Relationship will help create healthier communities, improve quality and reduce costs of health care services
DENVER & LOUISVILLE, Ky.--(BUSINESS WIRE)--Humana Medicare Advantage members in Colorado now have access to a new health care model known as value-based care, thanks to a relationship between population health leader FullWell and health and well-being leader Humana Inc. (NYSE: HUM). The arrangement is designed to offer a more proactive and wellness-focused health care experience and financially reward doctors for high quality care.
This value-based agreement unites FullWell and Humana around the common goal of improving the health of the Humana Medicare members served in FullWell’s Colorado Health Neighborhoods Network member practices. Humana Medicare Advantage members will have access to more than 150 FullWell primary care providers in the Denver metro area.
In 2015, on average, Humana Medicare Advantage members served by providers under value-based care experienced: 6 percent fewer ER visits, higher screening rates, including those for colorectal cancer (+8 percent) and breast cancer (+6 percent), and healthier outcomes versus members who were treated by providers in standard Medicare Advantage settings.
“FullWell’s mission and vision is to enable physicians to succeed in the transition to value-based health care. In a time of change, uncertainty, and increasing administrative burden, FullWell provides population health capabilities that help providers offer high quality, affordable care to their patients and transform their practices,” said Dr. Creagh Milford, FullWell’s Chief Executive Officer.
Value-based care represents a significant shift from the historic model of health care known as fee-for-service, which focuses on the costly treatment of sickness instead of disease prevention and keeping people in good health. In the fee-for-service model, physicians are paid and incentivized based on volume (number of services they perform), not improved health outcomes for the patient. By contrast, transitioning to value-based payment models will ensure that physicians are reimbursed for the health outcomes of the patients they serve, not the number of services they provide. By focusing on quality and health, Humana experienced 20 percent lower costs in total in 2015 for members who were treated by providers in a value-based reimbursement model setting versus an estimation of original fee-for-service Medicare costs using CMS Limited Data Set Files.
“Our new agreement with FullWell is bolstering the future of health care right here to Colorado. We are proud to support FullWell in building upon what is already a well-integrated care delivery system by providing Humana’s care management support to the relationship,” said Mark Iorio, Central West Region Medicare President for Humana. “FullWell’s care teams are focused on coordinating care around each patient’s unique health needs. By working with Humana, we are helping to strengthen FullWell’s team-based approach to care delivery, providing useful information, incentives, and resources to help those teams operate at their very best.”
For doctors thinking about entering into a value-based care agreement, many cite not having adequate resources and support as key barriers to adopting this new model. By working with Humana and FullWell, providers have access to a number of different services to help support their transition to value-based care.
As part of the agreement, FullWell and Humana will develop strategies to improve the health of Humana’s Medicare Advantage members in Colorado, lower costs, and manage the ongoing health needs of the population. Participating practices will utilize FullWell and Humana population health management tools to help identify gaps in care, manage medication adherence, follow up on patients needing PCP visits, and identify high ER utilizers and at-risk patients so they can receive the right care before requiring serious medical attention. Patients will also benefit from wellness programs, as well as screening and monitoring for chronic conditions such as diabetes and heart disease.
As of Sept. 30, 2016, Humana has 1.8 million individual Medicare Advantage members and 200,000 commercial members who are cared for by 49,600 primary care providers, in more than 900 value-based relationships across 43 states and Puerto Rico.
As of Sept. 30, 2016, approximately 63 percent of Humana individual Medicare Advantage members are in value-based payment relationships. Humana’s goal is to have 75 percent of individual Medicare Advantage members in value-based payment models by the end of 2017. For more information, visit humana.com/accountable-care or www.humana.com/valuebasedcare.
FullWell, located in Centennial, Co., is a collaborative, physician-centric organization bringing population health management tools, resources and competencies to the Colorado Health Neighborhoods network of providers. FullWell believes in approaching healthcare differently. We inspire and empower care teams to deliver the highest quality, highest value care to people in our communities. We believe in helping all people live their fullest lives. More information regarding FullWell can be found on our website at www.fullwell.com.
Humana Inc., headquartered in Louisville, Ky., is a leading health and well-being company focused on making it easy for people to achieve their best health with clinical excellence through coordinated care. The company’s strategy integrates care delivery, the member experience, and clinical and consumer insights to encourage engagement, behavior change, proactive clinical outreach and wellness for the millions of people we serve across the country.
More information regarding Humana is available to investors via the Investor Relations page of the company’s web site at www.humana.com, including copies of:
Humana is a Medicare Advantage HMO and PPO organization with a Medicare contract. Enrollment in any Humana plan depends on contract renewal. Other Physicians/Providers are available in our network.
Humana Inc. and its subsidiaries (“Humana”) do not discriminate on the basis of race, color, national origin, age, disability, or sex.
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