Research reveals lack of common language in value transformation of U.S. health care

Delphi panel finds distinct differences in the way common terms are
understood by health care professionals, illustrating the complexity of
concepts integral to health care transformation

Health care professionals, policymakers, and payers should consider
differences when creating policy and implementing payment methodologies
associated with value-based care and population health

PHILADELPHIA & LOUISVILLE, Ky.–(BUSINESS WIRE)–Today’s U.S. health policy initiatives, including those from the Centers
for Medicare & Medicaid Services, are aiming to derive more value from
the health care dollar. This involves a shift from reimbursement based
on volume to reimbursement based on the value of care delivered.

With this shift comes a new set of terms being used across the industry,
like value-based care and population health. Yet these
terms have been found to hold different meanings for different
stakeholders, and that has a variety of consequences for health care
professionals, health care policymakers, patients, and payers, to name a
few.

Humana Inc. (NYSE: HUM), one of the nation’s leading health and
well-being companies, and Penn Medicine, set out to find consensus on
three terms. Through the use of a Delphi research method that convenes a
panel of experts to arrive at a group opinion or decision, lead
researcher Marilyn Schapira, MD, MPH, led the panel through multiple
rounds of surveys to achieve broadly applicable definitions for three
terms: value-based care, value-based payment, and population
health.

After more than six months, the Delphi panel reached consensus on the
term value-based payment but, after three rounds of ratings, was
unable to arrive at a consensus definition for value-based care
and population health, though distinct areas of agreement and
disagreement were made clear. These findings were presented
June 3 at the AcademyHealth Annual Research meeting. See infographic
that summarizes process and findings.

Findings illustrate complexity of concepts integral to transformation
of health care

Researchers reviewed the peer-reviewed literature to collect current
definitions in use to be evaluated by the Delphi panel. Then the panel
met in person in early 2018 to discuss goals of the process and key
components to use in the definitions. Ultimately, after three rounds of
rating definitions and potential components for each of the terms, the
Delphi panel achieved the following:

A consensus definition of value-based payment:
“Value-based payment aligns reimbursement with achievement of
value-based care (health outcomes/cost) in a defined population with
providers held accountable for achieving financial goals and health
outcomes. Value-based payment encourages optimal care delivery,
including coordination across health care systems and community
resources, to improve health outcomes for both individuals and
populations.”

No consensus definition for value-based care
or population health, but specific areas of agreement and
divergence became clear, illustrating the complexity of the concepts.

“We sponsored this research because, in talking with physicians and
health systems, we were finding that increasingly the words we were each
using to discuss value-based care and population health were
incongruent. That was becoming more and more problematic as parties were
coming together to discuss how care was being delivered, the way that
care was being compensated, and the outcomes that care was achieving,”
said William Shrank, MD, MSHS, Chief Medical Officer for Humana. “These
findings illustrate the differences we, in the health care industry,
should consider when creating policy and implementing payment
methodologies associated with value-based care and population health.”

Delphi panel comprised esteemed leaders in health care

The Delphi process is a systematic, structured consensus-forming method
using recognized experts who represent different perspectives relevant
to the question posed. The Delphi process has proven useful to answer
questions and address topics that cannot be addressed though clinical,
experimental, or epidemiological methods. The Delphi process has been
used in the past, for example, to define imaging procedures¹,
establish clinical consensus for the diagnosis and treatment of patients
with certain pathologies², and define advance care planning³.

Eighteen experts from a diverse range of professional backgrounds and
geographic locations made up the Delphi panel to develop consensus
statements for the terms value-based care, value-based payment,
and population health. They included:

Alan Balch, PhD, National Patient Advocate Foundation; Richard
J. Baron, MD, MACP, American Board of Internal Medicine; Patricia
Barrett, MHSA, National Committee on Quality Assurance; Roy
Beveridge, MD, Humana; Tracie Collins, MD, MPH, MHCDS,
University of Kansas School of Medicine; Susan C. Day, MD, Penn
Medicine; Rushika Fernandopulle, MD, MPP, Iora Health; Anders
M. Gilberg, MGA, Medical Group Management Association; Douglas E.
Henley, MD, FAAFP, American Academy of Family Physicians; Amy
Nguyen Howell, MD, MBA, FAAFP, America’s Physician Groups; Christine
Laine, MD, MPH, FACP, Annals of Internal Medicine, American College
of Physicians; Christina Miller, MSS, Health Promotion Council of
Southeastern Pennsylvania, Inc.; Jaewon Ryu, MD, JD, Geisinger
Health System; Donald F. Schwarz, MD, MPH, MBA, Robert Wood
Johnson Foundation; Mark Schwartz, MD, FACP, New York University; Jeffrey
Stevens, MD, Summit Medical Group; Elizabeth Teisberg, PhD,
Dell Medical School, University of Texas at Austin; Ken Yamaguchi,
MD, MBA, Centene Corporation.

About Humana

Humana Inc. (NYSE: HUM) is committed to helping our millions of medical
and specialty members achieve their best health. Our successful history
in care delivery and health plan administration is helping us create a
new kind of integrated care with the power to improve health and
well-being and lower costs. Our efforts are leading to a better quality
of life for people with Medicare, families, individuals, military
service personnel, and communities at large.

To accomplish that, we support physicians and other health care
professionals as they work to deliver the right care in the right place
for their patients, our members. Our range of clinical capabilities,
resources and tools – such as in-home care, behavioral health, pharmacy
services, data analytics and wellness solutions – combine to produce a
simplified experience that makes health care easier to navigate and more
effective.

More information regarding Humana is available to investors via the
Investor Relations page of the company’s web site at www.humana.com,
including copies of:

• Annual reports to stockholders
• Securities and Exchange Commission filings
• Most recent investor conference presentations
• Quarterly earnings news releases and conference calls
• Calendar of events
• Corporate Governance information

1. Boccardi M, Bocchetta M, Apostolova LG, et al. Delphi definition of
   the EADC-ADNI Harmonized Protocol for hippocampal segmentation on
   magnetic resonance. Alzheimers Dement. 2015;11(2):126-138.
2. Bartlett SJ, Hewlett S, Bingham CO, 3rd, et al. Identifying core
   domains to assess flare in rheumatoid arthritis: an OMERACT
   international patient and provider combined Delphi consensus. Ann
   Rheum Dis. 2012;71(11):1855-1860.
3. Sudore RL, Lum HD, You JJ, et al. Defining Advance Care Planning for
   Adults: A Consensus Definition From a Multidisciplinary Delphi Panel. J
   Pain Symptom Manage. 2017;53(5):821-832.e821.

Contacts

Alex Kepnes
Humana Corporate Communications
(502) 580-2990
[email protected]