Humana brings episodes of care for total joints to NC, Virginia orthopedic groups: 5 key notes

Written by Laura Dyrda | May 11, 2017 | Print  |

Humana is partnering with several orthopedic groups in Virginia and North Caroline to provide an episode of care model for total joint replacements.

Here are five things to know:


1. The insurer will implement its Total Joint Replacement Episode-Based Model for Humana Medicare Advantage members. Under the model, Humana provides orthopedic practices with data and analytics to manage all aspects of patient care from diagnosis to recovery.


2. The participating practices in North Carolina include:


• EmergeOrtho — a collaboration between Blue Ridge Bone and Joint Clinic, Carolina Orthopaedic Specialists, Triangle Orthopaedic Associates and Wilmington Orthopaedic Group
• Carolina Orthopaedic & Sports Medicine Center
• Raleigh Orthopaedic Clinic
• OrthoCarolina
• Wake Forest University Health Sciences


The participating practices in Virginia include Appalachian Orthopaedic Associates, Hampton Roads Orthopaedics & Sports Medicine and Jordan-Young Institute.


3. Twelve orthopedic groups in Ohio and Tennessee partnered with Humana last year on the episode of care model for joint replacements, and last month the insurer announced it would partner with eight orthopedic groups in Indiana and Kentucky on the initiative.


4. The episode of care model is expected to facilitate more coordinate care and incentivize innovative ways to reduce complications and unnecessary readmissions after surgery. In 2015, Humana reported 20 percent lower costs for members treated by healthcare professionals in value-based reimbursement models.


5. Humana's individual Medicare Advantage plan included 1.8 million members at the end of the first quarter and has entered into more than 900 value-based relationships in 43 states.


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