Humana launches value-based model for oncology

Humana is working with physician groups across the U.S. to launch a value-based care oncology program designed to provide integrated treatments for its Medicare Advantage (MA) and commercial members.

Called Humana’s national Oncology Model of Care (OMOC), the program aims to improve patient experiences and health outcomes for patients with a cancer diagnosis, the insurer announced

Humana will give providers analytics and provide compensation for enhanced care navigation based on quality and cost within the following care components: inpatient admissions, emergency department visits, medical and pharmacy drugs, radiology as well as laboratory and pathology services.

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The OMOC program is the fourth specialty care model launched by Humana’s specialty care payment model. Other models include MA members undergoing total hip or knee joint replacement or spinal fusion procedures and its maternity episode-of-care bundled payment program for commercial plan members.

At the end of 2018, Humana had more than 2 million MA members and 115,000 commercial members, with more than 1,000 value-based care relationships across 43 states.

The goals are to offer patients more personalized care, tailored to each person’s unique health situation; to offer access to proactive screenings to prevent illness; to bring improved care to those living with chronic conditions; to leverage technologies; and to link reimbursement to physicians based on health outcomes.

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Humana is one of a growing number of healthcare systems embracing value-based care. And a recent analysis from Express Scripts revealed the success of these value-based programs at keeping costs down while also improving care and outcomes for patients. For example, in 2018, plans that participated in Express Scripts’ value-based SafeGuardRx programs saved more than $2.4 billion and saw lower growth rates in drug spending among the costliest therapy classes.

However, many consumers still remain skeptical of value-based insurance design. In a study published in the March issue of Health Affairs, Northern California consumers favored the VBID approach known as value-based benefit design by 41%. And if participants are not provided with educational tools and supplied with credible resources, such as healthcare providers and employers, to help participants navigate choices, value-based designs will not succeed.