Humana Report Finds Value-Based Care Improves Outcomes for Medicare Advantage Members

Key Terms

medicare advantage regulatory

Medicare Advantage is a type of health insurance plan offered by private companies that covers services traditionally provided by government-run Medicare. Think of it as a bundled package that combines hospital, doctor, and other medical care into one plan, often with added benefits. For investors, it matters because the popularity and profitability of these plans can influence healthcare companies and the broader health insurance industry.

original medicare regulatory

Original Medicare is the U.S. federal health insurance program that provides basic hospital coverage (Part A) and outpatient/doctor coverage (Part B) to eligible people, usually older adults and certain disabled individuals. Investors watch it because it sets payment rules, coverage limits, and patient demand that directly affect hospitals, drugmakers, medical suppliers and insurers—think of it as the baseline rules and budget for a large public customer in healthcare.

value-based care technical

A health-care delivery approach that rewards providers for keeping patients healthy and improving outcomes instead of charging for each test or visit. For investors, it matters because it shifts where profits and losses come from—favoring providers and technologies that lower long-term costs, prevent complications, and demonstrate measurable results; think of it like paying a contractor only when the house stays sound, which changes who wins and loses financially.

fee-for-service financial

A payment model where a provider is paid separately for each test, procedure, visit, or service it delivers, like paying a mechanic for each repair rather than buying a maintenance plan. For investors, it matters because revenue rises with the number and price of services but can be unpredictable and may encourage higher volume over efficiency, affecting profit margins, cash flow stability, and long-term growth prospects.

net promoter score technical

Net Promoter Score (NPS) is a single-number measure of customer loyalty based on asking customers how likely they are to recommend a company’s product or service to others; responses are grouped and converted to a score from -100 to +100. It matters to investors because a high NPS suggests strong customer satisfaction, lower churn and more organic growth through word-of-mouth—like a reputation score that can predict future sales and brand resilience.

emergency department medical

A hospital’s emergency department is the 24/7 clinical unit that evaluates and treats people with urgent or life‑threatening conditions, acting like the hospital’s front door for immediate care. For investors, its volume and performance signal demand for healthcare services, affect hospital revenue and cost patterns, and influence regulatory and reimbursement risks—similar to how customer foot traffic informs the health of a retail business.

interoperability standards technical

Interoperability standards are agreed rules and formats that let different software, devices, or systems exchange and use information smoothly, like common plugs that let appliances fit any outlet. For investors, they matter because widespread standards reduce technical barriers, lower costs, speed up adoption, and create larger, more competitive markets—factors that can affect a company’s revenue growth, margins, and long-term value.

• Medicare Advantage members in value-based care arrangements had 24.3% fewer inpatient hospital admissions than those in Original Medicare in 2024.

• Humana Medicare Advantage members receiving value-based care had 13.4% fewer emergency department visits and 7.6% fewer hospital admissions than members in non-value-based care arrangements.

• Medicare Advantage members receiving value-based care reported higher satisfaction with their care, including a 13-point higher Net Promoter Score than those using fee-for-service.

LOUISVILLE, Ky.--(BUSINESS WIRE)-- Humana Inc. (NYSE: HUM), a health and well-being company focused on helping people live their healthiest lives, today released its latest Value-Based Care By the Numbers Report. The findings show that value-based care helps Medicare Advantage patients receive more personalized, preventive care while improving their overall health experience.

The report draws on Humana’s leadership in value-based care and 2024 data showing that Medicare Advantage members receiving care under value-based arrangements experience fewer unnecessary emergency department visits, fewer hospitalizations, higher satisfaction, and more preventive care. These results demonstrate that value-based care is not only a better way to deliver better health outcomes — it’s a smarter model to create a sustainable healthcare system.

Why Value-Based Care Matters

“Value-based care means seeing the whole patient — not just the chart. It’s the reason I chose medicine in the first place. Every path in value-based care leads to one goal: helping people achieve their best health,” said Alex Ding, M.D., Deputy Chief Medical Officer at Humana. “It’s about proactively delivering the right care, understanding individual needs, and making sure every patient feels seen and supported.”

The report also highlights benefits for clinicians, including more time with patients and improved primary care practice sustainability – contributing to lower rates of clinician burnout and improved care delivery.

Value-based care enables a team of clinicians to holistically, proactively care for a patient’s care needs. In contrast, the fee-for-service model puts clinicians in a reactive stance with no incentives to deliver preventive care or to reduce costly, low-value care. Value-based care shifts the priority from patient volume to patient health outcomes.

Humana’s newest Value-Based Care By the Numbers Report reaffirms over a decade of evidence that value-based care models deliver a better healthcare system for patients and clinicians.

Impact on Patients: Less Time Spent in the Hospital

According to Humana’s 2024 analysis, Medicare Advantage members receiving care from value-based clinicians spent less time in the hospital and were less likely to rely on emergency care compared with patients in non-value-based arrangements.

• 24.3% fewer inpatient admissions for value-based care patients with Medicare Advantage plans versus those enrolled in Original Medicare in 2024
• 13.4% fewer emergency department visits and 7.6% fewer admissions for Humana Medicare Advantage members treated by value-based clinicians than those not in a value-based arrangement

Improved Management of Chronic Conditions

The report also highlights stronger chronic disease management for Medicare Advantage members in value-based care arrangements, particularly among older adults managing multiple conditions.

• More eye exam screenings and kidney health evaluations for members who have diabetes
• Higher use of statin therapy for members with cardiovascular disease
• Higher medication adherence rates for hypertension and diabetes medication

More Preventive Care

Preventive care remains a cornerstone of value-based care. Humana’s analysis of its Medicare Advantage, value-based care members found higher rates of:

• breast cancer screening
• colorectal cancer screening
• osteoporosis management

Higher Patient Satisfaction

In addition to clinical improvements, patients reported:

• Higher patient satisfaction of their health plan, health care, care coordination, customer service, and more for Humana Medicare Advantage members receiving value-based care per Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey data
• 13 points higher Net Promoter Score for Medicare Advantage members receiving value-based care than those with fee-for-service providers

Helping Older Adults Thrive with Personalized Primary Care

For older adults managing multiple chronic conditions, value-based care offers a more coordinated and proactive approach than traditional fee-for-service models. According to the CenterWell Aging Well in America survey, conducted with Morning Consult, older adults identified their primary care provider as the most important factor, other than themselves, in their ability to age well.

Research published in NEJM Catalyst by Humana Healthcare Research found that patients receiving care from senior-focused primary care providers experienced:

• 20% more primary care visits per year
• 6% more regularly scheduled visits
• Higher continuity of care (75% of senior-focused primary care patients vs. 55% of FFS patients)

Expanding Value-Based Care Across the System

Beyond primary care models, Humana’s report also identifies opportunities to extend value-based care into specialty care. For example, Medicare Advantage patients diagnosed with heart failure experience a higher quality of care and better evidence-based medication prescription adherence under value-based care arrangements.

“Value-based care is no longer an aspiration – it's a necessity,” said George Renaudin, Humana’s Insurance President. “Insurers, providers and clinicians must work together to accelerate adoption. All efforts should center on helping patients live healthier for longer while enabling a healthcare system that is more sustainable.”

To support this transition, Humana is investing in technology and data-sharing capabilities that enable providers to deliver more coordinated care. In October, Humana and Providence announced a new data exchange initiative using national interoperability standards to streamline secure data sharing. This collaboration supports upcoming regulations from the Centers for Medicare & Medicaid Services (CMS) and aims to reduce administrative burden and improve care coordination for Medicare Advantage members.

Read Humana’s Value-Based Care By the Numbers Report in full here.

About Humana

Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers, and our company. Through our Humana insurance services, and our CenterWell health care services, we strive to make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large. Learn more about what we offer at Humana.com and at CenterWell.com.

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Media Contact

Kristen Schabert

Humana Corporate Communications

kschabert@humana.com

Source: Humana Inc.