A paradigm shift for the healthcare field

Medicare consumers turning 65 or already navigating a complex healthcare system may feel overwhelmed by confusing options, countless bills, impersonal visits and feeling unnoticed. Behind the scenes, how some healthcare providers are paid is changing—and it can directly impact the experience patients have when they seek care.

The changing landscape of healthcare-provider compensation

Traditionally, doctors and hospitals have used a fee-for-service model, where each appointment, test or treatment is billed separately. The more you receive, the more providers are paid, regardless of results. In contrast, a newer model, called value-based care, is growing fast.

Here, participating providers are rewarded for keeping patients healthy, catching issues early and helping them live better—instead of simply focusing on the number of services delivered.

This shift from volume to value is transforming what patients may expect from their providers.

What reimbursement models can mean for patient care

How doctors and clinics are paid shapes every encounter from the check-in desk to the follow-up call—and the differences are striking.

Fee-for-service may lead to:

• Providers seeing as many patients as possible since payments are tied to the number of services provided.¹ That could result in brief appointments and rushed visits for patients.
• Fragmented care with little coordination between different doctors or specialties.²
• More bills for every test or separate treatment.³
• Disjointed chronic-condition management.⁴

Value-based care puts patients first by:

• Encouraging coordinated teams who share information
• Allowing for longer or more focused appointments, prioritizing conversations about your goals and preferences
• Member rewards for prevention, screenings and helping patients manage chronic or complex conditions
• Focusing on lowering your out-of-pocket costs by preventing unnecessary services and hospital visits
• Using technology and data to flag gaps in care, so patients with greater needs get extra support

For many, especially those struggling with multiple health issues or feeling underserved, value-based care may offer a more personalized care plan, clear next steps and a team that listens.

Humana’s commitment to value-based care

Humana is at the forefront of value-based care in Medicare, believing that staying healthy shouldn’t be complicated or impersonal. Here’s how:

• Many Humana Medicare Advantage providers work in value-based contracts designed to keep patients well, not just treat them when they’re sick
• Care teams are encouraged to spend more time getting to know you, understanding your needs and helping you navigate the system
• There is an emphasis on prevention and proactive outreach, especially for those with chronic or complex health conditions
• Technology and data insights help identify issues before they become emergencies
• Humana supports providers with resources for team-based and comprehensive care models, taking extra steps to ensure everyone feels respected and heard

Conclusion: More power and choice for patients

The move to value-based care puts more control in the hands of patients and consumers. It means you can expect your care team to listen, tailor clinical recommendations to your needs and coordinate across specialists for the best outcomes.

You should feel empowered—not lost—when making health decisions. Get in touch to learn more about Humana’s Medicare plans and the providers in their network.

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