Real-World Benefits of Value-Based Care

Roy Beveridge, MD

There’s not a lot of peer-reviewed research that proves paying physician practices for positive patient outcomes is better than paying for services only. Certainly, anecdotal evidence exists that shows patients are benefitting from practices getting into value-based care. But what can practices expect?

For 30 years, Humana has been entering into some form of value-based care arrangements through its Medicare plans, but it wasn’t until five years ago that we began releasing results on Medicare Advantage plans. For the past two years, this has taken the form of the “Value-based Care Report,” which features physician practices and the progress they’re making.

Humana MA members totaled 3.3 million at the end of 2017 (the latest year of processed data). Among them, 91% had at least one medical condition (like congestive heart failure or depression), and 83% had at least two.

Highlights include some of what you might expect from a patient perspective: preventive screenings were up for patients affiliated with value-based care practices. For patients with diabetes, those increased condition-specific screenings led to better medication adherence and better management of their blood glucose levels. The same was true for people with hypertension and their ability to better manage their blood pressure.

Related: The Missing Link in Value-Based Care

Emergency department visits and admissions to the hospital were down for patients affiliated with value-based practices. Also, patients affiliated with value-based practices had a 20% higher average HEDIS Star score compared to those affiliated with fee-for-service practices.

But what’s most striking may be the answer to the question: what can primary care practices expect from value-based care?

• Lower healthcare costs. Medical costs for patients attributed to PCP practices in Humana MA value-based care settings were nearly 16% lower vs. original fee-for-service Medicare.

• More shared savings. In 2017, across all value-based models, 10% more practices experienced shared savings than in 2016 (70% vs. 60%).

• Higher percent of the overall healthcare dollar compared to the national average. The American Academy of Family Physicians calculates PCPs, in general, receive about 6% of the total payments made to providers for a patient’s care. PCPs practices in a Humana MA value-based care arrangement are receiving nearly 17%.

These results would not be possible without leaders forging the way in value-based care and showing us what’s possible. Below are just a few examples from the report.

• Jeff Galles, DO, is chief medical officer at Utica Park Clinic, a 150 PCP practice in Oklahoma with 4,000+ Humana MA patients. Galles writes in the “Value-based Care Report” that, in 2017, the clinic increased the number of patients with two or more PCP visits per year to 80%, leading to a decrease in hospital readmission rates.

• David Hatfield, DO, is CEO and lead physician at Hatfield Medical Group, a 15 PCP practice with nearly 1,000 Humana MA patients. Hatfield cites value-based care as the reason he is more fulfilled and happier as a physician today because of the time he spends with patients and, as a result, the ability to affect outcomes.

• Larry Blosser, MD, is outpatient medical director for Central Ohio Primary Care, a 370+ PCP practice with more than 3,500 Humana MA patients. Blosser writes how quickly the group saw results in its transition to value-based care, going from a 3-star to a 4-star practice in a year. In 2017, each of the physicians caring for adults received a 20% shared savings bonus.

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. I invite you to check out our full report here. 

Roy Beveridge, MD, is a Managed Healthcare Executive editorial advisor and Humana’s chief medical officer.