RevCycle Intelligence (11/14/18) LaPointe, Jacqueline
A new study by Humana indicates that value-based reimbursement models are helping to reduce costs while enhancing quality. Last year, medical costs for patients linked to primary care practices (PCPs) in Humana's value-based reimbursement models for Medicare Advantage (MA) were 15.6 percent lower compared to Medicare fee-for-service (FFS), the study found. Moreover, internal medical costs were 1 percent lower for patients seeing PCPs in value-based payment models compared to those seeing PCPs in Humana's Medicare Advantage FFS environment. Compared to patients in traditional Medicare, patients in value-based reimbursement agreements were admitted to the hospital inpatient department nearly 25 percent less in 2017, while trips to the emergency department were down about 15.6 percent. Furthermore, patients involved in PCPs with bonus-only arrangements experienced fewer hospital admissions and emergency room visits, with declines of 19.1 percent and 10.1 percent, respectively.
Meanwhile, Healthcare Effectiveness Data and Information Set (HEDIS) Star scores for physicians in value-based reimbursement agreements on average were 4.21 out of 5 stars from 2014 to 2017. These scores were higher compared to those of providers in all other types of agreements through Humana's Medicare Advantage business lines. Physicians who migrated from bonus-only arrangements to value-based reimbursement agreements after 2014 also saw the highest HEDIS Star scores in 2017, according to Humana.