Accountable Care Supports Improved Population Health, Results for Humana Medicare Advantage Members

Results from approximately one million Humana Medicare Advantage members in Accountable Care programs shows solid improvements in quality, outcomes and costs in 2013

Humana Population Health Infographic (Graphic: Business Wire)

LOUISVILLE, Ky.--()--Better quality, improved population health and lower costs are seen as key measurements for successful value-based reimbursement models. These measurements are all widely reflected in results released today by Humana Inc. (NYSE: HUM), the country’s second largest Medicare Advantage (MA) provider.

The results show that Humana’s Accountable Care Continuum has had a positive, measurable impact on the quality of care of approximately one million Humana MA members who have experienced improved care. Humana compared quality, outcomes and costs for these MA members who were treated by providers in Humana’s Accountable Care Continuum programs versus members who were treated in traditional, fee-for-service and original Medicare settings.

Key findings are as follows:

  • Better Quality: Humana’s accountable care, or pay-for-value, relationships experienced a higher Healthcare Effectiveness Data and Information Set (HEDIS) Star score average of 4.25 as compared to providers outside of accountable care settings with a HEDIS Star score average of 3.65.
  • Improved Population Health: Humana MA members in accountable care relationships experienced seven percent fewer emergency room visits per thousand and four percent fewer inpatient admits per thousand than those in traditional, fee-for-service settings. These members also experienced improvements in clinical management and screening compliance. For example, screening compliance for Humana MA members with diabetes increased by seven percent for each of the following: cholesterol control, eye exams and blood sugar. Cholesterol screening for cardiovascular care increased by five percent.
  • Lower Costs: Humana experienced a 19 percent cost improvement in total in 2013 for members who were treated in an accountable care setting versus members who were treated by providers in original Medicare settings.

Humana’s Accountable Care Continuum is guided by the company’s integrated health approach; a defined, measurable patient population and pay-for results based on improved clinical outcomes and reduced costs. Humana’s assessment of the impact of its value-based approach supports the shift from a fee-for-service model to an accountable care model of health care showing significant results in improved quality outcomes and cost savings.

“Humana’s accountable care approach is effective in obtaining results that help patients manage their health, which leads to improved outcomes for patients and is reflective of our intent to serve as a health partner to our members,” said Bruce Broussard, Humana’s President and Chief Executive Officer. “Humana is committed to improving the overall health of our members, and we are pleased to see that our Continuum of programs is working to encourage and support primary care physicians to become successful population health managers.”

“With 75 percent of our health care dollars in the United States going to treatment of chronic conditions1, helping patients effectively manage these conditions is critical,” said Roy Beveridge, MD, Humana’s Chief Medical Officer. “With an accountable, value-based model, our results show that doctors are successfully improving quality, managing population health and keeping patients healthier and out of the hospital.”

Additional results include:

  • Screening and Monitoring: Improved clinical management and increased screening compliance when the Humana MA member was treated in an accountable care setting was also noted in:
    • Osteoporosis Management in women with a fracture (increased by 16 percent)
    • Colorectal Cancer Screening (increased by seven percent)
    • Adult BMI Assessment (increased by five percent)
  • Special Needs Population Care: Care for Older Adults (COA) - Medication Review (increased by eight percent)

Humana has a 26-year accountable care relationship history with more 1.2 million MA members today that are cared for by 38,000 primary care physicians, in more than 900 accountable care relationships across 43 states and Puerto Rico.

The results were based on providers in accountable care settings as compared to providers with no incentives and original Medicare and included a range of 800,000 to one million Humana MA members from 2013.

Results for cost improvement, fewer emergency room visits and reduced number of inpatient admits were based on 800,000 members; all other results were based on one million members.

About Humana

Humana Inc., headquartered in Louisville, Ky., is a leading health and well-being company focused on making it easy for people to achieve their best health with clinical excellence through coordinated care. The company’s strategy integrates care delivery, the member experience, and clinical and consumer insights to encourage engagement, behavior change, proactive clinical outreach and wellness for the millions of people we serve across the country.

More information regarding Humana is available to investors via the Investor Relations page of the company’s web site at, including copies of:

  • Annual reports to stockholders;
  • Securities and Exchange Commission filings;
  • Most recent investor conference presentations;
  • Quarterly earnings news releases;
  • Replays of most recent earnings release conference calls;
  • Calendar of events (including upcoming earnings conference call dates and times, as well as planned interaction with research analysts and institutional investors);
  • Corporate Governance information.

1 Centers for Disease Control and Prevention, Chronic Disease Prevention and Health Promotion: Accessed on April 29, 2014.


Humana Corporate Communications
Alex Kepnes, 502-580-2990

Release Summary

Accountable Care Supports Improved Population Health, Results for Humana Medicare Advantage Members


Humana Corporate Communications
Alex Kepnes, 502-580-2990