Value-based care has strong showing in prevention and adherence

J. Nwando Olayiwola M.D., MPH, FAAFP

Senior VP and Chief Health Equity Officer


Dr. Olayiwola is responsible for creating and implementing a strategy to achieve health equity across all lines of business, including care delivery, giving all communities and groups of people a fair and just opportunity to be as healthy as possible.
Despite pandemic public health precautions that led to deferring in-person medical care through much of 2020, physicians in value-based agreements found ways to overcome those medical-distancing hurdles by capitalizing on telemedicine and other innovative approaches to improve health outcomes.

Increased access resulted in MA members affiliated with value-based physicians outperforming those in non-value-based settings in all Healthcare Effectiveness Data and Information Set (HEDIS®) preventive screenings and adherence measures. Screenings were between 8% and 20% higher for the value-based cohort compared to non-value-based for colorectal screenings, diabetic eye exams, osteoporosis management and controlling blood sugar.1

Value-based members with certain chronic conditions routinely showed more screenings and better control than those non-value based. For example, value-based members with diabetes not only had their blood sugar levels under control but adhered to their medication regimens more frequently.1

Patient safety related to medication adherence among members affiliated with value-based physicians earned a HEDIS Stars 4-star rating and outpaced those affiliated with non-value-based clinicians.

The consistency of medication use among value-based members for diabetes, hypertension and statins was as high as 89%. Data analysts attribute those rates in part to actions taken at the outset of the pandemic allowing for early and extended prescription refills by members, who filled roughly 400,000 through June 2020.

The prevention and adherence figures led to overall Stars ratings and average HEDIS Stars ratings for preventive screenings both being a half star higher for value-based physicians than for non-value based, a 15% difference.1

Why it matters:

Prevention is the foundation for member well-being and the effectiveness of value-based care. In the face of the pandemic, medical distancing emerged as a challenge. But value-based physicians focused on whole-person health quickly found new and innovative ways to increase patient access to care.

Virtual visits proved to be a viable platform for physicians for everyday treatment and some screenings. Additionally, Humana sent more than 1 million kits to MA members—at no cost to them—so they could be tested for colorectal cancer, diabetes control and nephropathy without having to go to a clinic or lab. Of the kits returned, 10% of the screenings identified members with unfavorable results.

Those members were notified and clinical follow-ups recommended. If no follow-up was noted via a claim within 120 days, Humana’s outreach team contacted the member and assisted in scheduling an appointment for him or her.

The way forward:

Nontraditional approaches to care delivery are quickly becoming regularly used methods, primarily in the virtual space. The increased use of telemedicine provided a vital connection between physicians and their patients, and healthcare leaders say the technology will be a permanent part of their approach going forward.

Although in-person medical visits rose in the latter part of 2020, a resurgence in COVID-19 transmissions has pushed some practices to reduce physical interactions as many patients express concerns with visiting physicians’ offices. That has prompted practices to rely again on those alternative approaches to care delivery. Only this time, they’re employing tactics that are proven and refined.

Effective use, though, will only happen with a lens toward health equity, working to improve access to all modalities of care patients need, which also requires understanding their unique needs and barriers to care. Telehealth is only successful if patients have all the tools necessary for digital health engagement— stable broadband connectivity, connected devices, digital literacy and health literacy. It is imperative that medical and social services communities recognize their intricate connections to empowering the full health of each and every patient cared for.