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Humana launches oncology model to reward integrated care

Providers get analytics and compensation determined by metrics on access to care, clinical status assessments and patient education.

Susan Morse, Senior Editor

Humana is launching a value-based oncology program to reward providers for  more integrated cancer care for Medicare Advantage and commercial members.

Humana will provide compensation based on an incremental evaluation of quality and cost in several key areas: inpatient admissions; emergency room visits; medical and pharmacy drugs; laboratory and pathology services; and radiology. The evaluation will be determined by metrics that address access to care, clinical status assessments and patient education.

The company will offer analytics to support providers.

THE IMPACT

Humana's Oncology Model of Care is among the insurer's initiatives to reward integration of care that results in better outcomes and lower costs, the basis of value-based care.

Humana said its specialty-care payment programs emphasize more personal time with health professionals and personalized care; 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 on the quantity of services they provide.

TREND

The OMOC program is Humana's fourth specialty-care payment model, following its episode-based programs for Medicare Advantage members undergoing total hip or knee joint replacement or spinal fusion procedures, and its maternity episode-of-care bundled payment program for commercial plan members.   

As of December 31, 2018, Humana has more than 2 million individual Medicare Advantage members and approximately 115,000 commercial members. Humana's total Medicare Advantage membership is approximately 3.6 million, which includes members affiliated with providers in value-based and standard Medicare Advantage settings.

WHAT ELSE YOU NEED TO KNOW

The OMOC program's inaugural practices are: Southern Cancer Center, a practice in The US Oncology Network in Alabama; Arizona Oncology Associates, a practice in The US Oncology Network; Highlands Oncology Group in Arkansas; Cancer Specialists of North Florida; Baptist Health Medical Group and St. Elizabeth Healthcare in Kentucky; Pontchartrain Cancer Center and Slidell Memorial Hospital Physicians Network in Louisiana; Michigan Healthcare Professionals;  Minnesota Oncology, a practice in The US Oncology Network; Comprehensive Cancer Centers of Nevada, a practice in The US Oncology Network; TriHealth and University of Cincinnati Physicians Company in Ohio; and The Center for Cancer and Blood Disorders, The START Center for Cancer Care, and Texas Oncology, a practice in The US Oncology Network.

ON THE RECORD

"With the field of oncology rapidly evolving, we're very pleased to announce the launch of a quality-based program specifically focused on the delivery of cancer care," said Dr. Bryan Loy, corporate medical director of Humana's Oncology, Laboratory, and Personalized Medicine Strategies Group. "Humana is committed to providing physician support and working together to improve coordination across the continuum of care for our members with cancer."

 

Twitter: @SusanJMorse
Email the writer: susan.morse@himssmedia.com

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