Humana Spent $93M in Quality Payments for Provider Network
Humana has incentivized its provider network to improve the quality of care through value-based care arrangements and quality payments.
By - The national payer Humana announced in a company press release earlier this week that it has reimbursed more than $93.6 million to more than 4,000 provider groups countrywide participating in their Provider Quality Rewards Program. These particular healthcare providers received these quality payments due to value-based care improvements.
These results show that Humana’s provider network is succeeding at reaching the benchmarks of value-based care payment contracts. The Humana Provider Quality Rewards Program has ensured that clinicians and healthcare systems receive quality payments for their achievements since 2012.
Humana is committed to moving toward value-based care reimbursement while bringing less and less focus to the fee-for-service payment model. Among Humana’s Medicare Advantage members, a total of 63 percent are served by primary care physicians participating in value-based care partnerships.
“This year’s payments suggest that physicians who provide care in value-based relationships continue to experience success,” said Chip Howard, Humana’s Vice President of Payment Innovation in the Provider Development Center of Excellence. “Physicians participating in our value-based programs are making significant strides in improving their patients’ health and care experience.”
The Provider Quality Rewards Program is also focused on improving value-based care reimbursement for Humana’s provider network and ensuring high quality care for its patient community. There are specific programs that Humana offers for providers taking part in the Provider Quality Rewards Program including shared savings programs, Star Rewards, Model Practice, and the Medical Home.
With 4,465 physician groups receiving quality payments from Humana for their efforts in 2015, improved health outcomes for the patient community are becoming a reality countrywide. The providers participating in the quality payment program had to meet key metrics including those of the Healthcare Effectiveness Data and Information Set (HEDIS) scores.
“As the industry continues to shift toward value-based payment, programs such as these are proving that care tied to quality metrics can have a meaningful impact on a patient’s health,” said Dr. Roy Beveridge, Humana’s Chief Medical Officer. “Physicians are benefitting, too, by being paid for the complex care they are delivering.”
Some of the areas in which providers were able to show strong quality care include diabetes treatment management, breast cancer screening, colorectal cancer screening, and high-risk medication management.
As many as 1.2 million Medicare Advantage members have benefited from Humana’s quality payment program and their push for value-based care reimbursement models. The results have shown improved HEDIS scores as well as better chronic disease management and control of medical costs.
Cigna is another national health insurance company that has worked to implement value-based care reimbursement and improve patient health outcomes. Mark Slitt, Spokesman and Public Relations Manager at Cigna, spoke to HealthPayerIntelligence.com previously about Cigna’s work to expand value-based care.
“Cigna has been a leader in value-based care reimbursement since 2008 and we are well on the way to having value-based reimbursements represent the majority of our arrangements with providers by 2018,” Slitt said. “This is fundamentally changing the relationship between payers and providers by making the relationship much more collaborative. There is now much more focus on working together to improve quality and affordability so that the customers/patients we jointly serve have better outcomes and enjoy a better experience.”
Slitt also discussed how Cigna has been working to improve price transparency for its members through the Cost of Care Estimator tool.
“In 2007, Cigna introduced the Cigna Cost of Care Estimator for health care providers. Because it estimates the cost of service, the Estimator helps eliminate financial surprises,” he continued. “It shows the patient’s anticipated payment responsibility and produces a printed Explanation of Estimate for the provider and patient.”
“Providers that use the Cigna Cost of Care Estimator get highly accurate and personalized estimates of the amount that patients will owe for specific medical services. It facilitates financial discussions between doctors and patients in Cigna administered medical plans so payment arrangements can be made before treatment. By helping patients understand their financial obligation, the Estimator helps them plan in advance for their out-of-pocket expenses,” Slitt concluded.
The future for value-based care reimbursement will likely depend on major payers like Cigna and Humana to lead the way in adopting and operating alternative payment models.
Dig Deeper:
How Payers Should Prepare for Value-Based Reimbursement
How to Overcome the Challenges of Bundled Payment Models
