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.
