A Paradigm Shift for the Healthcare Field

Healthcare in our country is complex and continuously evolving. That’s probably not news to you. But right now, the industry is undergoing one of its biggest transformations in recent history. The topic at hand? Reimbursement models.

In layman’s terms, this refers to how healthcare providers, like physicians and hospitals, are compensated for their services.¹ Historically, providers have been reimbursed on a fee-for-service (FFS) basis.² Under this model, they are paid for each office visit, test, and procedure performed.³ But with recent increased pressure for better outcomes and lower costs (particularly since the passage of health care reform legislation in 2010), the U.S. is ushering in a new era: one of value-based care (VBC).^2,4

Under a VBC model, health care providers are compensated for the quality of care they provide (versus the quantity)—and the overall outcomes of that care.^5,6This model is slowly but surely gaining popularity across the country.⁷

What Reimbursement Models Can Mean for Patient Care

For patients like you, the issue of reimbursement may seem unimportant—or at least unrelated to your consumer experience. In fact, the reimbursement models your medical providers operate under can have a big impact on your care and the amount you pay for it.

A fee-for-service model allows patients to freely choose their physicians and hospitals with little interference from their insurance provider.⁸On the other hand, there is little incentive for FFS provider to deliver proactive, holistic care, as they are compensated for their volume of services, regardless of patient outcomes.⁸

According to recent reports, patients served by value-based providers receive more preventive care and see costs that are more than 15 percent less than those who go to fee-for-service providers.⁹

Humana’s Commitment to Value-Based Care

At Humana, we’re proud to have an extensive—and growing—value-based care presence.¹⁰ As of September 2018, we have more than 2 million Medicare Advantage members cared for by more than 52,000 primary care physicians across 43 states and Puerto Rico.¹⁰

Just like their value-based care counterparts across the country, the providers in our value-based care network are rewarded for delivering proactive, integrated care—grounded in dignity and respect—that contributes to better health and a better experience for their patients.¹⁰

Power to the Patient

One thing is clear: when it comes to healthcare, the power has shifted to the consumer. We have more choice than ever before in how we approach our health and how we access care. We encourage you to do your own research on different healthcare delivery and reimbursement models.

If you’re interested in learning more about Humana’s Medicare plans and the providers in our network, we’d love you to get in touch.