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Delaware Valley ACO renews value-based contract with Humana

Press releases may be edited for formatting or style | October 12, 2016 Business Affairs

In the fee-for-service model, physicians are paid and incentivized primarily based on volume (number of services they perform), instead of improved health outcomes for the patient. By contrast, transitioning to value-based payment models means that physicians are reimbursed primarily for the health outcomes of the patients they serve, rather than the number of services they provide.

By focusing on quality and health, Humana experienced 18 percent lower costs in total in 2014 for Medicare Advantage members who were treated by providers in a value-based reimbursement model setting, compared to Centers for Medicare & Medicaid Services data for similar situated Medicare beneficiaries covered by original fee-for-service Medicare.

“Our renewed agreement with Delaware Valley ACO is helping bring the future of health care here to Philadelphia,” said Humana East Region Medicare Vice President Eric Bohannon. “We’re aligning Delaware Valley ACO’s physicians and facilities with Humana’s expertise in value-based care, population health tools and data-driven insights around the same goal: improving the health of the people we serve.”

As part of the agreement, DVACO and Humana will develop strategies to improve the health of Humana’s Medicare Advantage members in the five-county Philadelphia metro area, lower costs, and manage the ongoing health needs of the population.

DVACO utilizes data and tools supplied by Humana to help identify gaps in care, follow up on Humana members needing primary care physician visits, and to identify high emergency room utilizers and at-risk Humana members so they can receive the right care before requiring serious medical attention.

Humana members will also benefit from wellness programs and screening and monitoring for chronic conditions such as diabetes and heart disease.

As of June 30, 2016, Humana has 1.7 million individual Medicare Advantage members and 200,000 commercial members who are cared for by 48,200 primary care providers, in more than 900 value-based relationships across 43 states and Puerto Rico.

As of June 30, 2016, approximately 61 percent of Humana individual Medicare Advantage members are seeing providers who are in value-based payment relationships with Humana. Humana’s goal is to have 75 percent of individual Medicare Advantage members using providers in value-based payment models by the end of 2017. For more information, visit humana.com/accountable-care or humana.com/valuebasedcare.

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