Value-based care simplifies health care for patients, clinicians

Value-based care results in patients spending more time with their primary care clinician, less time in the hospital and more frequent preventive care, based on research released by Humana in its annual Value-Based Care Report.

The report’s shows that Medicare Advantage patients receiving care under value-based arrangements saw fewer emergency department visits, fewer inpatient hospitalizations and received more preventive care screenings.

Humana noted that clinicians under the traditional fee-for-service model are reimbursed based on the volume of patients and services provided, with no incentive to reduce costly or low-value interventions. The value-based model emphasizes preventive care and incentivizes health outcomes, the group said.

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“Coordinated care that delivers the right care at the right time must become the standard,” said Dr. Kate Goodrich, chief medical officer at Humana. “Our report paints a clear picture: value-based practices deliver better patient experiences and health outcomes. Patients spend more time with their primary care clinician, which means more preventive care and better management of chronic diseases, like diabetes and high blood pressure. Seniors in value-based care models receive the care they deserve with a clinician who holistically understands their care needs. At Humana, we are committed to advancing value-based care as the best model for improving health outcomes and the healthcare experience for seniors everywhere.”

Humana pointed out that the need to accelerate value-based adoption is more imperative than ever. Clinicians are increasingly experiencing high levels of burnout, while patients struggle with a fragmented healthcare system characterized by disjointed appointments and lack of coordinated care, the company added.

Value-based agreements range from financial rewards to full-risk reimbursement models that allow practices to choose what works best for them. Clinicians are incentivized to prioritize high-value, preventive care to keep patients healthy longer. As practices mature in value-based arrangements, care coordination becomes more effective across care teams, which results in more high value services and fewer unnecessary or duplicative services. With the alignment of financial incentives to delivery of high-quality care, care gaps close and patient engagement increases under an integrated clinical team, Humana said.

Humana noted the following value-based care advances based on more than a decade of its data: 

• Patients spend more time with their primary care clinician and have fewer emergency department and hospital visits, in turn reducing costly, low-value care.
• A clinical team-based approach to care coordination - after a hospital stay, between primary care visits, or when beginning a new medication.
• A sustainable healthcare system, where patients, clinicians and payers benefit from the financial stability and better outcomes of value-driven models.
• Technology integrations allow for real-time, actionable data at the fingertips of clinicians to eliminate gaps in care.

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Key findings from the report:

• Regular primary care appointments mean better prevention and healthcare maintenance. In 2023, value-based care members saw their primary care clinicians 10% more than non-value-based care patients.
• VBC Medicare Advantage patients report 90 out of 100 satisfaction with their healthcare provider, per Consumer Assessment of Healthcare Providers and Systems survey data.
• Less time spent in the hospital. VBC Medicare Advantage patients saw 32.1% fewer inpatient admissions in 2023 versus those enrolled in Original Medicare.
• Humana Medicare Advantage members treated by value-based clinicians experienced 11.6% fewer ER visits and 7.2% fewer admissions than those not in a value-based arrangement.
• Humana Medicare Advantage members receive more preventive screenings than those under non-value-based practices across these measures: annual wellness exam, colorectal screening, diabetes eye exam and mammogram.
• Value-based care allows for better chronic disease management. Humana Medicare Advantage members were more likely to receive diabetes care eye exam screenings and to meet blood sugar control measures versus members not in a value-based care arrangement.
• Senior-focused primary care organizations combine a VBC model with a care delivery approach tailored for seniors. Black patients visited their senior-focused primary care clinician 39% more, and low-income beneficiaries had 21% more visits versus Original Medicare.
• Senior-focused primary care patients had 17% more primary care visits, 6% fewer hospitalizations and 11% fewer emergency department visits.
• Value-based arrangements allow for investments in benefits members value most at an affordable price. In 2023, Humana Medicare Advantage value-based arrangements saved 25.8%, in medical costs compared to Original Medicare. Humana said it invests these savings directly into more member benefits, such as lower premiums, home care, prescription delivery and healthy food cards.

The new report also spotlights how value-based arrangements in specialty practices positively impact patient outcomes. Humana MA patients aligned to value-based nephrology programs experienced 5% fewer unnecessary hospitalizations versus fee-for-service clinicians.

"We must unite to address clinicians’ pain points, creating a system where every stakeholder can prioritize health first,” said George Renaudin, Humana’s insurance president. “Over a decade of our experience and research shows that providers navigating the shift to value achieve greater success with proactive support, an operational roadmap and actionable data. The path forward is clear: the value-based model is the future – we have seen it in action, and it’s the key to sustainable, patient-centered care.”

Read Humana's Value-Based Care Report here.