Humana to offer Primary Care First model across 48 states

Humana building
Humana has announced an expansion of its use of the Primary Care First model. (Humana)

Humana signed on with the Trump administration for its Primary Care First model earlier this year and is now unveiling plans to significantly expand its use of the model.

The Centers for Medicare & Medicaid Services (CMS) is rolling out Primary Care First in 26 regions for 2021 in traditional, fee-for-service Medicare. As part of the launch, CMS urged private payers to also take up the model, which aims to better coordinate primary care.

Humana will offer the model to qualified primary care providers across the 48 contiguous states and the District of Columbia who are in-network for Medicare Advantage PPO and HMO plans, the insurer announced.

CMS' iteration of the model will begin Jan. 1, with Humana launching its expanded version July 1.

RELATED: Humana saved $4B through its value-based care programs last year

“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, in a statement.

“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," Roman said.

Under the model, Humana will offer participating providers a monthly prospective capitated payment, which will account for performance on achievement in quality and outcomes metrics. Humana said the model will also offer an opportunity for income stabilization for primary care practices hit hard financially by the pandemic.

Eligible providers must focus chiefly on primary care services and have more than 125 Humana Medicare Advantage PPO and/or HMO members aligned with them, the insurer said.

Humana has a broad slate of value-based care arrangements, with 2.7 million members treated by 67,000 providers across 1,000 value-based relationships.