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Humana Expands Orthopedic Bundled Payment Program to NC, VA

Eleven providers in North Carolina and Virginia will join Humana’s growing orthopedic bundled payment program.

Humana expands bundled care into NC, VA

Source: Thinkstock

By Jesse Migneault

- Humana will bring its value-based orthopedic bundled payment program to 11 orthopedic specialty groups in North Carolina and Virginia.  The move follows a recent expansion into Kentucky and Indiana in 2017, and Ohio and Tennessee in 2016. 

The program will focus on Humana’s Medicare Advantage members who will be undergoing total hip or knee joint replacement procedures.

“Humana has made great strides when it comes to value-based care in the primary care space so it’s exciting to see where we can take value-based care when we apply it to more involved medical procedures like total joint replacement,” said Chip Howard, Humana’s Vice President of Payment Innovation.

Humana will be partnering In North Carolina with EmergeOrtho (Blue Ridge Bone and Joint Clinic, Carolina Orthopaedic Specialists, Triangle Orthopaedic Associates and Wilmington Orthopaedic Group), Carolina Orthopaedic & Sports Medicine CenterRaleigh Orthopaedic ClinicOrthoCarolina and Wake Forest University Health Sciences.

In Virginia, Humana will work with Appalachian Orthopaedic AssociatesHampton Roads Orthopaedic & Sports Medicine, and Jordan-Young Institute.

The value-based care bundled payment program continues Humana’s efforts to incorporate data-driven analytics to elevate quality and outcomes for patients.

The bundled payment process works by offering one pre-negotiated payment for all the costs associated with an entire episode of care. 

Ultimately, the provider is responsible for all costs of care in the bundle in addition to being rated for the clinical outcomes of the patients.  Providers are rewarded by the payer for better outcomes at lower costs. 

This value-based care arrangement resulted in 20 percent lower costs in total in 2015 for members.

Humana reported that as of September 30, 2016, close to 63 percent of its Medicare Advantage members were seeing providers who were in value-based payment relationships.

In 2016, Humana released data on the efficacy of its value-based care programs.  The outcomes were based on 2015 data from 1.2 million Medicare Advantage members receiving care in a value-based program compared to 170,000 members in standard Medicare Advantage arrangements.

The data showed Humana providers in value-based care arrangements had 19 percent higher HEDIS scores versus providers in standard Medicare Advantage arrangements.

Data also pointed to better results for patients in value-based care, with 6 percent fewer ER visits.   Value-based arrangement especially yielded better care management for older adults in vulnerable populations.  

“Humana is now moving to apply the approach to specialties, such as orthopedics, where highly coordinated care supported by population health data has the ability to potentially improve outcomes, lower cost and deliver a better healthcare experience for patients,” the company said.


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