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Humana adds two new value-based payment programs for select Medicare Advantage plans

The programs are for coronary artery bypass grafting and shoulder replacements. They incentivize clinicians to improve patient care and lower costs.

Mallory Hackett, Associate Editor

Humana announced today the expansion of its value-based program portfolio by adding two new programs for members of select Humana Medicare Advantage plans.

The first is the coronary artery bypass grafting episode-based model for certain members undergoing heart bypass surgery. The model provides cardiothoracic clinicians with data and analytics, as well as financial incentives for enhancing patient care, thus delivering a more coordinated care experience and reducing unnecessary services readmissions and complications.

Participating organizations for the coronary artery bypass grafting program include Infirmary Health Cardio-Thoracic and Vascular Surgical Associates, Cardiothoracic and Vascular Surgical Associates, Ballad Health CVA Heart Institute, CHRISTUS Health and CHRISTUS Trinity Clinic, and West Virginia University Heart and Vascular Institute.

The other new program is Humana's third orthopedic payment program. It's for certain members undergoing total shoulder arthroplasty. This program also provides clinicians with data and analytics, and offers payments when better health outcomes are achieved and when lower-costing surgery sites, such as at ambulatory surgical centers, are selected.

The first participants for the shoulder replacement program are the Florida Orthopaedic Institute, OrthoCincy Orthopaedics and Sports Medicine, EmergeOrtho and OrthoCarolina, and OrthoTennessee and Tennessee Orthopaedic Clinics.


Value-based programs reward healthcare providers for giving better quality care rather than the quantity of care they give.

Across the board for providers, patients and payers, value-based programs save money and improve outcomes.

In fact, clinicians who were affiliated with health systems under the Medicare merit-based incentive payment systems had better performance scores and received fewer payment penalties, compared to clinicians not affiliated with health systems, according to research from the Journal of the American Medical Association.


Humana now has six specialty-care payment models, including those for coronary artery bypass grafting, orthopedics, maternity, oncology and a program for acute care inpatient admissions. Its programs include more than 2.6 million members, 66,000 primary care physicians and 1,000 value-based relationships across the U.S.

In a long-awaited update to current payment models, the Centers for Medicare and Medicaid Services issued a proposed rule to begin removing barriers to the development of value-based payment agreements between drug manufacturers and payers. If finalized, the rule would provide flexibility to how manufacturers report and calculate the best price in order to encourage them to enter into value-based payment arrangements with states.


"Humana is proud to further diversify our value-based program offerings in support of clinicians who share our vision for the future of healthcare," 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."

"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."

Twitter: @HackettMallory
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