During the pandemic, value-based care helped keep doors open

Oraida Roman, MHA

VP, Value-based Strategies

Bio

Ms. Roman supports successful value- based provider relationships, with a focus on improving the provider experience and achieving Humana’s path-to-value goals.
The COVID-19 pandemic exposed many shortcomings of the healthcare system, especially the financial strain of operating a practice with a fiscal reliance on certain quantities of patients being treated each day.

As non-value-based practices suffered amid restrictions that forced cancelations of procedures and traditional care delivery, those in value-based agreements that relied on technology, infrastructure and support staff—and monthly capitated payments—pivoted quickly and adapted to a new way of caring for patients when they could not see them face-to-face.

Persistent income over time facilitated moves by practices to prepare for times of crisis. The continuing cash flow as crisis struck enabled them to remain connected with those they serve.

And when some of those practices’ coffers dwindled, those payer partnerships closed the financial gaps. Humana, for instance, accelerated value-based quality recognition payments to value-based providers at the onset of the pandemic. Most of that money was paid in April 2020, up to three months earlier than it would have ordinarily been issued.

Already dealing with stress of the health emergency, those payments allowed providers to deliver care without the added stress of financial strain on their practices.

Why it matters:

In 2020, primary care practices lost approximately $15 billion15 when community shutdowns were put in place to slow the spread of the virus. By mid-year, almost 16,000 practices had closed their doors due to the fiscal losses caused by the pandemic.16

At the same time, the crisis reinforced the value of the value-based care model by spotlighting improved financial stability, strong infrastructure and technology, payer-provider collaboration and support to allow clinicians to keep their focus on their patients.

The way forward:

Many providers who were on the fence about value-based care, or whose practice had a mix of contracts with payers, began switching some non-value-based contracts to value-based during the pandemic to solidify their footing. In 2020, various initiatives with healthcare providers helped move over 95,000 Humana MA members under value-based contracts.1

Piedmont HealthCare, a value-based provider in central North Carolina, had an alternative care delivery infrastructure in place so that when the pandemic hit, it shifted operations immediately.

“Our physicians were very nimble and highly engaged in the efforts that were taken at the pandemic’s onset. We saw everyone collectively coming together to do what needed to be done,” said Joy Durham, director of operations and quality.

As the long-term financial impact of the pandemic comes into greater focus, many value-based providers see a positive aspect related to their bottom lines. Because the stability of their value contracts sheltered them from the worst of the turmoil, many are able to continue the practices they had put in place in 2020 and invest in longer-term programs that would not have been possible under a traditional non-value-based arrangement.

“We had teams in place to service both providers and patients in value-based care. Having this support structure in place allowed us to centralize our efforts on establishing new care and safety protocols, providing COVID testing and follow-up care, and educating patients on the telehealth offering. This allowed physicians to focus on their patients and, as a result, more quickly get them back in the door for care.”
Joy Durham
director of operations and quality