Value-Based Care and Heart Failure: Evidence on GDMT Adherence

Heart failure continues to affect a growing number of Americans, with 11.4 million expected to be diagnosed by 2050. Patients with heart failure experience a higher likelihood of hospitalizations and visit the emergency department twice as often. The guideline-directed medical therapy is quadruple therapy, however, less than one in five patients hospitalized with heart failure with reduced ejection fraction (HFrEF) receive this therapy within six months of discharge. 

Data analyzed in Humana’s Value-Based Care Issue Brief compares patients diagnosed with heart failure with reduced ejection fraction (HFrEF) after a hospitalization who receive care from value-based clinicians and those who do not. Patients treated by value-based care clinicians were nearly 28% more likely to receive full quadruple therapy, the gold standard evidence-based medical treatment. 

“Coordinated care impacts the quality of care, particularly for seniors post-hospitalization. A care team who holistically sees a patient’s needs and relies on their collective expertise to provide the highest quality of care is the value-based care model,” said Dr. Kate Goodrich, Chief Medical Officer at Humana. “Value-based care depends on primary care physicians (PCP), specialists, care teams, and patients working together to achieve better health outcomes.” 

Humana’s newest Value-Based Care Issue Brief reinforces that the value-based care model is the meaningful difference for patients with heart failure with HFrEF. Those receiving care from value-based primary care clinicians experienced better medical management. 

Clinicians under value-based care deliver proactive care and are incentivized to provide high-value interventions. The traditional fee-for-service model is a fragmented experience for clinicians and patients with no incentives to reduce low-value care. In addition, patients aligned with value-based care practices better manage chronic diseases, according to Humana’s Value-Based Care Report. These findings affirm more than a decade of Humana’s research advancing value-based care that concludes patients aligned with value-based care see their primary care physician more often, are more satisfied with the quality of care, and have better management of chronic diseases.

What’s inside the brief

• Clear explanation of the four-drug GDMT regimen for HFrEF and why complete therapy matters for outcomes. 
• Cohort results from 2,328 Medicare Advantage patients (2022–2024), including the less-than-1-in-5 rate of quadruple therapy at 180 days and a ~28% higher likelihood of full therapy among value-based practices. 
• Subgroup signals (e.g., age, rurality, affordability) that can inform equity and access strategies. 
• Practical steps organizations can take now to close GDMT gaps in post-discharge care pathways.