Humana Announces Two Milestones in Value-Based Orthopedic Specialty Care, Launching Bundled Payment Model for Spinal Fusion S...
March 12 2019 - 10:00AM
Business Wire
Designed to Benefit Humana Medicare Advantage
Members
Leading health and well-being company Humana Inc. (NYSE: HUM) is
announcing two key milestones as it expands value-based orthopedic
specialty care for Humana Medicare Advantage members, launching a
bundled payment model for spinal fusion surgeries, and broadening
the reach of its Total Joint Replacement Episode-Based Model for
total hip or knee joint replacement procedures.
Humana Launches Spinal Fusion Episode-Based Model, Announces
First Program Participants
Humana is teaming up with orthopedic and neurosurgery practices
to launch a value-based care bundled payment initiative designed
specifically to provide coordinated care for Humana Medicare
Advantage members undergoing spinal fusion surgery.
The Spinal Fusion Episode-Based Model (EBM) 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. Improvement is measured based on three
clinical indication rates – readmissions, cervical complications,
and lumbar complications – as well as by average risk-adjusted
episodic cost-of-care.
The program’s inaugural participants are Fort Wayne Orthopedics
and Ortho NorthEast (Indiana), Mayfield Brain & Spine (Ohio),
and OrthoVirginia (Virginia).
“We’re excited to focus on spinal fusion surgery with our newest
orthopedic episode-of-care model,” said Oraida Roman, Vice
President of Humana’s Value-Based Strategies Organization. “This
program is a logical ‘next step’ for us in value-based care,
considering the prevalence of spine surgeries and, therefore, the
need for a coordinated, quality patient experience. We’re deeply
committed to sharing our knowledge and experience with
participating providers, as we have a mutual dedication to
improving clinical outcomes and lowering the cost of spinal
care.”
Humana Expands Availability of Total Joint Replacement
Episode-Based Model
Humana also is announcing the expansion of its first orthopedic
bundled payment program, the Total Joint Replacement Episode-Based
Model for Humana Medicare Advantage members undergoing total hip or
knee joint replacement procedures.
Through eight additional agreements with orthopedic specialty
groups across the nation, the program now is offered at more than
60 medical practices in 19 states, including, for the first time,
in Michigan. Humana’s newest agreements are with Southern Bone and
Joint Specialists (Alabama); Florida Orthopaedic Institute and
Watson Clinic LLP (Florida); Louisiana Orthopaedic Specialists
(Louisiana); Michigan Orthopaedic Surgeons (Michigan); Signature
Medical Group’s Kansas City-area practices (Missouri); MSK Group,
P.C. and Tennessee Orthopaedic Alliance (TOA) (Tennessee);
Orthopedic Associates of Central Texas, Rio Grande Orthopedic
Center, and The Orthopaedic Center of Corpus Christi (Texas).
Initially launched in 2016, the Total Joint Replacement
Episode-Based Model has expanded each year since then. The program
is designed to improve quality, outcomes, and cost across a
member’s entire joint replacement episode of care, and it offers
the opportunity for additional payment for better outcomes.
“We’re pleased to support additional orthopedic practices with
robust data and analytics regarding total joint replacement
procedures,” said Roman. “Our mutual goal is to reduce readmissions
and complication rates through a program designed to offer a
coordinated patient experience, from diagnosis to recovery.”
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 three specialty-care bundled
payment models. The third is its Maternity Episode-Based Model,
launched in 2018 for Humana commercial members with
low-to-moderate-risk pregnancies.
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 Dec. 31, 2018, Humana has more than two million individual
Medicare Advantage members and approximately 115,000 commercial
members who are cared for by more than 53,000 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 3.6 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 a Humana plan depends on contract
renewal.
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Alissa KrinskyHumana Corporate
Communications312-441-5576akrinsky@humana.com
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