Insights from the outcomes: Prevention, personalization and connections matter

Bryan Loy, M.D.

Corporate Medical Director

Bio

Dr. Loy is an industry- recognized physician executive serving as corporate medical director for Humana. Board-certified in anatomic and clinical pathology and hematology, he leads many of Humana’s cancer care initiatives
Critical to keeping members well in 2020 were already-persistent focuses on whole-person well-being and care access that were amplified by the pandemic.

In fact, despite widespread care aversion nationally, 86% of Humana MA members still saw their value-based primary care physicians at least one time last year, compared to 78% among non-value-based. Those value-based members saw their primary care physicians an average 4.19 times during the year vs. 3.97 times among non-value-based.

That consistency of care sharply reduced incidences of hospital admissions and emergency room visits during 2020 for value-based members—7% and 12% lower, respectively—compared to those with Humana non-value-based healthcare providers. Hospitalization avoidances was even better—a whopping 22% less—when measured against Original Medicare.

 

Value-based practices such as AMA Medical Group never closed during the emergency, recognizing the need to facilitate in-person visits for those needing them. The Dunedin, Florida, facility implemented stringent protocols that entailed installing special air filters, removing furniture in waiting and exam rooms to force social distancing and only allowing patients inside one at a time.

“When you’re a value-based provider, you focus on the well-being of your patients and prevention. An ounce of prevention is worth a pound of cure,” said Dr. Cruz Fana-Souchet, AMA founder. “Value-based medicine helped me care for our patients to where there was no delay in their care. It makes a difference, and it showed during the pandemic.”

When you’re a value-based provider, you focus on the well-being of your patients and prevention. An ounce of prevention is worth a pound of cure.
Dr. Cruz Fana-Souchet
AMA founder
Value-based providers helped keep patients out of the hospital

Humana MA members who sought care from physicians in value-based care arrangements during 2020 experienced fewer hospital admissions and ER visits, both when compared to patients in Original Medicare models and patients in Humana MA non-value-based arrangements.10

245,000 fewer days

as hospital inpatients for Humana individual MA members seeking care from physicians in VBC arrangements compared to those seeking care from NVB physicians.10

Why it matters:

Physicians continually stress the importance of primary care intervention first, freeing up space for true emergencies and helping control costs without unnecessary visits to high-cost acute care facilities. This message, which physicians emphasized even more during the pandemic, appeared to resonate.

Members personally gave high ratings for the outcomes they experienced directly as a result of the care they received from value-based clinicians.

Internal Humana surveys designed to mimic the Health Outcomes Survey that polled members remaining with the same physician during the last two years showed value-based physicians spent more time discussing general health issues, monitoring physical activity and working with their patients to reduce their risk of falls than non-value-based physicians did.

The way forward:

Deferred care, of widespread concern across the industry, did not appear to translate into new or worsening medical conditions requiring acute attention or inpatient treatment among Humana MA members by the end of 2020. High-frequency outreach—in-person, virtually and telephonically—closed well-being gaps in care and allowed physicians to continue assessing conditions and administering treatment as necessary, even from a distance.

While in-person visits have become more frequent in the second year of the pandemic, it’s unclear what impact deferred care will have on the healthcare system moving forward. Meanwhile, a number of physicians are modifying their reliance on distanced care methods such as telemedicine. They’re pushing for less medical separation by requiring chronically ill patients and those with other outstanding conditions to receive tests that cannot be administered virtually. They want to see patients physically so care regimens can be adequately adjusted.