Humana launches value-based programs focused on heart surgery, shoulder replacements

medical surgery
Humana is launching two new value-based care programs for members of its select Medicare Advantage plans: one to cover coronary artery bypass grafting and another for total shoulder replacement procedures. (Pixabay)

Humana is launching two new value-based care programs for members of its select Medicare Advantage (MA) plans, including one to cover coronary artery bypass grafting and another for total shoulder replacement procedures.

The insurance giant announced the expansion of its value-based program portfolio Thursday, saying the new payment bundles would result in better coordinated care and improved costs and outcomes for patients undergoing one of the two common procedures.

The new coronary artery bypass grafting procedure is a common cardiac procedure performed on patients with coronary artery disease in which arteries are narrowed or blocked due to plaque buildup. The procedure involves grafting a separate artery or vein, typically from the patient’s chest wall or leg, to the obstructed artery to circumvent the blocked portion and reroute blood flow to the heart, officials said.

Under the new episode-based payment model, Humana provides data and analytics and financially incentivizes cardiothoracic clinicians to enhance patient care, deliver better coordinated care and reduce duplicative services, readmissions and complications.

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Its inaugural participants in the program include facilities in Alabama, Florida, Tennessee, Texas and West Virginia. 

Meanwhile, Humana is also launching the total shoulder specialist rewards program, its first orthopedic payment program for members of certain Humana plans undergoing total shoulder replacement. The surgery is typically for patients with arthritis or rotator cuff problems.

The shoulder program also provides clinicians data and analytics, and it offers incentives for better health outcomes and lower costs derived from site of care selection, such as ambulatory surgical centers. Its inaugural facility participants in the program are located in Florida, Indiana, Kentucky, Ohio, North Carolina and Tennessee. 

The model is Humana’s third orthopedic value-based payment program, following those created for total hip and knee joint replacement surgeries and for spinal fusion procedures.

The value-based care models are part of a portfolio of payment bundles created by Humana including a Maternity Episode-of-care Model and an Oncology Model of Care. Humana also offers a Hospital Incentive Program for acute care inpatient admissions. About 2.4 million MA members and 115,000 commercial members are enrolled in value-based models, Humana has said.

Humana is seeing significant cost savings and reductions in unnecessary care through its value-based MA arrangements with providers, the insurer said in the release of its annual report last year. That report found MA members in these arrangements were admitted to the hospital 27% less often than those in traditional Medicare, and they made 14.6% fewer emergency room visits in 2018. 

MA members in value-based arrangements saved 20.1% in medical costs compared to traditional Medicare, equal to about $3.5 billion in services, Humana said.