13 new orthopedic groups join Humana's bundled payment model for joint replacements

Practice Management

Humana expanded access to its value-based care bundled payment model for Humana Medicare Advantage payments for joint replacement procedures to 13 new orthopedic groups across the country.

 "Humana is excited to expand the geographic reach of our voluntary episodic bundling programs, which are a critical part of our continued dedication to value-based care," said Director of Humana's Value-Based Strategies Organization Brent Stice.

Here are five things to know:

1. The new providers added to Humana's value-based care bundled payment model include some of the largest practices across the country, as well as smaller, local orthopedic groups. The new practices include:

• The CORE Institute (Phoenix)

• Coastal Orthopaedics and Sports Medicine (Bradenton, Fla.)

• Physicians Clinic of Iowa (Cedar Rapids)

• Baton Rouge (La.) Orthopaedic Clinic

• Lafayette (La.) General Orthopaedic Hospital
• LMG (Dallas)

• Musculoskeletal Institute of Louisiana

• Syracuse (N.Y.) Orthopedic Specialists

• Christ Hospital Orthopedic Associates (Cincinnati)

• Texas Orthopedics, Sports & Rehabilitation Associates (Austin)

• Carilion Clinic (Roanoke, Va.)

• Bellin Health Partners (Green Bay, Wis.)

• Orthopaedic Associates of Wisconsin (Pewaukee)

2. The value-based care model is designed to offer bundled payments for the entire joint replacement episode of care, giving providers the opportunity to achieve additional payment for better outcomes. Humana provides orthopedic practices with data and analytics on care delivery from diagnosis to recovery. The program is aimed to drive more coordinated care, reduce readmissions and lower complication rates.

3. Humana initially launched the program in 2016 with Ohio- and Tennessee-based groups and expanded to include four additional states in 2017. Already this year, the program has grown to Alabama, Florida, Georgia, Illinois and Texas; the most recent expansion adds Arizona, Iowa, Missouri, New York and Wisconsin.

4. As Humana's inaugural specialty care bundled payment model, the program has been successful and has expanded to 50 practices nationwide. The company recently launched a maternity episode-based model for members with low- to moderate-risk pregnancies.

5. As of June 30, Humana reported around 2 million individual Medicare Advantage members and 130,000 group members. Beneficiaries receive care from 52,000 primary care physicians within the network, and Humana has 1,000 value-based relationships in 43 states.


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