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Issue At a Glance | Health Plan Payment and Reimbursement

Q&A: Humana expands value-based payment push

Issue At a Glance | Health Plan Payment and Reimbursement

Q&A: Humana expands value-based payment push

  • In 2019, 31% of Humana’s Medicare Advantage enrollees received care from providers in downside-risk contracts.
  • Providers are expressing increased interest in value-based payment (VBP) arrangements due to the pandemic.
  • Humana VBP arrangements mostly are with primary care practices but also are open to hospitals.

Humana continues to increase the use of value-based payment (VBP) in its Medicare Advantage (MA) plans, with a boost coming from the challenges created the COVID-19 pandemic.

Illustrating the change is the increase in Humana’s MA enrollees who are affiliated with providers in VBP models from 2.04 million in 2018 to 2.41 million in 2019, according to the health plan’s recently issued Value-based Care Report.

HFMA spoke with William Shrank, MD, chief medical officer of Humana, about the company’s expectations for 2021.

HFMA: What new or changing approaches in value-based payment is Humana looking to implement in its MA plans?

Shrank: COVID has really shined a light on the value of value-based payment.

Our providers, in particular those that were in the more progressive models that were pre-paid, were just far better positioned to financially weather the storm and also to be very nimble and flexible and adopt more patient-centered approaches to caring for our members.

This is a really good proof point to show that value-based care is really enabling at a time of uncertainty. So, we’re seeing more and more interest from providers about moving to those kinds of relationships, and we expect only to see more growth.

There is an argument, that I think is fair, that value-based care promotes resiliency. At a time when creating a resilient healthcare workforce or healthcare system is such a high priority, we anticipate continued growth in that space.

HFMA: How did the volume of your VBP contracts with physicians or hospitals fare in 2020, and what are your projections or targets for 2021?

Shrank: We have a considerable number of providers that take downside risk.

Approximately, two-thirds of our patients are managed by providers in value-based arrangements, and nearly half of [those providers] take meaningful downside risk.

So , we are pretty progressive in the marketplace around engagement with providers that are financially aligned with us and with the health outcomes of our members.

HFMA: Do your MA plans include just physicians, or hospitals as well?

Shrank: We’ve had our greatest success in moving to full-value relationships where our providers are taking full risk for the population of our members that they serve in primary care relationships.

We are eager to work with any type of provider that wants to move to value-based care and value-based purchasing arrangements.

We don’t have a priori preferences. The primary care providers have been quicker to adopt, but we continue to believe that we’re going to meet providers wherever they are and help them on their path, that transition to value-based care. We will work with any provider, whether they are a hospital, an integrated health system, a small primary care practice, to engage them and partner with them and move them in the direction of value-based care.

HFMA: Are there any changes you’re looking to make to your upfront health-risk assessments?

Shrank: We’ve shown that there is a really important opportunity, when you meet with patients in the home, to more deeply understand their social context, the environment in which they live and gaps in their current care process.

It is much easier to understand if someone is socially isolated, if they are food insecure, if they have housing insecurity, from visiting a patient in their home. Understanding that deeper context of the circumstances in which they live, we believe we’re in a much better position to help them address the barriers that they are facing [in] managing their chronic conditions.

So, we do think it is a really important part of the management of patients. We’ve made a lot of investments to have stronger relationships with our members in the home. We’ve made a big investment in Kindred at Home [of which Humana owns 40%], we are doing as much as we can around virtual care to make sure we are connecting with patients in the home, and those connections with patients in the home are really important to supporting our members in helping them achieve their best health.

HFMA: Any plans to give providers access to those upfront health-risk assessments of enrollees?

Shrank: I’m not exactly sure to what extent those are currently available, but I can say without any hesitation that our biggest priority from a data perspective is to create data interoperability, to make sure we share every bit of data we have with our providers. And we want our providers to share with us. And we think only that kind of transparency is going to enhance our ability to be deeper or better or more constructive partners and manage our members — their patients — longitudinally in a more collaborative way.

From a philosophical perspective, overwhelmingly the answer is, “Yes, we want to create more and more data interoperability.”

HFMA: How are you working with providers on social determinants of health?

Shrank: Particularly in value-based arrangements, our partners appreciate the partnership. Some providers in large health systems have a lot of infrastructure to help identify community-based organizations that can help our members, their patients, with challenges with health-related social needs. But many providers do not have a good network or do not have the resources to really help their patients address social needs when they arise.

Our ability to help create a network of community-based organizations and a more integrated system for addressing health-related social needs is now integrated into our business model. Many providers appreciate our partnership, appreciate the fact that those are gaps that we can help them fill and those are resources that we can bring to the table to help support the holistic management and needs of our members, their patients.

About the Author

Rich Daly, HFMA Senior Writer and Editor,

is based in the Washington, D.C., office. Follow Rich on Twitter: @rdalyhealthcare

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