Companies operating under the PayVider business model, such as VNS Health and Humana Inc. (NYSE: HUM), point to the ability to provide a more integrated care experience and increased engagement with value-based care as a key differentiator.
In the case of Humana, the clearest example of engaging in value-based care using integrated care is the company's latest risk bearing model.
“In central North Florida, we have created a risk model for around 65,000 members,” Kirk Allen, president of Humana Home Solutions, said at a future meeting of Home Health Care News. “These members were served in the Primary Care Physicians and Center Well Senior Care Organization, and served by Center Well Home Health, Onyem, our convener and our Humana Pharmacy.
Humana has over 5 million Medicare Advantage (MA) members in its health plan. It is one of the largest insurance companies in the country. Centrewell is Humana's provider services division, including home hygiene, pharmacy and primary care. The company offers over 9 million home medical appointments per year.
According to Allen, to eliminate the latest risk bearing model, Humana has really focused communications between all physicians, pharmacies, home hygiene departments and health plans.
“We are truly pleased to be able to achieve better results with comparable, or sometimes shorter stays, by providing care in a variety of ways, as we assessed the outcomes of that model,” he said. “There are models we believe will come in the future. I don't think we could do that because we have communication, coordination and infrastructure in our family.”
By prioritizing value-based care, Humana can address costs and avoidable hospitalizations.
“As a provider, being able to participate in avoiding unnecessary hospitalizations is an element of value-based contracts and we are really trying to implement them,” Allen said. “From a home health perspective, what we did was not only work in home health, but we entered into an agreement that could demonstrate the financial risks of easy-to-avoid hospitalizations, as well as the impact we have.”
John Burke, Dr. Laura Lawson, Kirk Allen
Finally, VNS Health has many levels of integrated care at the planning level.
“We have programs that integrate Medicare, Medicaid and long-term services and support them under one health plan,” said John Burke, Vice President and Chief of Health Planning at VNS Health, in the discussion. “Historically, these have been fragmented. …We have a fully integrated health plan product that is our lead program.”
New York-based VNS Health is a full-service, nonprofit home-based care organization. On certain days, the company has over 73,000 patients, members and clients in its care.
The company's health planning business focuses solely on government programs Medicare and Medicaid, with orientation for complex populations, low-income individuals and individuals with special needs. Currently, the Health Plan has over 70,000 members.
According to BURKE, the provider side of VNS Health offers an additional level of integrated care.
“Integrating with the provider business is important,” he said. “If you want to succeed in Medicare's advantage, you have to be good at quality. You need to be particularly good at risk adjustment and healthcare cost management, especially for members with complex risk. Our provider business has managed to get some of them.”
Burke also highlighted VNS Health's value-based arrangements between the company's health plans and the provider's division.
“Some of it unfolded,” he said. “Some people are in development and they really help manage this business. They have a longitudinal care management program run by the provider business. They care for high-risk (individuals) and have performance-based contracts, so they get incentives or penalties based on the quality of care and total cost of care.
Looking ahead, Dr. Laura Lawson, vice president of client solutions at Research and Advisory Firm ATI Advisory, noted that Payviders is a good choice to enhance integrated care and provide value.
“I'm inspired, and when we see collaboration across stakeholders, I think it allows for a lot of good work,” she said in the discussion. “As organizations move forward in these times, I think the evolving and growing groups will be a really good place to care for those complex, frail groups, especially those ages 85 and above.”
