The Medicare program is a health insurance program funded by the federal government for older adults, aged 65 and above, as well as younger individuals who have disabilities or end-stage renal disease. There are both strategic opportunities and challenges for health and human service provider organizations serving Medicare beneficiaries, who often have complex health and social support needs. As a result, Medicare plans are looking for innovative services and initiatives that demonstrate a return-on-investment in spending and consumer outcomes.

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During 2020, Humana Medicare Advantage members under the care of a physician in a value-based care (VBC) reimbursement arrangement had fewer hospitalizations and received more preventive services than Humana members under the care of a physician reimbursed on a fee-for-service basis. Hospital admissions were 12% lower for Humana Medicare Advantage members whose physician was in a VBC arrangement. They had 12% fewer emergency department visits. Primary care professionals in a VBC arrangement, compared to those in non-VBC arrangements, conducted 8% more screenings overall, 19% more colorectal screenings, 19% more diabetic eye exams, and 22% more post . . .
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