Exclusive: Catherine Field on Humana’s Accountable Care agreement with OHSU

This fall, Humana and Healthcare Resources NW (HRNW) announced an expansion of their accountable care agreement to include Oregon Health & Science University (OHSU). Catherine Field, Intermountain Vice President for Senior Products at Humana, sat down with State of Reform to talk about this new partnership and what accountable care means for Humana’s Medicare Advantage members.

catherine field humana

Catherine Field, Intermountain Vice President for Senior Products at Humana / source: LinkedIn

Mary Powell: Why has Humana Inc. chosen to include OHSU in its accountable care agreement with HRNW?

Catherine Field: Well, there are a couple of reasons. First of all, we are always looking to expand our value based agreement and this is an awesome opportunity to increase our provider base in the Portland area and in particular to be able to offer our members the opportunity to go to the OHSU hospital and have access to over a thousand physicians. We wanted to bring OHSU into the network but also bring them into a value based agreement.

 

MP: How many Medicare Advantage members does this affect? When does this take effect?

CF: If you look at the three big counties that make up the Portland metro area, that’s about 275,000 Medicare-eligible seniors. So, all of those folks now have the opportunity to access a Humana plan and an OHSU provider. Humana has about 64,000 members enrolled in Medicare Advantage plans across the state of Oregon.

It goes into effect as of January 1, 2016. And now we are in the middle of the annual enrollment period, so members are signing up for Humana and will have the ability to access those facilities and physicians starting at the beginning of the year.

 

MP: Can you tell me about Humana’s pay-for-value programs? Specifically, what metrics does Humana use to measure “value”?

CF: Humana has been involved in value based agreements for the past 25 years. Right now, of our nearly 3 million Medicare Advantage members, about 59%  are in value based contracts. Our goal as an organization is to have 75% of our membership in value based arrangements by 2017.

Our metrics generally focus on quality and outcomes. In fact, we just took a look at our membership that was in value based arrangements through the end of 2014 (see more information here). When we looked at various outcome measures we found that those members that were in value based reimbursement settings in general had 21% higher Healthcare Effectiveness Data and Information Set (HEDIS) scores than members that were not in value based arrangements. When you look at hospital admissions per thousand, there were 7% fewer admits and 6% fewer emergency room visits. When you looked in general at diabetes and osteoporosis compliance, there was a higher number of screenings and then just over all, about 18% lower cost for members that were associated with value based agreements. So, those are the kind of metrics and outcomes that we are looking at to ensure that we are providing high quality, low cost care for our seniors.

 

MP: Can you tell me a little bit Humana’s accountable care partnerships?  Specifically, what Oregon partners are helping Humana localize care and drive community engagement?

CF: We have been in the Oregon market for the last 5 years, and we have had a wonderful relationship with HRNW and the Adventist system. We also have value based arrangements with Columbia Independent Practice Association (IPA), which is made up of PeaceHealth and the Vancouver clinic. We also have value based arrangements with the Compass IPA and Pacific IPA.

 

MP: What are Humana’s priorities as it expands in the Oregon market?

CF: I think our number one priority is always to provide value to our seniors, and to provide more value than traditional Medicare because that’s what is really going to encourage seniors to look at Medicare Advantage as a viable option. The second thing we are looking to do is continue to grow. We are geographically focused on the Portland metro area as well as central Oregon and the Bend market. We also are interested in continuing to add more providers into our network that have common values, aligned incentives, and really focus on offering a world class patient experience.

This agreement is really exciting for us. OHSU is a terrific add to our network. But, it’s really about how we continue to grow with partners that want to do the same thing we do, which is help seniors get better quality of care at a lower cost.

Once open enrollment ends, then the real work begins of helping our seniors who are new to Humana get in to see their provider early and get all the preventative care services that help keep them healthy.  That’s really what we are focused on as we head into the New Year.