Humana Announces Launch of Two National Value-Based Programs
September 10 2020 - 9:00AM
Business Wire
For Coronary Artery Bypass Grafting and Total
Shoulder Replacement Procedures
Leading health and well-being company Humana Inc. (NYSE: HUM)
today announced an expansion of its value-based program portfolio
with the creation of two national programs for members of select
Humana Medicare Advantage plans:
Humana’s Coronary Artery Bypass Grafting (CABG) Episode-Based
Model
The CABG bundled payment initiative is designed to provide
coordinated care for members of certain Humana plans undergoing
heart bypass surgery. CABG is a common cardiac procedure
performed on patients with a form of heart disease - coronary
artery disease - in which arteries are narrowed or blocked due to
plaque buildup. The procedure involves grafting a separate artery
or vein, typically from the patient’s chest wall or leg, to the
obstructed artery, circumventing the blocked portion and rerouting
blood flow to the heart.
Humana’s CABG model is designed to improve quality, outcomes,
and cost across a member’s entire episode of care, including
surgery and post-discharge care. Humana provides data and
analytics, and financially incentivizes cardiothoracic clinicians
who enhance patient care; deliver a more coordinated care
experience; and reduce duplicative services, readmissions, and
complications.
Humana’s six inaugural CABG
program participants are: Infirmary Health Cardio-Thoracic
and Vascular Surgical Associates (Alabama); Cardiothoracic and
Vascular Surgical Associates (Florida); Ballad Health CVA Heart
Institute (Tennessee); CHRISTUS Health and CHRISTUS Trinity Clinic
(Texas); and WVU Heart and Vascular Institute (West Virginia).
“Humana is proud to further diversify our value-based program
offerings in support of clinicians who share our vision for the
future of health care,” said Oraida Roman, Vice President of Value
Based Strategies at Humana. “It’s particularly important that we
focus on quality of care and health outcomes for our members in
need of such a widely-performed and critical procedure as heart
bypass surgery.”
Humana’s Total Shoulder Specialist Rewards Program
Humana also is announcing its first orthopedic payment program
for members of certain Humana plans undergoing total shoulder
arthroplasty (also known as shoulder replacement). The surgery
typically is for people with arthritis or rotator cuff
problems.
The Total Shoulder Specialist Rewards Program provides
clinicians data and analytics, and offers the opportunity for
additional payment for achievement of two program goals. One is to
realize better health outcomes. The other is to lower costs derived
from site of care selection, which incentivizes independent
surgeons to perform shoulder replacement procedures at ambulatory
surgical centers (ASC) when clinically appropriate.
“We’re pleased to expand value-based orthopedic specialty care
with Humana’s first model for shoulder replacement procedures,”
said Brent Stice, Associate Vice President of Value Based
Strategies at Humana. “As with replacements done for the knee or
hip, the procedure can be a good option for our members suffering
from chronic joint problems that
have not resolved with more conservative therapy. Humana is pleased
to commit our support to clinicians as they coordinate a more
holistic approach to orthopedic care.”
The first six Total Shoulder
Specialist Rewards Program participants are: Florida
Orthopaedic Institute (Florida); OrthoCincy Orthopaedics &
Sports Medicine (Indiana, Kentucky, Ohio); EmergeOrtho and
OrthoCarolina (North Carolina); and OrthoTennessee and Tennessee
Orthopaedic Clinics (Tennessee).
The model is Humana’s third orthopedic value-based payment
program, following those created for total hip and knee joint
replacement surgeries, and for spinal fusion procedures.
Humana’s Longstanding Commitment to Value-Based Care
Humana’s value-based program portfolio now encompasses a total
of six specialty-care payment models. In addition to those for
coronary artery bypass grafting and for orthopedics, Humana offers
a Maternity Episode-Based Model and Oncology Model of Care.
Humana also offers a Hospital Incentive Program for acute care
inpatient admissions.
All of these 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 June 30, 2020, Humana has more than 2.6 million individual
Medicare Advantage and commercial members cared for by more than
66,000 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 4.5 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
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version on businesswire.com: https://www.businesswire.com/news/home/20200910005218/en/
Alissa Krinsky Humana Corporate Communications
akrinsky@humana.com
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