Humana Expands Reach of Value-Based Orthopedic Specialty Care to Benefit More Humana Medicare Advantage Members
July 17 2019 - 10:00AM
Business Wire
Announces Additional Participants in Bundled
Payment Models for Spinal Fusion and Total Joint Replacement
Surgeries
Leading health and well-being company Humana Inc. (NYSE: HUM)
announced that value-based orthopedic specialty care is available
for more of its Medicare Advantage members than ever before, with
the participation of additional providers in Humana’s bundled
payment models for spinal fusion surgeries and hip or knee joint
replacement procedures.
Humana Announces Second Group of Participants in Spinal
Fusion Episode-Based Model
Launched earlier this year, Humana’s Spinal Fusion Episode-Based
Model is designed specifically to provide coordinated care for
Humana Medicare Advantage members of Health Maintenance
Organization (HMO) and Preferred Provider Organization (PPO) health
plans undergoing spinal fusion surgery.
Through four additional agreements with orthopedic and
neurosurgical practices, the program now extends to nine groups in
seven states, including, for the first time, in Georgia, Louisiana,
North Carolina, and Tennessee. The program’s newest participants are Resurgens
Orthopaedics (Georgia); Baton Rouge Orthopaedic Clinic (Louisiana);
EmergeOrtho, P.A. (North Carolina); and OrthoTennessee
(Tennessee).
“We’re delighted to support provider groups as they quarterback
a more coordinated approach to care for their patients undergoing
spinal fusion surgery,” said Oraida Roman, Vice President of
Humana’s Value-Based Strategies Organization. “Humana is proud to
share data and analytics with physicians and clinicians in
collaboration toward improving the patient experience and health
outcomes in spinal care.”
The program offers the opportunity for additional payment to
physicians and clinicians for improved health outcomes and cost
across a member’s entire spinal surgery episode-of-care, as
measured by three clinical indication rates – readmissions,
cervical complications, and lumbar complications – as well as by
average risk-adjusted episodic cost-of-care.
Humana Expands Availability of its Total Joint Replacement
Episode-Based Model
Humana also is announcing further expansion of its very first
orthopedic bundled payment program, the Total Joint Replacement
Episode-Based Model for Humana Medicare Advantage members of HMO
and PPO health plans undergoing total hip or knee joint replacement
procedures. Launched in 2016, the program is designed to improve
quality, outcomes, and cost across a member’s entire joint
replacement episode of care, and it offers providers the
opportunity for additional payment for better outcomes.
Humana’s newest agreements are with The Orthopaedic Group, PC
(Alabama); Florida Orthopaedic Associates PA, Florida Sports
Orthopaedic & Spine Medicine, and The Orthopaedic Institute
(Florida); Community Physicians of Indiana and OSMC (Indiana);
Summit Orthopedics and Twin Cities Orthopedics (Minnesota); The
Orthopaedic Center (Oklahoma); Holston Medical Group (Tennessee);
and Orthopaedic Specialists of Austin (Texas).
In all, the program now is offered at more than 75 medical
practices in 21 states, including, for the first time, in Minnesota
and Oklahoma.
Humana’s Longstanding Commitment to Value-Based Care
Humana’s Total Joint Replacement and Spinal Fusion episode-based
models are two of the company’s four specialty-care payment models.
Its third program, the Maternity Episode-Based Model, was launched
in 2018 for Humana commercial members with low-to-moderate-risk
pregnancies. Humana announced earlier this year the launch of its
fourth program, the Oncology Model of Care (OMOC), designed to
provide more integrated cancer care for Humana Medicare Advantage
and commercial members.
The programs are in keeping with Humana’s longstanding
commitment to value-based care, which emphasizes:
- More personal time with health professionals and personalized
care that is tailored to each person’s unique health
situation;
- Access to proactive health screenings and programs that are
focused on preventing illness;
- Improved care for people living with chronic conditions with a
focus on avoiding health complications;
- Leveraging technologies, such as data analytics, that connect
physicians and help them work as a team to coordinate care around
the patient; and
- Reimbursement to physicians linked to the health outcomes of
their patients rather than based solely on the quantity of services
they provide (fee-for-service).
Humana has an extensive and growing value-based care presence.
As of March 31, 2019, Humana has more than 2.2 million individual
Medicare Advantage members and approximately 115,000 commercial
members who are cared for by approximately 58,000 primary care
physicians in more than 1,000 value-based relationships across 43
states and Puerto Rico. Humana’s total Medicare Advantage
membership is approximately four million members, which includes
members affiliated with providers in value-based and standard
Medicare Advantage settings. For more information, visit
humana.com/provider/support/vbc.
About Humana
Humana Inc. 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
Additional Information
Humana is a Medicare Advantage HMO and PPO organization with a
Medicare contract. Enrollment in any Humana plan depends on
contract renewal.
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version on businesswire.com: https://www.businesswire.com/news/home/20190717005099/en/
Alissa Krinsky Humana Corporate Communications 312-441-5576
akrinsky@humana.com
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