32% less hospitalizations, $11 billion saved from value-based care

Primary care physicians (PCPs) practicing in value-based care (VBC) practice models spend more time with patients, reduce unnecessary hospitalizations and demonstrate more frequent preventive care, according to Humana’s 11th annual Value-Based Care Report released Wednesday.

“Coordinated care that delivers the right care at the right time must become the standard,” Kate Goodrich, MD, MHS, chief medical officer at Humana, said in a news release. “Our report paints a clear picture: value-based practices deliver better patient experiences and health outcomes. Patients spend more time with their primary care clinician, which means more preventive care and better management of chronic diseases, like diabetes and high blood pressure. Seniors in value-based care models receive the care they deserve with a clinician who holistically understands their care needs.”

Results

Humana’s report highlights that Medicare Advantage (MA) patients in VBC arrangements experienced 32.1% fewer inpatient hospital admissions and 11.6% fewer emergency department (ED) visits compared to non-VBC patients. Preventive care also improved, with patients more likely to receive screenings for colorectal cancer, diabetes eye exams and mammograms. As a result, these patients were also more likely to meet blood sugar control measures compared to members not in VBC arrangements.

The report also demonstrates increased primary care engagement and reduced reliance on emergency and inpatient services. In 2023, VBC members had 10% more primary care visits than non-VBC patients, allowing for better preventive care and management of chronic diseases.

VBC MA patients also reported 90% satisfaction with their health care provider, according to Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey data.

Senior-focused primary care organizations (PCOs) combine a VBC model with a care delivery approach tailored to seniors. Compared to Original Medicare, senior-focused primary care patients had 17% more primary care visits, 6% fewer hospitalizations and 11% fewer trips to the ED. Notably, Black seniors visited their senior-focused PCP 39% more, and low-income seniors visited at a 21% higher rate.

Financials

Beyond clinical improvements, patients, clinicians and payers all benefit from the financial stability of VBC. In 2023, Humana MA VBC arrangements saved an estimated $11 billion — 25.8% in medical costs compared to Original Medicare. These savings were reinvested into expanded benefits, including lower premiums, at-home care, prescription delivery and food assistance for members.

Physicians in VBC models also saw financial benefits. According to the report, VBC physicians earned up to 241% above Medicare’s fee-for-service schedule, allowing for investment in better care delivery and operational sustainability.

Burnout

With physician burnout rates remaining high, Humana’s report suggests that VBC can help mitigate stress by fostering deeper patient relationships and shifting the focus from volume-driven care to meaningful health outcomes.

VBC providers report higher professional satisfaction due to smaller patient panels, team-based coordination and integrated technology that streamlines patient care.

“VBC is the best model for clinician satisfaction,” Snehal Parikh, MD, of Palmetto Pediatrics, said in the report. “This absolutely makes me happier as a physician. It’s possible to love what you do and to get great results.”

George Renaudin, insurance president of Humana, called for the wider adoption of VBC based on its track record. “Over a decade of our experience and research shows that providers navigating the shift to value achieve greater success with proactive support, an operational roadmap and actionable data. The path forward is clear: the value-based model is the future — we have seen it in action, and it’s the key to sustainable, patient-centered care.”