Humana Physician Quality Rewards Boost Population Health across Accountable Care Continuum

Tuesday, December 23rd, 2014
This post was written by Patricia Donovan

Humana offers primary care physicians a four-tiered value-based rewards program.

You can’t argue with the data: the total cost of care for Humana’s Medicare Advantage members treated in accountable care settings in 2013 was 19 percent lower than MA members receiving care in traditional Medicare fee-for-service (FFS) environments.

Humana’s successful approach is honed from twenty-six years of experience with value-based reimbursement, explained Chip Howard, Humana’s vice president of payment innovation in the provider development center of excellence, during a December 2014 webinar on Physician Quality Rewards for Population Health Management.

Today, Humana not only offers physicians four levels of participation and rewards in fee-for-value programs but supports their shift from an episodic to population health mindset with training and reporting.

This stepped approach has paid off for the payor and its Medicare Advantage (MA) members in other areas as well, including higher HEDIS® scores, fewer ER visits and hospital admissions, and improved clinical management and screening compliance levels for Medicare Advantage members.

Howard walked webinar participants through the four models, from Humana’s Star Rewards program that incents providers who meet a subset of NCQA HEDIS goals, to its Medical Home program for high-functioning physician practices with a well-developed infrastructure, a physician population health champion and a robust team approach.

Each value-based option across Humana’s Accountable Care Continuum supports the Triple Aim objectives of improving care, improving health outcomes and lowering cost—with the bonus of enhancing the overall patient experience, Howard noted.

Participating physicians are exposed to Humana’s population health management initiatives, including the Humana at Home program for high-risk patients, with its goal of keeping MA members healthier, out of the hospital and safe in their homes; a 30-day Transitions program that reduced readmissions by 39 percent less than expected; and a bank of technologies and data tools that help providers become better population health managers.

Encouraged by gains from its pay-for-value strategy at the primary care level—the payor recently distributed $76.8 million in quality awards to approximately 4,700 physician practices— Humana is exploring programs to engage and incentivize specialists to achieve similar Triple Aim goals.

The intent would be to then promote interactions between the primary care physician, which Humana views as the “care quarterback,” Howard noted, and sub-specialists that result in high-quality, efficient healthcare delivery.

Click here to listen to an interview with Chip Howard on the value of care coordination in Humana’s Accountable Care Continuum.

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