Humana Expands Reach of Value-Based Orthopedic Specialty Care to Benefit More Humana Medicare Advantage Members

Business Wire

Announces Additional Participants in Bundled Payment Models for Spinal Fusion and Total Joint Replacement Surgeries

LOUISVILLE, Ky.--(BUSINESS WIRE)-- 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: