Humana is expanding its value-based orthopedic care program by offering Humana Medicare Advantage members access to bundled payments for spinal fusion surgery.
What you should know:
1. The Spinal Fusion Episode-Based Model will offer physicians additional payments based on patient outcomes and cost across the episode-of-care. Humana measures outcome improvement by weighing readmissions, cervical complications and lumbar complications. The payer compares that figure to average risk-adjusted episodic cost-of-care.
2. Humana also expanded its total joint replacement bundle program by entering into agreements with eight more orthopedic groups across the U.S.
3. The total joint bundle is offered at more than 60 practices in 19 states. Humana launched its spinal fusion bundle with four practices: Fort Wayne (Ind.) Orthopedics, Fort Wayne-based Ortho NorthEast, Cincinnati-based Mayfield Brain & Spine and OrthoVirginia with locations in Lynchburg, Richmond and northern Virginia.
4. Since Humana launched the total joint replacement bundle in 2016, it has expanded its reach on a yearly basis.
5. Humana has three value-based bundled payment offerings in total, the aforementioned two in orthopedics and a maternity episode-based model.
6. Humana's President of Value-Based Strategies Organization Oraida Roman said, "We're excited to focus on spinal fusion surgery with our newest orthopedic episode-of-care model. This program is a logical 'next step' for us in value-based care."