Humana Inc. is partnering with eleven orthopedic specialty groups in North Carolina and Virginia on an orthopedic value-based care model for Humana Medicare Advantage members undergoing total hip or knee joint replacement processes.
Total Joint Replacement Episode-Based Model of Humana is established to make better the quality, outcomes and cost across a person’s whole joint replacement episode of care. Humana will give the orthopedic specialty groups practices with robust data and analytics required to better handle all aspects of their patients’ care from diagnosis to recovery. For the sufferer, this is hoped to deliver a more coordinated care experience and to decrease the complication rates and unimportant readmissions after surgery.
In the region of North Carolina, Humana will work with EmergeOrtho (Blue Ridge Bone and Joint Clinic, Carolina Orthopaedic Specialists, Triangle Orthopaedic Associates and Wilmington Orthopaedic Group), Carolina Orthopaedic & Sports Medicine Center, Raleigh Orthopaedic Clinic, OrthoCarolina and Wake Forest University Health Sciences.
In the region of Virginia, Humana will work with Appalachian Orthopaedic Associates, Hampton Roads Orthopedic Center, and Jordan-Young Institute.
Humana has thirty years of experience teaming up with primary care physicians in value-based care arrangements. By concentrating on quality and health, Humana experienced 20 percent lower costs in total in 2015 for members who were treated by doctors and other health care experts in a value-based reimbursement model setting versus an estimation of original fee-for-service Medicare charges using the Centers for Medicare and Medicaid Services (CMS) Limited Data Set Files. Humana is now shifting to apply the approach to specialties, like orthopedics, where largely coordinated care supported by population health data has the capability to possibly improve outcomes, lower cost and deliver a better health care experience for sufferers.
The participating North Carolina and Virginia orthopedic specialty groups join the 12 orthopedic groups in the region of Ohio and Tennessee who joined Humana’s orthopedic value-based care model in the year of 2016 and the 8 groups in Indiana and Kentucky that were declared by Humana last month.
The model of Humana is similar to the State of Tennessee’s Innovation Model (SIM) Grant through the CMS for Medicaid beneficiaries.
Through the new contract, Humana’s population health capabilities, involving sufferer data and analytics as well as chronic disease management and wellness programs, will complement the integrated care approach that each orthopedic group will employ with Humana members.
“Humana has made remarkable strides when it comes to value-based care in the primary care space so it is amusing to see where we can take value-based care when we apply it to more engaged medical procedures such as total joint replacement,” stated Chip Howard, Humana’s Vice President of Payment Innovation. “Humana’s approach is to give orthopedic surgeons the tools they require coordinating all aspects of their patients’ diagnosis, treatment, recovery and rehabilitation to in turn make better the quality, lower cost and develop a better experience for our members.”
As of the day March 31, 2017, Humana has 1.8 million individual Medicare Advantage members and 160,000 commercial members who are cared for by 51,300 primary care providers, in more than 900 value-based relationships across 43 states and Puerto Rico. For further information, please visit humana.com/accountable-care or www.humana.com/valuebasedcare.
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