Humana issued a progress report Wednesday on its accountable care efforts to date. The company issued a statement in conjunction with a White House launch event for its Health Care Payment Learning and Action Network, a new group comprised of chief medical officers from large insurers, integrated health systems and ACOs.
“Humana applauds HHS for its continued commitment to fostering and expanding value-based reimbursement in the traditional, fee-for-service Medicare program,” said Humana president and CEO Bruce D. Broussard. “We believe that expanding pay-for-performance programs will result in improved population health for Americans.”
The four quality and cost improvements that Humana announced include:
Improving Access to Accountable Care: Humana has 53 percent of its members in accountable care relationships today and is on course to have more than 75 percent in accountable care relationships by 2017.
Improving the Quality of Patient Care: In 2014, Humana’s accountable care providers had a HEDIS Star score average of 4.25, compared to providers outside of accountable care settings with a HEDIS Star score average of 3.65.
Reducing Hospital Readmissions and ER Visits: According to the company, Humana members in accountable care relationships have a 4 percent lower hospital readmission rate than traditional, fee-for-service Medicare and 7 percent fewer emergency room visits per thousand beneficiaries.
Lowering Costs: Humana experienced a 19 percent cost improvement in 2013 for members who were treated in an accountable care setting compared with members treated by providers in original Medicare settings.
Humana has more than 1.3 million Medicare Advantage members in accountable care programs in 43 states.
Our Take: One of the stated goals of the Affordable Care Act is transparency. Why? Our patchwork health system, with misaligned incentives and buyers operating with little (or inaccurate) information, is rife with inefficiencies. Increased transparency is one step in improving the decisions we make about our health care, whether it be a consumer choosing a health plan, or an employer choosing which plans to offer, or a hospital deciding who to choose in a myriad of partnerships—such as home health agencies, outpatient clinics and rehabilitation services.
Humana made some news with its PR statement on Wednesday, but commercial ACOs could be more transparent about the results that they are achieving. More detailed data are being reported now on how Medicare ACOs are performing—both in terms of quality and cost—and transparency should encourage better performance. As consumers, we would like to know which commercial model is working best, in the same way we compare hospitals and physicians with publicly available data. Large, commercial insurers implementing accountable care-like initiatives aren’t required to disclose such information, but it may be to their advantage to do so, especially if they are high-performing organizations.