Home health providers’ involvement in Medicare Advantage (MA) plans is growing, and a focus on value-based care could help in that process, a study from Humana Inc. (NYSE: HUM) suggests.
Seniors enrolled in MA plans can see lower costs of care and better care when they’re part of value-based programs, according to the study.
As home health care continually aims to become a valuable partner in Medicare Advantage plans and value-based care initiatives, looking at how some of the biggest players are achieving better outcomes may help the industry get a grip on where the opportunities lie. Humana is based in Louisville and is a for-profit health insurance company with numerous provider branches and affiliations, including Humana at Home.
The federal government provides Medicare Advantage plans with a set amount of money to provide benefits to their beneficiary population. The plans have considerable flexibility in managing and coordinating the care in order to make a profit while keeping up quality.
Humana’s report discussed three categories of payment — fee-for-service, bonus and value-based care — and covered four value-based payment models, which include more pay for meeting quality measures and preventing repetitive treatments, among other factors.
Medicare-certified home health agencies already have some experience with value-based payments, with the Centers for Medicare & Medicaid Services (CMS) implementing the home health value based purchasing pilot program (HHVBP) last year in nine states. The program uses different quality measures to calculate a total performance score for the HHVBP model, and adjusts payments up or down according to how well agencies perform.
Humana, which has more than 900 relationships with value-based provider organizations, found total health care costs for practices in value-based arrangements were 15% lower than original fee-for-service Medicare. Compared with Humana standard MA settings, total health care costs were 4% lower.
In its report, “Making Progress, Seeing Results,” Humana compared quality metrics and prevention measures in 2016 for about 1.65 million MA members affiliated with providers in value-based reimbursement model agreements against 191,000 members linked to standard MA providers, which does not offer additional incentives to providers who meet cost or quality targets.
It also looked at costs for 2016 for approximately 1.4 million MA members connected with providers in value-based arrangements, comparing them to fee-for-service Medicare. In addition, it compared outcomes for those 1.4 million to 216,000 members linked to providers in standard Medicare settings.
Humana’s value-based care approach heavily leans on the primary care physician as the central role to manage all aspects of the patient’s care, but it also works with other providers, including home health care agencies, according to Dr. Roy Beveridge, Humana’s chief medical officer. The approach aims to fix the fragmentation seen in traditional fee-for-service Medicare.
“Fee-for-service is a fragmented system, it’s fragmented in the primary care world, it’s certainly fragmented in the specialty world and it’s certainly fragmented in the at-home world,” Beveridge told Home Health Care News.
Much of the focus of VB care should on where most of the health care dollars are currently being spent—on care for patients with chronic conditions, wherever they are.
“A lot of these people are either in nursing homes facilities…or at home postoperatively,” Beveridge said.
Working With Other Providers
And in care coordination, Humana’s work could come in handy. Within its VB care, Humana aims to leverage care coordination to ensure patients get the right care to achieve better outcomes with lower care costs, centering around the primary care physician.
“What we’re trying to do is use our analytics to understand what’s happening with our patients and then coordinate with the home care company or any post-acute company… and to help with the coordination back to the doctor’s offices,” he explained.
Humana’s approach led to 6% fewer hospital inpatient admissions and 7% fewer emergency department visits among its MA members affiliated with in value-based reimbursement model agreements in 2016, compared to members in standard MA settings.
Patients treated by doctors in Humana’s MA value-based agreements also saw more preventive care screenings.
Beyond the primary care physician, value-based care can address more health care concerns related to patients with chronic conditions, including overcoming social determinants of health, Beveridge argued.
This echoes a panel of industry leaders at the Visiting Nurse Associations of America’s (VNAA) annual leadership conference in San Diego, which stressed the importance of identifying social determinants of health, such as transportation access, the home environment and the role of home health care.
“That same population [that] has problems with medication adherence, those folks are the same ones who have trouble getting transportation to the doctor’s office and getting the care that they need,” Beveridge said.
Low Cost, High Quality
Humana is taking steps to address these outside factors. The insurer will provide food for patients for two to four weeks after discharge if they are food-insecure, or help with transportation in certain areas, Beveridge noted. The goal is to care for the highest-cost patients, many of whom are under the sway of forces other than physical ailments.
“What we’ve found is that a lot of these things can be related to social determinants of health, such as food insecurity,” he said.
While Humana continues to improve its value-based care approach centered around the primary care physician, home health care providers are increasingly looking for ways to become more involved with Medicare Advantage and value-based care initiatives as care coordination partners.
But MA beneficiaries tend to use less home health, compared with seniors on traditional fee-for-service, one study found. That report, published in the American Journal of Managed Care, noted MA plans have direct incentive to minimize financial costs.
But this doesn’t mean MA beneficiaries lack for quality care, as the Humana study suggests.
Written by Maggie Flynn