The Louisville, Ky.-based payer found that Medicare Advantage beneficiaries under a two-sided risk value-based payment model had lower rates of hospitalizations, observation stays and emergency department visits compared to fee-for-service Medicare beneficiaries.
The study was conducted using data from 489,796 of Humana’s Medicare Advantage beneficiaries. Nearly 17 percent of enrollees were under a fee-for-service plan, 32 percent were under an upside-only risk plan, and 51 percent were under a two-sided risk plan.
Adjusted analyses showed:
- The rate of emergency department visits per 1,000 patients for two-sided risk models was 375.8, compared with 434.1 for fee-for-service.
- Compared with fee-for-service, two-sided risk models were associated with a nearly 16 percent reduction in avoidable hospitalizations, compared with about 4 percent for all-cause hospitalizations.
- No significant differences in use were found between beneficiaries cared for under upside-only risk models and fee-for-service for all outcomes.
The correlation between value-based payments and decreased acute care use was most apparent for measures of avoidable care.
The lack of a significant difference in acute care use between beneficiaries under upside-only risk models and fee-for-service models for all outcomes suggests that downside financial risk may be critical for effective value-based payment models.
Researchers say that the study’s limitations include the potential for residual confounding and the likelihood of some selection bias around which providers use value-based payment models.
The study’s findings suggest that payers and providers engaging in advanced value-based payment models in Medicare Advantage deliver differential outcomes to the Medicare Advantage beneficiaries under their care. Additional research is needed to explain why value-based primary care is associated with reductions in acute care use.
At the Becker's 5th Annual Fall Payer Issues Roundtable, taking place November 2–3 in Chicago, payer executives and healthcare leaders will come together to discuss value-based care, regulatory changes, cost management strategies and innovations shaping the future of payer-provider collaboration. Apply for complimentary registration now.
