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Humana Healthcare Research and Harvard University Collaboration
Provided by AAFP partner
Humana recently published a study on senior-focused primary care — a value-based care model that tailors the environment and services of clinical organizations to the unique needs of older adults. This joint study, conducted in partnership with a leading researcher and professor at Harvard University, found better access to primary care for patients of senior-focused primary care organizations compared to other types of primary care organizations, like the traditional fee-for-service model. Published in Health Affairs, the study is the first of its size and scope in analyzing this type of organization.
This study shows that patients in senior-focused primary care organizations had better access to care, and that’s important because it informs Humana’s efforts to effectively address the needs of seniors, many of whom have chronic conditions and complex needs. Of note, it showed even larger benefits for Black and low-income patients that reduced health disparities.
The traditional primary care system that primarily operates in fee-for-service arrangements with insurers can be difficult to access and is often more reactive than proactive. Alternatively, senior-focused primary care organizations operate within a value-based care model supported predominantly by population-based payment contracts with Medicare Advantage. This payment arrangement, enabled by current CMS payment policies, provides the infrastructure, flexibility and financial incentives for senior-focused primary care organizations to provide tailored, holistic, coordinated and proactive care to older adults, particularly historically underserved populations. Senior-focused primary care organizations offer longer appointment times, same-day appointments when needed, and access to on-site teams of doctors, nurses, pharmacists, social workers, behavioral health specialists and referral specialists who provide a wide range of extended services to meet the comprehensive needs of seniors.
The study analyzed data across six different senior-focused primary care organizations and on more than 462,000 patients enrolled in Medicare Advantage in 2021 to compare healthcare service use and quality of care between those who were and were not patients of senior-focused primary care organizations. The main takeaways validate primary care clinicians’ long-term investment in integrated senior care services.
Relative to more traditional primary care settings, patients of value-based, senior-focused primary care organizations had 17% more primary care visits, with larger differences among Black and low-income beneficiaries. Senior-focused primary care organizations served more Black and low-income beneficiaries than other primary care settings, and these patients had 39% and 21% more primary care visits, respectively, than Black and low-income beneficiaries in other primary care settings, which helped to reduce health disparities. Findings from the study also suggest that patients of senior-focused primary care organizations might experience better performance on several quality measures, including recommended cancer screenings, medication adherence, controlled blood pressure and diabetes, and less hospital use, but due to study design limitations, more research is needed on these outcomes.
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