Health insurer Humana and independent primary care network Aledade are expanding their partnership, extending services to rural health clinics and federally qualified health centers with an eye toward achieving and sustaining value-based care.
The expanded collaboration will provide up-front resources, support and a timeframe for success for FQHCs and rural health clinics in 26 states. Aledade said this will give them an opportunity to share savings in Medicare Advantage.
Dr. Farzad Mostashari, Aledade's cofounder and CEO, said the expansion responds to the "unique and evolving needs" of its health centers.
"It recognizes the challenges that health centers must address to provide high-quality, preventive care to high-needs populations and demonstrates our commitment to addressing healthcare disparities," he said.
WHAT'S THE IMPACT?
Humana Insurance President George Renaudin said the expanded agreement is important because it allows for expanded access to quality healthcare in areas such as rural communities, which historically have experienced shortages of hospitals and clinics.
"We are pleased to strengthen our relationship with Aledade, which shares a strong commitment to value-based care and its proven positive impact on health outcomes," he said.
Aledade partners with more than 300 health centers nationwide and collaborates with primary care organizations across both urban and rural settings. Nearly two-thirds of these health centers are located in areas designated as health professional shortage areas by the U.S. Health Resources and Services Administration.
In 2023, all eight of Aledade's Accountable Care Organizations that were exclusively made up of health centers earned shared savings, the company said. Together, they achieved a 6.12% savings rate, which resulted in $423 in shared savings per beneficiary.
THE LARGER TREND
Humana's financial results for Q4 and for full-year 2024 show a 10% revenue increase, but the insurer was hit by significant losses in Q4.
Rising healthcare utilization and insufficient CMS rate increases have impacted Humana's profitability, with shares down 50% from their 2023 peak, numbers showed.
For the quarter, Humana posted a $693 million loss, more than in the previous quarter, when it lost $541 million. Profits were also down: They stood at about $1.2 billion for the year, about half of its 2023 total, when it raked in $2.5 billion in profit.
Humana shares plunged in October after the insurer disclosed a sharp reduction in the number of members enrolled in high star Medicare Advantage plans, prompting it to challenge the results.
Jeff Lagasse is editor of Healthcare Finance News.
Email: jlagasse@himss.org
Healthcare Finance News is a HIMSS Media publication.