Humana Brings Value-Based Orthopedic Specialty Care to North Carolina and Virginia
May 10 2017 - 11:20AM
Business Wire
Model expected to improve quality, lower cost
of care for Humana Medicare Advantage members
Humana Inc. (NYSE: HUM) is teaming up with 11 orthopedic
specialty groups in North Carolina and Virginia on an orthopedic
value-based care model for Humana Medicare Advantage members
undergoing total hip or knee joint replacement procedures.
Humana’s Total Joint Replacement Episode-Based Model is designed
to improve quality, outcomes and cost across a person’s entire
joint replacement episode of care. Humana will provide the
orthopedic practices with robust data and analytics needed to
better manage all aspects of their patients’ care from diagnosis to
recovery. For the patient, this is expected to deliver a more
coordinated care experience and to reduce complication rates and
unnecessary readmissions after surgery.
In North Carolina, Humana will work with EmergeOrtho (Blue Ridge
Bone and Joint Clinic, Carolina Orthopaedic Specialists, Triangle
Orthopaedic Associates and Wilmington Orthopaedic Group), Carolina
Orthopaedic & Sports Medicine Center, Raleigh Orthopaedic
Clinic, OrthoCarolina and Wake Forest University Health
Sciences.
In Virginia, Humana will work with Appalachian Orthopaedic
Associates, Hampton Roads Orthopedic Center, and Jordan-Young
Institute.
Humana has 30 years of experience partnering with primary care
physicians in value-based care arrangements. By focusing on quality
and health, Humana experienced 20 percent lower costs in total in
2015 for members who were treated by doctors and other health care
professionals in a value-based reimbursement model setting versus
an estimation of original fee-for-service Medicare costs using the
Centers for Medicare and Medicaid Services (CMS) Limited Data Set
Files. Humana is now moving to apply the approach to specialties,
such as orthopedics, where highly coordinated care supported by
population health data has the ability to potentially improve
outcomes, lower cost and deliver a better health care experience
for patients.
The participating North Carolina and Virginia orthopedic groups
join the 12 orthopedic groups in Ohio and Tennessee who joined
Humana’s orthopedic value-based care model in 2016 and the eight
groups in Indiana and Kentucky that were announced by Humana last
month.
Humana’s model is similar to the State of Tennessee’s Innovation
Model (SIM) Grant through the CMS for Medicaid beneficiaries.
Through the new agreement, Humana’s population health
capabilities, including patient data and analytics as well as
chronic disease management and wellness programs, will complement
the integrated care approach that each orthopedic group will employ
with Humana members.
“Humana has made great strides when it comes to value-based care
in the primary care space so it’s exciting to see where we can take
value-based care when we apply it to more involved medical
procedures like total joint replacement,” said Chip Howard,
Humana’s Vice President of Payment Innovation. “Humana’s approach
is to provide orthopedic surgeons the tools they need to coordinate
all aspects of their patients’ diagnosis, treatment, recovery and
rehabilitation to in turn improve quality, lower cost and create a
better experience for our members.”
As of March 31, 2017, Humana has 1.8 million individual Medicare
Advantage members and 160,000 commercial members who are cared for
by 51,300 primary care providers, in more than 900 value-based
relationships across 43 states and Puerto Rico. For more
information, visit humana.com/accountable-care or
www.humana.com/valuebasedcare.
About HumanaHumana Inc.,
headquartered in Louisville, Ky., is a leading health and
well-being company focused on making it easy for people to achieve
their best health with clinical excellence through coordinated
care. The company’s strategy integrates care delivery, the member
experience, and clinical and consumer insights to encourage
engagement, behavior change, proactive clinical outreach and
wellness for the millions of people we serve across the
country.
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
- Calendar of events
- Corporate Governance information
More InformationHumana is a
Medicare Advantage HMO, PPO and PFFS plan with a Medicare contract.
Enrollment in any Humana plan depends on contract renewal. This
information is not a complete description of benefits. Contact the
plan for more information. Limitations, copayments and restrictions
may apply. Benefits may change each year. Other providers are
available in our network.
Humana Inc. and its subsidiaries (“Humana”) do not discriminate
on the basis of race, color, national origin, age, disability or
sex.
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Humana Inc.Marina Renneke, APR, 602-760-1758Corporate
Communicationsmrenneke@humana.com
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