Companies operating under the payvider business model, such as VNS Health and Humana Inc. (NYSE: HUM), have pointed to the ability to provide a more integrated care experience, as well as an increased engagement with value-based care, as a key differentiator.

For Humana, the clearest example of leveraging its integrated care to engage in value-based care is the company’s latest risk-bearing model.

“In Central North Florida, we created a risk model around 65,000 of our members,” Kirk Allen, president of Humana Home Solutions, said at Home Health Care News’ FUTURE conference. “Those members were served by our primary care physicians and in our CenterWell senior care organization, and served by CenterWell Home Health, and by Onehome, our convener and also by our Humana pharmacy. We are able to design a payment model and a delivery model that varied from what we do currently, that didn’t pay for activity, but paid for outcomes.”

Humana has over five million Medicare Advantage (MA) members in its health plans. It is one of the largest insurers in the country. CenterWell is Humana’s provider services arm, which includes home health, pharmacy and primary care. The company performs more than 9 million home health visits annually.

To pull off its latest risk-bearing model, Humana really focused communications between all of its physicians, its pharmacy, its home health arm and the health plan, according to Allen.

“As we have evaluated the results of that model, we’ve been really pleased to see that delivering care in different ways can achieve the same, and sometimes better results on equivalent, or even sometimes shorter lengths of stay,” he said. “There are models we believe will come in the future. I don’t think we could have done that without the communication, the coordination and the infrastructure that comes with everybody being in the family.”

Prioritizing value-based care allows Humana to address costly and avoidable hospitalizations.

“Being able to participate, as providers, in the avoidance of unnecessary hospitalizations is a component of the value-based contract, and that we really try to put into place,” Allen said. “Things we have done, from the home health perspective, we’ve entered into contracts that put us, not just at financial risk for the home health work, but for avoidable hospitalizations, and then that allows us to demonstrate the impact that we’re having.”

On its end, VNS Health has many levels of integrated care at the plan level.

“We have a program that integrates Medicare, Medicaid and long-term services and supports under one health plan,” John Burke, executive vice president and chief of health plans at VNS Health, said during the discussion. “Historically, these have been fragmented. … We have a fully integrated health plan product that really is our lead program.”

New York-based VNS Health is a full-service nonprofit home-based care organization. On any given day, the company has over 73,000 patients, members and clients in its care.

The company’s health plan business is exclusively focused on government programs, Medicare and Medicaid, with an orientation towards complex populations, low-income populations and individuals with special needs. Currently, the health plan has over 70,000 members.

VNS Health’s provider side offers an additional level of integrated care, according to Burke.

“The integration with our provider businesses is key,” he said. “If you want to be successful in Medicare Advantage, you have to be good at quality. You have to be good at risk adjustment and medical and medical cost management, particularly of complex high-risk members. Our provider business has enabled us to be good at some of those things.”

Burke also highlighted VNS Health’s value-based arrangements between the company’s health plan and provider arm.

“Some have been rolled out,” he said. “Some are in development, and they’re really helping us manage this business. We have a longitudinal care management program that our provider business operates. It takes care of high-risk [individuals], and they have a performance-based contract, so they get paid for the work. Then they get incentivized or penalized based on quality and total cost of care. It’s an opportunity for the health plan to perform better. It’s also an opportunity for the provider side to earn additional dollars.”

Looking ahead, Dr. Laura Lawson, vice president of client solutions at research and advisory firm ATI Advisory, pointed out that payviders are well-suited to beef up integrated care and provide value.

“I get inspired, and I think it enables a lot of good work when we see collaborations up and downstream, as well as across stakeholders,” she said during the discussion. “I think as organizations find their way forward during these times, the groups that evolve and grow are going to be the ones that will be really well-positioned to take care of those complex, frail groups, particularly the 85 and older.”