Improving access to accountable care is one of four improvements Humana disclosed from ongoing programs to improve quality and reduce costs for Medicare beneficiaries, according to Humana.
Humana disclosed results to date from initiatives to foster value-based reimbursement in the traditional, fee-for-service (FFS) Medicare program in conjunction with the Health Care Payment Learning and Action Network launched by the White House. The Learning Network supports HHS’s recently announced timeline for shifting Medicare payments to alternative payment models such as Accountable Care Organizations (ACOs), patient-centered medical homes or bundled payment arrangements.
Humana’s quality and cost improvements to date include the following:
- Improving Access to Accountable Care: While HHS aims to have 30 percent of Medicare payments in alternative payment models by the end of 2016 and 50 percent by the end of 2018, Humana has 53 percent of its members in accountable care relationships today and is on course to have more than 75 percent in accountable care relationships by 2017.
- Improving the Quality of Patient Care: Humana’s accountable care relationships are improving the quality of patient care delivered to its health plan members. In 2014, Humana’s accountable care providers had a Healthcare Effectiveness Data and Information Set (HEDIS) Star score average of 4.25 as compared to providers outside of accountable care settings with a HEDIS Star score average of 3.65.
- Reducing Hospital Readmissions and ER Visits: While HHS has reduced the Medicare fee-for-service hospital readmission rate from 19 percent in 2011 to 17.5 percent in 2013, Humana members in accountable care relationships have a 4 percent lower hospital readmission rate than traditional, fee-for-service Medicare and 7 percent fewer emergency room visits per thousand beneficiaries.
- Lowering Costs: Humana experienced a 19 percent cost improvement in total in 2013 for members who were treated in an accountable care setting compared with members who were treated by providers in original Medicare settings.
Source: Humana March 25, 2015
Value-Based Reimbursement Answer Book: 97 FAQs on Healthcare Models, Measures and Methodology draws from initiatives at WellPoint, Highmark, BCBS Michigan, and advice from Optum, Navigant, Healthcare Strategy Group and others, structuring experts’ give-and-take in an easy-to-follow Q&A format.