Value-based care tied to better care for patients with heart failure, Humana report finds

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Humana Healthcare Research has released new data showing that Medicare Advantage patients with heart failure who are treated by value-based care (VBC) physicians are significantly more likely to receive recommended therapies than those in traditional care models.

According to Humana’s Value-Based Care Issue Brief, patients in VBC arrangements were nearly 28% more likely to receive full quadruple therapy — the gold-standard, evidence-based regimen for heart failure with reduced ejection fraction (HFrEF).

Heart failure affects more than 6.7 million Americans today, a figure expected to climb as high as 11.4 million by 2050. The condition is one of the leading causes of hospitalization among older adults and carries higher rates of emergency department use and overall health care costs.

The treatment gap

Despite strong evidence and guidelines from the American Heart Association (AHA), American College of Cardiology (ACC) and Heart Failure Society of America (HFSA), fewer than one in five patients hospitalized with HFrEF are prescribed all four recommended therapies within six months of discharge.

Humana’s data, drawn from 2022-2024 claims for 2,328 Medicare Advantage patients, found that adherence remains suboptimal, but value-based models improve the odds of complete therapy.

“We recognize the importance of Guideline-Directed Medical Therapy — it’s lifesaving care grounded in the best available evidence,” said Susan Mani, M.D., a cardiologist and associate vice president of clinical strategy at Humana. “In value-based care, we have the right incentives and support to ensure patients actually receive it. By aligning payment models with outcomes, VBC gives us the tools to overcome the inertia and barriers that often prevent patients from getting the full benefit of therapy. For heart failure, this means more lives saved, fewer hospitalizations and better quality of life.”

Who is most affected

The analysis highlighted disparities in access to recommended therapies:

• Older adults (ages 85-89) were 58% less likely to receive full quadruple therapy compared with those ages 65-74.
• Rural residents were 33% less likely than urban patients to receive all four medications.
• Patients with low-income subsidies were 48% more likely to receive full therapy.

“Heart failure has such a big impact on senior population,” said Rich Sheer, lead research scientist at Humana Healthcare Research. “We have been tracking the use of these important and helpful medications for the last few years and have been very encouraged to see that the use of these therapies has been increasing (although slowly) and that good primary care can make such a meaningful difference — a statistically significant improvement of almost 30% is not something that we see often.”

What this means

Humana’s findings add to more than a decade of research into the effectiveness of VBC, suggesting that it improves chronic condition management, increases physician visits and raises patient satisfaction.

In its 11^th annual Value-Based Care Report, the company also noted that its Medicare Advantage VBC arrangements generated an estimated $11 billion in medical cost savings in 2023 compared with traditional Medicare.

“Coordinated care impacts the quality of care, particularly for seniors post-hospitalization. A care team who holistically sees a patient’s needs and relies on their collective expertise to provide the highest quality of care is the value-based care model,” said Kate Goodrich, M.D., Humana’s chief medical officer. “Value-based care depends on primary care physicians, specialists, care teams and patients working together to achieve better health outcomes.”

As the number of Americans living with heart failure continues to rise, the numbers suggest that expanding access to VBC could help close treatment gaps and improve outcomes for a growing population of patients.