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Humana partners with orthopedic specialists in bundled payments for knee, hip replacement

Bundled payments for knee and hip replacement based on CMS Innovation Model Grants for states.

Susan Morse, Senior Editor

Knee replacement therapy. Photo by <a href=""> </a>Knee replacement therapy. Photo by

Humana is partnering with four orthopedic specialty groups in Tennessee, and an additional two in Ohio, on bundled payments for Humana Medicare Advantage members undergoing total hip or knee joint replacement.

The program is funded through a State Innovation Model grant from the Centers for Medicare and Medicaid Services.

For an entire episode of care for joint replacement, CMS provides financial and technical support for states to develop a value-based payment care model designed to improve quality, outcomes and cost, and to financially reward orthopedic surgeons for better outcomes.

In March, Humana announced a similar partnership with five orthopedic groups in Ohio.

Humana will provide the orthopedic practices with its population health data and analytics, information that is needed to better coordinate care, from diagnosis to recovery, aimed at reducing the readmission and complication rates, the company said.

In November 2015, Humana released value-based care data indicating that patients cared for through value-based models generally experienced healthier outcomes and lower costs.

Humana said it is now applying the approach to specialties, such as orthopedics.

[Also: HHS doles out $665M to states for healthcare innovation projects]

Humana will be working with Appalachian Orthopaedic Associates in the Tri-Cities, OrthoTennessee and Tennessee Orthopaedic Clinics in Knoxville and Premier Orthopaedics & Sports Medicine in Nashville.

In Ohio, Humana is working with Beacon Orthopaedics & Sports Medicine and Reconstructive Orthopaedics and Sports Medicine in Cincinnati; Orthopaedic Institute of Dayton, Ohio; Orthopaedic Associates of Zanesville, Ohio; and Wooster Orthopaedic & Sports Medicine Center in Wooster, Ohio.

The two additional practices in Ohio announced Wednesday are Adena Medical Clinic in Columbus and University of Cincinnati Physicians in Cincinnati.

"Value-based care is a powerful new approach to more involved medical procedures like total joint replacement," said Humana Vice President of Payment Innovation Chip Howard. "It's the key to building a health system that focuses on improving quality, lowering cost and creating a better experience for our members."

Humana has 1.7 million individual Medicare Advantage members and 200,000 commercial members.

Twitter: @SusanJMorse

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