John Muir and Humana has teamed up to bring value-based care for Humana Medicare Advantage members in Contra Costa County. The partnership will offer a more proactive and wellness-focused health care experience for Humana’s Medicare Advantage members.
As part of the agreement, John Muir Health and Humana will develop strategies to improve the health of Humana’s Medicare Advantage members in Contra Costa County, lower costs, and manage the ongoing health needs of the population. Under the terms of this agreement, both organizations will benefit financially if the health of this population improves. Doctors will also be rewarded financially for high-quality care.
Additionally, John Muir Health will collaborate with Humana to manage prescriptions, follow up on patients who miss appointments, and identify at-risk patients so they can receive the right care before requiring serious medical attention. Patients will also benefit from wellness programs and improved screening and monitoring for chronic conditions such as diabetes and heart disease.
Value-based Care Benefits
Transitioning to value-based payment models means that physicians are reimbursed for the health outcomes of the patients they serve. By focusing on quality and health, Humana experienced 18 percent lower costs in total in 2014 for members who were treated by providers in a value-based reimbursement model setting versus original fee-for-service Medicare. John Muir Health has also participated in several value-based programs, including the Medicare Shared Savings Program ACO. John Muir Health was a top performing Medicare ACO in California and the only participant in California to achieve shared savings for the 2014 performance year.
Nationally, Humana has nearly 30 years of accountable care experience, including approximately 1.7 million individual Medicare Advantage and 200,000 commercial members, cared for by more than 47,800 primary care physicians in more than 900 value-based payment relationships across 43 states and Puerto Rico. Currently, approximately 61 percent of Humana individual Medicare Advantage members are in value-based payment relationships. Humana’s goal is to have 75 percent of individual Medicare Advantage members in value-based payment models by 2017.