  • Lower Costs Obtained Through Value-based Approach: Humana found that medical costs for Medicare Advantage members affiliated with providers in value-based reimbursement model agreements were 15 percent lower versus those affiliated with physicians under original fee-for-service Medicare. As previously stated, medical cost reductions such as these can benefit plan members through reduced out-of-pocket costs, lower member premiums, and/or additional benefits.
'Based on our experience, the value-based care model helps physicians spend more time with their patients, which builds stronger relationships between the physician and patient,' said Roy A. Beveridge, M.D., Humana's Chief Medical Officer. 'The result is a bond of trust, which serves as the foundation for changing unhealthy behaviors and addressing social determinants of health. As we've seen at Humana, supporting physicians with actionable data gives them a deeper understanding of their patient − and that can result in more preventive care, which leads to better chronic condition management.'

In addition to the improvements in chronic condition management, the report also details physician progress in controlling blood pressure, diabetes care/controlling blood sugar, and medication adherence.

Humana's Report Methodology and Value-based Stats

Humana Medicare Advantage member health results were limited to medical claims incurred during the 2016 calendar year. Humana compared members affiliated with providers in a value-based reimbursement model agreement versus an estimation of original fee-for-service Medicare medical costs using CMS Limited Data Set Files from 2015. Estimates of cost, admission and emergency department savings are subject to restatement with the availability of more current CMS data.

Humana has 1.9 million individual Medicare Advantage members (out of 2.8 total individual MA members) today who are cared for by approximately 51,500 primary care physicians, in more than 900 value-based relationships across 43 states and Puerto Rico.

As of September 30, 2017, Humana has reached its calendar year goal of having approximately 66 percent of Humana individual Medicare Advantage members in value-based payment relationships. Humana's total Medicare Advantage membership is approximately 3.3 million members, which includes members affiliated with providers in value-based and standard Medicare Advantage settings. For more information, visit

About Humana

Humana Inc. (NYSE: HUM) is committed to helping our millions of medical and specialty members achieve their best health. Our successful history in care delivery and health plan administration is helping us create a new kind of integrated care with the power to improve health and well-being and lower costs. Our efforts are leading to a better quality of life for people with Medicare, families, individuals, military service personnel, and communities at large.

To accomplish that, we support physicians and other health care professionals as they work to deliver the right care in the right place for their patients, our members. Our range of clinical capabilities, resources and tools - such as in-home care, behavioral health, pharmacy services, data analytics and wellness solutions - combine to produce a simplified experience that makes health care easier to navigate and more effective.

More information regarding Humana is available to investors via the Investor Relations page of the company's web site at, including copies of:

  • Annual reports to stockholders
  • Securities and Exchange Commission filings
  • Most recent investor conference presentations
  • Quarterly earnings news releases and conference calls
  • Calendar of events
  • Corporate Governance information
For Medicare lines of business, Humana is a Medicare Advantage HMO, PPO, and PFFS organization with a Medicare contract. Enrollment in any Humana plan depends on contract renewal. The provider network may change at any time. Impacted members receive notice when necessary.


Standard Medicare Advantage settings refers to Humana fee-for-service only arrangements and excludes Humana Star Rewards, Model Practice, Medical Home, and Full/Global Value arrangements.

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Humana Inc. published this content on 14 November 2017 and is solely responsible for the information contained herein.
Distributed by Public, unedited and unaltered, on 14 November 2017 13:47:07 UTC.