Patients who get primary care from older adult-focused, value-based care organizations are more likely to use these services regularly, according to a study published in NEJM Catalyst: Innovations in Care Delivery, a digital journal published by The New England Journal of Medicine.
The study, produced by Humana Healthcare Research and Suhas Gondi, MD, attending physician at Boston-based Massachusetts General Hospital, covered 3.2 million Medicare Advantage members and included six older adult-focused facilities, most full-risk practices, according to Humana Chief Medical Officer Kate Goodrich, MD. The team found value-based care — as opposed to physicians offering a greater volume of services — is linked to increased use of primary care services.
“The exciting thing about this paper is that it shows that in those higher or more mature types of practices that are focused on seniors, they’re getting more primary care, and they’re getting more consistent primary care,” Dr. Goodrich told Becker’s.
This research builds from a 2024 study on how older adult-focused organizations can increase access to primary care, particularly among underserved populations.
Compared to older adult patients of fee-for-service providers, patients of older adult-focused organizations that often practice value-based care had 20% more primary care visits per year and 6% more regularly scheduled primary care visits. Three-quarters of these patients had highly continuous primary care visits, versus 55% of fee-for-service patients.
Still, fee-for-service remains an obstacle in value-based care expansion.
“I think fee-for-service itself is actually the biggest barrier,” Dr. Goodrich. “The payment system for primary care needs to change to allow for more upfront payments, not just relying on fee-for-service, so that clinicians and their practices can invest in the right resources to deliver this care.”
When it comes to getting value-based care off the ground, Dr. Goodrich identified how financial incentives are “the biggest lever,” helping providers invest in staffing and technology.
To further facilitate this transition, Humana offers care management fees as upfront payments, distributes analytic insights and brings together clinician groups, Dr. Goodrich said.
This study can also be a wake-up call for payers, specifically, she added.
“This should give them a lot of confidence in the need to accelerate that transition to value-based care,” she said. “This just further bolsters the case that CMS is making to continue that drive towards value-based care because it’s yet another study that demonstrates a positive impact on patients.”
While not directly addressed in this study, other research and case studies have found cost savings and better patient outcomes as primary care visits increased under value-based care.
