Payer-provider partnership drives value: Execs share lessons learned

With the unpredictability surrounding healthcare under a new administration, one thing is certain: The emerging winners in the healthcare space will be those who collaborate and engage in the nudge toward value-based care.

Humana and Oak Street Health are among the health plans and providers who are collaborating to navigate the shift to value-based care. Humana’s nearly 3.2 million members include a large Medicare population, and represents the second-largest Medicare Advantage health plan provider based on membership. Oak Street Health is a primary care provider organization with a patient population comprised of Medicare beneficiaries, half of whom are dual-eligible. Humana and Oak Street Health are in a risk-based, global capitation arrangement and collaborate on value-based care.

Managed Healthcare Executive editorial advisor Roy Beveridge, MD, chief medical officer of Humana and Griffin Myers, MD, chief medical officer of Oak Street Health, talked with MHE about addressing the challenges and opportunities of moving away from the fee-for-service model to value-based care. 

Q: How are health plans and providers collaborating to navigate the shift to value-based care? What are some challenges? Opportunities?

Beveridge: As the health industry transitions toward value-based care, Humana is collaborating with organizations such as Oak Street Health to provide quality care for members. Value-based care generates improved clinical results, quality care and impressive patient engagement. Health plan and provider collaboration fundamentally supports high-quality value-based care, and creates a beneficial partnership. Another challenge is the need to transform operations to adopt a value-based approach, which can be a timely process. It’s necessary to provide context around the value-based improvements, but once health plans and providers understand value-based care results they are quick to adopt.

Myers:The opportunity lies in patient population health. A sick population provides the opportunity to make patients as healthy as possible. Of course, a sick population can also be a challenge, but the opportunity and reward of improved health is the most exciting and promising aspect.

Q: You chose to focus on the Medicare population. Why?

Beveridge: Chronic conditions, many of which are the results of a person’s behavior, can severely restrict one’s ability to achieve his or her best health. At Humana, we want to empower our members to better manage their conditions.

Myers: Oak Street Health, in particular, operates in areas with a historically sick, unengaged patient population. The value-based delivery model provides a big opportunity to dramatically improve patient health, engagement and quality of care.

Q: What is unique about your delivery model?

Beveridge: The value-based care delivery model is powered by data and insights. Humana and Oak Street Health have a robust data-sharing platform so once a patient is entered into the system; everyone knows exactly who is living with chronic conditions and what resources are needed to provide quality care.

Myers: The delivery model also generates highly personalized care, resulting in an engaged community and ultimately creating improved health results.

Q: Why did you decide to partner?

Myers: Oak Street Health partnered with Humana because they are a leader in value-based care, with a shared goal of improving patient health. Value-based care is about giving everyone what they want: patients want great care and providers want to help sick people. Value-based care, through the partnership with Humana, provides the resources to benefit everyone.

Beveridge: Humana recognized the importance of supporting organizations like Oak Street Health to bring value-based care to its members.

Q: How have you demonstrated that you have improved quality and lowered overall costs?

Beveridge: Patient engagement is the common criteria for success in a value-based partnership. An engaged patient will be proactive and take steps to improve their health, which is key for value-based care. Additionally, Humana Medicare Advantage members served by providers in value-based delivery models in 2015 experienced 6% fewer emergency room visits than members in standard Medicare Advantage settings. Humana also reported screening rates were higher for colorectal cancer screening (+8%); breast cancer screening (+6%); and osteoporosis management (+13%), an important preventative health measure. Lastly, when it comes to lowering costs, we’ve found that healthier members tend to spend less money on their healthcare.

Myers: Oak Street Health knows members are happy and engaged because of its 92% net promoter score, which measures the willingness of consumers to recommend a service to others.

Q: Is this model applicable only to primary care, or does it work for specialty care as well?

Myers: Humana and Oak Street Health specifically collaborate on primary care.

Q: Do you anticipate any challenges to your model under the next administration?

Beveridge: As a company that is committed to improving the health of the communities we serve, Humana knows this work will succeed only if the public-private partnerships we’ve forged are also successful. In our nation’s capital, in state capitals across the U.S., and communities in between, Humana has a long history of working with leaders on both sides of the aisle-in the interest of our members, their health and well-being. We look forward to working with those in government who share our views about how to improve the health of the people we all serve.