For Coronary Artery Bypass Grafting and Total Shoulder Replacement Procedures
LOUISVILLE, Ky. — Sept. 10, 2020 — 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.
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