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Humana Brings Value-Based Orthopaedic Specialty Care Model to Tennessee, Expands in Ohio

Program, based on state Innovation Model Grants, brings payment bundling to four practices in Tennessee and two additional in Ohio


Wednesday, May 18, 2016 1:30 pm EDT



Public Company Information:

"It’s the key to building a health system that focuses on improving quality, lowering cost and creating a better experience for our members. We look forward to continue expanding this model."

LOUISVILLE, Ky.--(BUSINESS WIRE)--Humana Inc. (NYSE: HUM) is partnering with four leading orthopaedic specialty groups in Tennessee to bring a value-based bundled payment care model for Humana Medicare Advantage members undergoing total hip or knee joint replacement procedures. In addition, Humana is expanding the model in Ohio, which it announced last month, by adding two more specialty groups in that state.

The care model is designed to improve quality, outcomes and cost across a person’s entire joint replacement episode of care, and it financially rewards orthopaedic surgeons for better outcomes. Humana will also provide the orthopaedic practices with robust data and analytics needed to better manage all aspects of their patients’ care, from diagnosis to recovery. For the patient, this is expected to deliver a more coordinated care experience and reductions in readmission and complication rates.

The program is based upon the model of care standards developed for total joint replacement as part of the State of Tennessee’s and the State of Ohio’s State Innovation Model (SIM) Grant through the Centers for Medicare and Medicaid Services (CMS). The grants provide funding and guidance to help transform the health care system from a fee-for-service model to a value-based system, which aligns health care provider incentives with quality measures and rewards better outcomes.

In Tennessee, Humana will be working with Appalachian Orthopaedic Associates in the Tri-Cities, OrthoTennessee and Tennessee Orthopaedic Clinics in Knoxville, and Premier Orthopaedics & Sports Medicine in Nashville.

In addition to the five orthopaedic specialty groups announced earlier this year in Ohio, Humana will be partnering with Adena Medical Clinic in Columbus and University of Cincinnati Physicians in Cincinnati to expand the care model in that state.

Humana’s population health capabilities, including patient data and analytics as well as chronic disease-management and wellness programs, will complement the integrated care approach that each of the selected orthopaedic specialists will employ with Humana members.

Humana Vice President of Payment Innovation Chip Howard says the purpose is to give orthopaedic surgeons the tools they need to coordinate all aspects of their patients’ diagnosis, treatment, recovery and rehabilitation.

“Value-based care is a powerful new approach to more involved medical procedures like total joint replacement,” said Howard. “It’s the key to building a health system that focuses on improving quality, lowering cost and creating a better experience for our members. We look forward to continue expanding this model.”

Humana has 30 years of experience partnering with primary care physicians in value-based/accountable care arrangements. In November 2015, the company released value-based care data indicating that patients cared for through value-based models generally experienced healthier outcomes and lower costs. Humana is now moving to apply the approach to specialties, such as orthopaedics, where highly coordinated care supported by population health data has the ability to improve outcomes, lower cost and deliver a better health care experience for patients.

Humana has 1.7 million individual Medicare Advantage members and 200,000 commercial members today who are cared for by 47,800 primary care providers, in more than 900 value-based relationships across 43 states and Puerto Rico. For more information, visit humana.com/accountable-care.

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:

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  • Most recent investor conference presentations
  • Quarterly earnings news releases
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Humana Inc.
Marina Renneke, APR, 602-760-1758
Corporate Communications