Humana Announces New Primary Care Value-Based Model
December 10 2020 - 9:00AM
Business Wire
To Provide Greater Financial Certainty for
Medical Practices and Benefit Humana Medicare Advantage Members
Across Contiguous U.S.
Leading health and well-being company Humana Inc. (NYSE: HUM)
today announced an expansion of its value-based program portfolio
with the forthcoming launch of the Primary Care First (PCF) model.
It will expand the availability of coordinated primary care for
members of certain Humana Medicare Advantage plans in the nation’s
48 contiguous states and Washington, D.C., and aims to improve care
quality and health outcomes, lower the cost of care, and ease
financial stress for primary care groups.
“The creation of this model comes at a critical time. Primary
care is always important, but especially so as the nation continues
to navigate the disruptive effects of the coronavirus pandemic,”
said Oraida Roman, Vice President of Value Based Strategies at
Humana. “It’s important to us to provide support and resources for
primary care groups that seek greater financial stability and wish
to transition from fee-for-service to value-based care. Humana is
more committed than ever to innovation in value-based care toward
helping clinicians do their work in spite of challenging
circumstances.”
Rewarding Excellence in Primary Care Delivery
The PCF model was established by the Innovation Center at the
Centers for Medicare & Medicaid Services (CMS) to encourage
primary care practices to shift to value-based care and test
whether this new payment model will improve quality and reduce
costs in Original Medicare. As a newly-approved CMS payer partner –
and the only insurer to offer its own version of the PCF model in
all 48 contiguous states and Washington, D.C. – Humana will offer a
similar model to qualifying primary care groups currently
in-network for Humana Medicare Advantage Preferred Provider
Organization (PPO) and Health Maintenance Organization (HMO)
plans.
“We welcome payer participation in the effort to support primary
care physicians in their journey to a more patient-centered,
advanced approach to care,” said Shawn Martin, American Academy of
Family Physicians CEO. “It’s essential that Americans have access
to the best possible primary care now and in the future, and it is
through this kind of physician-payer collaboration that we can
advance this goal toward sustainability during the pandemic and
beyond.”
The Humana PCF model is scheduled to launch July 1, 2021. Each
month, it will offer participants a prospective capitated payment,
which takes into account achievement of quality and outcomes-based
measures. Such payments also will provide revenue stabilization,
which is of particular importance for primary care practices during
these uncertain times.
The model will be available to qualifying groups that focus
chiefly on primary care services, and have more than 125 Humana MA
HMO and/or PPO members aligned to them.
Value-Based Care and Patient Outcomes
Two-thirds of Humana’s individual Medicare Advantage (MA)
members seek care from primary care physicians with some form of a
value-based care agreement with Humana. Humana MA members who
sought care from physicians in value-based care arrangements in
2019 experienced fewer hospital admissions and ER visits when
compared to patients in Humana MA non-value-based arrangements.
Humana has an extensive and growing value-based care presence.
As of Sept. 30, 2020, Humana has more than 2.7 million individual
Medicare Advantage and commercial members cared for by more than
67,000 primary care physicians in more than 1,000 value-based
relationships across 43 states and Puerto Rico. Humana’s total
Medicare Advantage membership is more than 4.5 million members,
which includes members affiliated with providers in value-based and
standard Medicare Advantage settings.
Humana’s PCF model is the latest value-based payment model
launched by the organization, which in September announced the
creation of programs for coronary artery bypass grafting and total
shoulder replacement procedures.
For more information on Humana and value-based care, visit
humana.com/provider/support/vbc.
About Humana
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
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version on businesswire.com: https://www.businesswire.com/news/home/20201210005023/en/
Alissa Krinsky Humana Corporate Communications
akrinsky@humana.com
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