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Humana, DeKalb Medical and DeKalb Physician Hospital Organization Now Offer Value-based Care to Commercial Members

Expanded relationship designed to help improve the health and well-being of patients


Thursday, March 3, 2016 10:00 am EST



Public Company Information:

"DeKalb Medical and DPHO physicians are highly respected members of the local medical community"

ATLANTA--(BUSINESS WIRE)--DeKalb Physician Hospital Organization (DPHO), which is affiliated with DeKalb Medical, and Humana Inc. (NYSE: HUM) today announced that they have expanded their relationship by adding value-based care provisions to their agreement serving Humana commercial members. The expanded agreement allows the organizations to build on their long-term relationship and to further coordinate health care services, improve quality and reduce health care costs.

Value-based agreements reflect a shift away from the current episodic health care model to a model that emphasizes quality and provides a patient-centric experience that is focused on outcomes rather than procedures.

Humana and DPHO/DeKalb Medical have been working together on a fee-for-service basis for benefit coverage for members who have employer-based health insurance.

Under the new value-based care arrangement, which took effect January 1, Humana commercial and Humana Individual National Point of Service members continue to have in-network benefit access to physicians affiliated with DeKalb Medical facilities.

“The value-based agreement allows us to focus on measurable patient outcomes, care coordination, disease management and aligning quality with payment incentives,” said Albert Wildstein, MD, DPHO Chairman. “We believe this expanded agreement with Humana will greatly benefit our patients.”

The agreement includes value-based incentives tied to performance improvement and supports successful population health management and a world-class patient experience for Humana members and DPHO/DeKalb Medical patients in Atlanta. The arrangement offers more personalized care and allows Humana to offer a broad range of population health tools like predictive analytics, chronic care, disease management, care coordination and wellness programs.

“DeKalb Medical and DPHO physicians are highly respected members of the local medical community,” said Alan Stewart, Regional Vice President of Market Development for Humana. “We are pleased to build on our long-term relationship with DeKalb to focus on helping our members achieve their best health by including provider rewards for increased attention to preventive measures such as breast cancer screenings and diabetes testing.”

The value-based incentive arrangement emphasizes quality outcomes and leverages standard measures defined by the National Committee for Quality Assurance (NCQA) Healthcare Effectiveness Data and Information Set (HEDIS) such as emergency room visits per 1,000, breast cancer screenings, avoidance of antibiotic treatment in adults with acute bronchitis, and diabetes HbA1c testing.

DPHO also has a similar agreement in place to provide value-based health care services to Humana’s Medicare Advantage membership in Atlanta.

Humana has nearly 30 years of accountable care experience, reflected in results from approximately one million Medicare Advantage members that showed significant improvements in quality, outcomes and costs through partnerships like the one with DeKalb.

Today, Humana has 1.6 million individual Medicare Advantage members and 200,000 commercial members who are cared for by approximately 44,000 primary care physicians, in more than 900 value-based relationships across 43 states and Puerto Rico. For more information, visit humana.com/accountable-care.

About DeKalb Physician Hospital Organization

DeKalb Physician Hospital Organization (DPHO) was incorporated in 1994 as a nonprofit organization to improve the quality and availability of health care services to the community served by DeKalb Medical Center, in Decatur, Georgia and its affiliated physicians and their practices. Today, DPHO continues to carry out that mission by operating as a clinically integrated network of over 500 physicians and the 3 hospitals of DeKalb Medical (DeKalb Medical at North Decatur, DeKalb Medical at Hillandale, and DeKalb Medical at Downtown Decatur) whose primary goal is to work collaboratively to provide coordinated, high-quality, cost-effective patient care with improved outcomes.

About Humana

Humana Inc., headquartered in Louisville, Ky., is a leading health and well-being company focused on making it easy for people to achieve their best health with clinical excellence through coordinated care. The company’s strategy integrates care delivery, the member experience, and clinical and consumer insights to encourage engagement, behavior change, proactive clinical outreach and wellness for the millions of people we serve across the country.

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
  • Replays of most recent earnings release conference calls
  • Calendar of events
  • Corporate Governance information

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Humana Media Relations
Nancy A. Hanewinckel, 941-585-4763
DeKalb PHO
Susan L. Helton, 404-501-6027
Executive Director
DeKalb Medical Media Relations
Margaret Harrison, 404-501-2885