– Primary care support will bring the results of care based on value, claiming Chief Medical Officer Humana Roy Beveridge, MD.
The arrangements are based on value between providers and payers of high goals, but unacceptable to improve the quality of care in reducing the total cost of care for the healthcare system. The arrangements hold providers accountable for the financial and clinical consequences of patients, encouraging care delivery teams to provide the highest value care for patients.
However, to date, the results of models of care based on value have been faulty. Value-based payment models did not reduce the total cost of care or improve clinical quality results at market level, the recent analysis of the Healthcare Financial Management Association (HFMA) showed.
In addition, providers have been hesitant to take value-based care accountability. Only about a third of health care charges resulting from an alternative payment model, recently reported by the Healthcare Payments (LAN) Learning and Implementation Network. And 61 per cent of doctors fear that value-based arrangements will harness their financial and clinical practice, a new survey revealed.
But Humana, one of the largest healthcare in the US with over $ 53 billion in annual revenue, is finding success through its value-based arrangements with providers.
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The payer recently stated that his value-based models of care reduce medical costs by almost 16 per cent in 2017 in improving the quality of care, preventive care, and the use of healthcare. The insurer also reached his goal of getting 66% of 2.9 million individual Medicare Advantage members associated with a primary care doctor in a value-based agreement.
Humana CMO determines the success of the payer's care based on value with their emphasis on supporting primary care.
"Who are you thinking responsive? Well, here is the primary care doctor. Who is the one who makes the difficult decisions? And who is & # 39; Answering the telephone over Friday at 4:00 a.m. and a.m. at 10:00 p.m. talking to a patient and having to go to hospital or # 39 : The crisis room? This is the primary care doctor, "said Beveridge recently RevCycleIntelligence.com.
Humana supports their primary care doctors by appreciating the work they do through valued models of value.
"When you think about primary care doctors, historically, they have been underestimated, underachieved, and there are not enough resources," explained Beveridge. "When we worked with the American GP Academy, we found that our data was very consistent with them. For non-value-based clinical models, about six percent of the dollar amount is enter the family practitioners' fields. "
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"Given that we believe in the family practitioner's responsibility and the extra amount of work and time needed for these providers to spend with their patients, we have ensured that in recent years we are pay the family practitioners significantly more, "he continued.
Nearly seven percent of every dollar spent by Humana on members' care in 2017 for primary care doctors.
And that percentage was really increasing for primary care doctors taking the thigh to care based on value. Nearly 17 per cent of each dollar spent on the care of a member for primary care doctors in value-based agreements, reported by the payer.
Increasing capital allowed providers to act as a patient care quarterback, giving them the necessary financial support to invest in health IT systems or care co-ordination support. As a result, healthcare costs decreased, and preventive care increased.
"We are basically considering ourselves as agents to support clinicians who look after our members," said Beveridge. "That's an important difference to do. We do not see them as our patients. We do not say we're the best friends and doctors. What we say is our They basically recognize that they provide care and we need to support them in this effort. "
Care based on value moving to home
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Humana stimulates providers to take part in value-based agreements by providing the financial help needed to invest in value-based capabilities. But the agreements will also help push care beyond the traditional setting, which can be expensive to the whole healthcare system.
"When you talk to older people, about 90 percent of them want to be at home for care," said Beveridge. "You need to acknowledge that, even when a patient is going to see his doctor a few times a year, they still spend 8,200 or 8,300 hours in their homes. Or he said another way, not in a doctor's office."
The ability to control the health and cost outcomes within patient homes is the key to bending the cost curve in improving patient outcomes.
For example, almost every fifth hospital among fee beneficiaries for the Medicare service ends as an in-patient within 30 days. Influencing the patient's health in their home can prevent recovery from the expensive hospital and help control its condition in a comfortable, low cost setting.
"Where we're going is how we understand what is happening at home and what is happening not in hospital," he said. "And we are beginning to see the change of caring based on domestic value through analyzes, metrics and telemetics, which will allow members to have a higher quality result at lower costs."
However, providers need to engage in value-based models of care that change the risk away from carers for home care to implement the workflow and technologies necessary to really improve the healthcare system.
"We have 66,000 provider delivery groups that we work with in value-based care. We believe that this is the better payment methodology because it allows innovation and allows improvement to the health of our members," explained the CMO.
The value-based agreements, especially those with uneven financial risk, allow providers to extend their care beyond the hospital or doctor's office because Humana They pay for care management, not just for specific services.
"We will start paying not only for the visit, but also for the managers and the results," he expanded.
The value-based agreements will allow providers to send nurses into the home and liaise with primary care doctors through telemedicine or other technologies.
"Contacting nurses at home for primary care doctors by telemedicine is natural," he said. "The nurse goes in to care for the diabetic foot ulcer. The nurse, as there is, has the iPad and is contacting the patient's doctor. The patient's doctor said, "Well, let's review these medicines with me alone. Let's work on this." Each party exercises the highest license and doing things & # 39 ; n efficient. "
And a provider's repayment covers the costs of that diabetes, not just for treating the ulcer.
"I do not care if the nurse is 17 or seven times as long as the diabetic foot ulcer is being treated. And if that's that they bring technology in, iPads and telemetry , that's fine, "he said. "Those changes we want to see are quite fast."
Currently value-based care is based in the doctor's office as a whole. Providers still invest in the necessary abilities to provide high quality lower cost care that can ultimately change to the home.
But Beveridge is confident that transition will take place over time that payers invest in their primary care doctors. And there will be even more cost and quality improvements resulting from the transfer of patients to the home through models of care based on value.
"Value-based care has been around for a long time and, even a number of years to this, there are continuous improvements," he said. "This does not go into a medicine based on value, changes occur, and then it's stable. What this means is that continuous quality should be improved, which should continue to improve the health of our patients, our members. "