More Than The Money 

Greetings from Clearwater Beach and the 2025 OPEN MINDS Performance Management Institute. The day has been filled with discussions of strategy, margin management, growth, and financial sustainability. 

One integral part of planning for every executive in the health and human service market space is developing a strategy that syncs with whole person care models, integrated delivery systems, and value-based reimbursement models. Our recently conducted survey found that 64% of specialty care organizations participate in value-based contracts (VBC), compared to 82% of primary care organizations.

The growth of VBC has been glacial but steady. A recent report, Humana’s 11th Value-Based Care Report, illustrates health plan shifts over the past decade. Humana now provides health insurance for 9.7 million Americans—8.5 million Medicare members and 1.2 million Medicaid members.

Of the Humana Medicare Advantage (MA) members, 70% are aligned to primary care provider organizations with value-based arrangements—and 64% of MA members are in advanced payment models. The effect of VBC is striking. On every quality measure, the consumer statistics were better under VBC arrangements—with 5+ percentage point differences on many measures of chronic care management (blood pressure control, diabetes care, colorectal cancer screening), and on both post-discharge medication reconciliation and follow-up after hospitalization.

Humana also is using VBC reimbursement models in their networks managing 1.2 million Medicaid members in five states. The percentage of Medicaid members attributed to VBC primary care providers in 2023 was 79% in South Carolina, 90% in Florida, 92% in Louisiana, 94% in Kentucky, and 99% in Ohio. The data from Florida shows the big differences in consumer health measures: VBC provider organizations did better than non-VBC counterparts on 150 HEDIS measures. These include higher adherence to asthma medication (6.7 points higher), blood pressure control (8.3 points), breast cancer screening (8.6 points), controlling blood pressure (8 points), diabetes monitoring for consumers with schizophrenia (7.1 points); weight assessment and counseling for children (10.8 points), pharmacotherapy for opioid use disorder (9.1 points), eye exams for consumers with diabetes (12.4 points), and immunizations for adolescents (10.5 points).

VBC also has a positive impact on clinicians—with clinicians in Humana’s VBC models reporting reduced burnout and greater job satisfaction—driven by smaller caseloads, better relationships with consumers, better support from data analytics, and better pay. On the compensation front, Humana’s MA VBC providers earned up to 241% above the Medicare fee schedule, and in Florida, Medicaid providers in full-risk arrangements earned, on average, 200% above the Medicaid fee schedule.

The VBC success for clinicians and consumers was attributed to two “success factors”—a multidisciplinary care team structure and data liquidity. Data liquidity involves the seamless flow of actionable data across systems, enabling clinicians to make informed, real-time decisions. This data feeds the work of multidisciplinary care teams—fostering collaboration among physicians, nurses, social workers and other professionals. The key is using data for aligning roles, improving communication, and leveraging each team member’s expertise.

When structured and financed correctly, VBC models can both improve consumer care and reduce costs. In addition to the improved consumer outcomes, Humana reports that these arrangements have saved an estimated $11 billion in 2023 MA medical costs. This is due to 32.1% fewer inpatient admissions compared to the Medicare fee-for-service plan, 7.2% fewer admissions than non-VBC MA plans, and 11.6% fewer emergency room (ER) visits than non-VBC MA plans.

To quote Oraida Roman, Humana’s senior vice president for provider experience, “The road to the future of health care isn’t without its obstacles, but together, we can overcome them, and for many practices, it is about going back to basics. By refining workflows, aligning incentives, and building systems rooted in quality, equity, and sustainability, we can create a future where VBC isn’t just a model—it’s the standard…VBC is the best way to find success together while serving our patients and members.”