Humana Issues Brief on Value-Based Care in Nephrology

Health insurance provider Humana released a value-based care (VBC) issue brief focusing on nephrology. The brief highlights how VBC arrangements can improve patient outcomes and reduce health care costs for patients with chronic kidney disease (CKD) and end-stage renal disease (ESRD).

Humana’s issue brief posits that VBC can improve kidney care coordination and result in fewer unnecessary hospital admissions, as well as cost savings. Humana also pointed out that VBC can keep patients healthy longer to avoid crisis dialysis starts and transplant decisions.

The report states that, when comparing 2023 Humana Medicare Advantage patients aligned to VBC nephrology programs versus those aligned to fee-for-service clinicians, there were 5% fewer unnecessary hospital admissions for those in the VBC model. The report also says that in 2019, Humana CKD patients had a medical expense ratio over 100%, but as VBC engagement increased, that ratio dropped to 88% over 5 years. Humana members in VBC nephrology practices have also experienced improvements in patient engagement and more sustainable medical expense management of kidney disease.

Approximately 37 million Americans are affected by CKD, making it crucial to identify ways to improve outcomes and reduce costs for kidney care. VBC models financially incentivize clinicians to help patients manage their care proactively and prepare for easier dialysis and transplant conversations with appropriate resources and education. Health care providers receive incentives based on patient outcomes and quality, versus fee-for-service models, which incentivize them for the number of patients seen and procedures performed.

The VBC models implemented with clinicians in partnership with Humana also incentivize providers to manage care for Medicare recipients with CKD stages 4 and 5 and ESRD to delay the start of dialysis and increase kidney transplantation.