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Value-Based Care Agreements Gain Popularity Among Nation’s Largest Insurers


January 10, 2017

Leading national health insurance complains, including Humana, Aetna and Cigna, have invested in innovative value-based care managements in order to transform care delivery, according to recent reports by Zacks Equity Research.

A value-based care payment model depends on patient health outcomes; the model moves away from a fee-for-service reimbursement structure where the volume of service was the main focus instead of preventive care.

According to one of the reports, Humana Inc and Fullwell—a physician-centric organization in Colorado—entered into a value-based care agreement aimed at creating a wellness-focused, population health-based, patient-centric healthcare delivery system. Humana’s value-based care payment model will reimburse providers for quality of care over quantity.

“Under the terms of this value-based agreement, both FullWell and Humana are supposed to frame strategies to improve the quality of healthcare at a low cost for the Humana members in Colorado,” according to a report from Zacks Equity Research that investigated the arrangement. “Together, the companies are striving to find the gaps in care, manage medication adherence, follow up on patients needing PCP visits, and identify high emergency room seekers and at-risk patients to provide them proper treatment before their condition turns severe.”

The report highlighted that Humana decreased their overall health care spending by approximately 20% in 2015 due to value-based care payment models. Further, roughly 63% of Humana’s 1.8 million Medicare Advantage member are currently being treated through a value-based care payment model.

According to a second report by Zacks Equity Research, Aetna has invested in transforming its health care delivery strategy by expanding value-based care payment models such as accountable care organizations (ACOs). The report shows that Aetna currently has more than 40% of its health care spending in the form of value-based care payments.

The report noted that Aetna aims to the have approximately 75% of their spending in a value-based model by 2020. Aetna is also continually growing its ACO offerings and is growing in international markets, according to the report. Through value-based payment models, Aetna has decreased its operating costs to 18% in 2016.

Cigna, the third health insurer highlighted in the report, built a new service called CareAllies to bring on new talent to help provider organizations more closely improve patient outcomes and quality. CareAllies will bring on new health IT systems, strategies, and management to support Cigna’s value-based care payment models among providers.

“Our aim is to enable all of our provider clients to succeed in an extremely competitive and disruptive healthcare environment,” Julian Harris, MD, president of CareAllies, Inc, said in a press release. “Whether a provider’s business is focused on commercial, Medicare, or Medicaid patients, the new CareAllies has the know-how and patient health engagement experience to help deliver better quality and financial outcomes as providers navigate the transition to value-based payment.”

Julie Gould (Mazurkiewicz)

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