Value-Based Care: Better Outcomes at Lower Costs
When 56-year-old Mary learned of her son’s tragic death, it took a serious toll on her mental health. Mary lives with bipolar disorder and was managing well with medication and therapy, but when her son died, she found herself struggling with severe anxiety and depression.
Mary’s doctor focused on her emotional needs with regular check-ins and 30-40-minute visits to fully understand her grief and the challenges she faced mentally. He also coordinated with other providers to ensure Mary had a comprehensive care experience – from her medical appointments to therapy to medication management. This personalized care helped Mary get through a traumatic life event and find stability in her life again.
This may not sound like the type of care many of us are accustomed to receiving. That’s because Mary’s doctor is a value-based care provider, meaning the focus is on preventive care and better health outcomes. In value-based care settings, clinicians are primarily reimbursed for the quality of care they provide. This differs from the more traditional fee-for-service health care model, which generally reimburses clinicians based on the number of individual services provided to a patient with no direct incentive to avoid hospitalizations or emergency room visits.
Value-based care offers patients more timely and tailored care
I believe we can all agree on the importance of long-term health. I know I would much rather prevent a problem or catch it early than wait to address it after it becomes debilitating or even life-threatening.
In the value-based care model, it’s a team effort between the primary care provider, the care team, and the patient to address health conditions. This team-based holistic approach to patient care means the primary care physician serves as the quarterback with support from a multi-disciplinary team including nurses, medical assistants, pharmacists, social workers, and others. In this setting, patients typically spend more time with their doctor with longer appointments and more frequent visits, if they are needed.
This level of coordination, particularly when it involves transitions in care, such as after a patient is discharged from the hospital, helps minimize the risk of the patient requiring further hospitalization. The value-based care approach also generally provides more resources and incentives to manage health-related social needs. Think transportation benefits and community support programs – these types of services can make a huge difference in access to care and helpful resources.
There’s also a cost benefit to value-based care. Instead of incentivizing volume of services rendered, providers are incentivized to keep patients healthy through preventive, high-value care. On top of better health outcomes, Humana invests cost savings into member benefits. In fact, members who see value-based care providers on average use $527 more of their plan benefits than individuals who see non-value-based care providers.
Value-based care improves health outcomes
More preventive care, lower costs, and better health outcomes – that’s the consistent takeaway we see with Humana 's individual Medicare Advantage members in value-based-care models when compared to beneficiaries in fee-for-service Medicare.
Over the last decade, Humana has been evaluating the value-based care model, and we have made a lot of progress. Since we began reporting on the outcomes of value-based care in 2013, the number of members receiving care in these arrangements has increased by 2.3 million. After just 10 years, 70% of our individual Medicare Advantage members are receiving value-based care. And the data tells us it’s working.
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When compared to fee-for-service Medicare, Humana Medicare Advantage members in value-based care arrangements, on average, have:
We are seeing that patients in value-based models are more likely to get their preventive screenings and take their medications. They are building relationships with their providers and seeing fewer gaps in care because of it.
Beyond Medicare Advantage
Value-based care is transforming the health care industry. Over the last 10 years, we have seen tremendous progress with our Medicare Advantage members. As we think about how to continue improving this successful patient-centric, cost-effective and data-driven approach, we will determine ways to apply it beyond primary care and Medicare Advantage. For instance, we’re now starting to see aligned payment model benefits in Medicaid.
It’s inspiring to see the ways health care organizations are working together more and more. We are at the dawn of the next era in value-based care!
You can read more about Mary’s story and learn about the impact of value-based care in Humana’s 2023 Value-Based Care Report .
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Registered Nurse
10 个月Love this
Medical Sales Professional
11 个月Exactly with what is happening at C2N Diagnostics by creating Blood Based Biomarker tests to rule in / rule out Amyloid Plaques - the hallmark of Alzheimer Disease. It’s all about early detection giving real hope to these patients instead of using older technology to diagnose that’s very expensive to the patient and to the healthcare system.
Healthcare Sales Leader | Strategist Driving Growth & Success | Expertise in Health Plan, Pharmaceutical, & Health Services Sales | Team Inspirer | Value-Based Contracting, Network Optimization & Clinical Solutioning
11 个月Nicely done and validation that VBC PCPs were less likely to seek acute care than non-VBC PCPs and members had fewer admissions and ER visits and less low-value services. We'll need coordinated policies, regulations, and shared infrastructure to encourage multi-stakeholder cooperation and value-based innovation. https://catalyst.nejm.org/doi/full/10.1056/CAT.22.0332
Former neuroscientist, current CEO, soon-to-be circumnavigator
11 个月Thanks for sharing this. VBC is clearly what is needed, moving forward, and I love to see the positive data coming out!
Nurse Auditor @ Humana | Master's in Nursing Informatics
11 个月This is so exciting, such a great example! No surprise that VBC results in positive outcomes, seems it's what has been lacking for so long. Feeling like most patients had rather have a relationship with their providers and know they truly care vs. a looksee, listen, and 'here's your script.' In turn they walk away feeling cared for and are motivated to take ownership of their own health. You mentioned looking for ways to reach beyond Medicare and primary care. Recently learned the about the history of the reimbursement model for nurses and was wondering if it were revamped (nursing billed like PT/OT/NPs?)would that add value to nurses & would it help combat the nursing shortage we are experiencing, along with promote positive outcomes by allowing for better quality care, decreased hospitalizations/readmits/ER visits, etc...? Didn't realize that in the 19th century nurses billed separately for the care they provided and it wasn't until the Social Security Act passed that nurse's pay was rolled into the room & board and became costs for organizations. Anyway...long story, but something that has been on my mind lately.