Humana Starts Bundled Pay for Spinal Fusion, Expands Total Joint Replacement

Humana Inc. (NYSE: HUM) is announcing two key milestones as it expands value-based orthopedic specialty care for Humana Medicare Advantage members, launching a bundled payment model for spinal fusion surgeries, and broadening the reach of its Total Joint Replacement Episode-Based Model for total hip or knee joint replacement procedures.

Humana Launches Spinal Fusion Episode-Based Model, Announces First Program Participants

Humana is teaming up with orthopedic and neurosurgery practices to launch a value-based care bundled payment initiative designed specifically to provide coordinated care for Humana Medicare Advantage members undergoing spinal fusion surgery.

The Spinal Fusion Episode-Based Model (EBM) offers the opportunity for additional payment to physicians and clinicians for improved health outcomes and cost across a member’s entire spinal surgery episode-of-care. Improvement is measured based on three clinical indication rates – readmissions, cervical complications, and lumbar complications – as well as by average risk-adjusted episodic cost-of-care.

The program’s inaugural participants are Fort Wayne Orthopedics and Ortho NorthEast(Indiana), Mayfield Brain & Spine (Ohio), and OrthoVirginia (Virginia).

“We’re excited to focus on spinal fusion surgery with our newest orthopedic episode-of-care model,” said Oraida Roman, Vice President of Humana’s Value-Based Strategies Organization. “This program is a logical ‘next step’ for us in value-based care, considering the prevalence of spine surgeries and, therefore, the need for a coordinated, quality patient experience. We’re deeply committed to sharing our knowledge and experience with participating providers, as we have a mutual dedication to improving clinical outcomes and lowering the cost of spinal care.”

Humana Expands Availability of Total Joint Replacement Episode-Based Model

Humana also is announcing the expansion of its first orthopedic bundled payment program, the Total Joint Replacement Episode-Based Model for Humana Medicare Advantage members undergoing total hip or knee joint replacement procedures.

Through eight additional agreements with orthopedic specialty groups across the nation, the program now is offered at more than 60 medical practices in 19 states, including, for the first time, in Michigan. Humana’s newest agreements are with Southern Bone and Joint Specialists (Alabama); Florida Orthopaedic Institute and Watson Clinic LLP(Florida); Louisiana Orthopaedic Specialists (Louisiana); Michigan Orthopaedic Surgeons (Michigan); Signature Medical Group’s Kansas City-area practices (Missouri); MSK Group, P.C. and Tennessee Orthopaedic Alliance (TOA) (Tennessee); Orthopedic Associates of Central Texas, Rio Grande Orthopedic Center, and The Orthopaedic Center of Corpus Christi (Texas).

Initially launched in 2016, the Total Joint Replacement Episode-Based Model has expanded each year since then. The program is designed to improve quality, outcomes, and cost across a member’s entire joint replacement episode of care, and it offers the opportunity for additional payment for better outcomes.

https://www.marketscreener.com/HUMANA-13000/news/Humana-Announces-Two-Milestones-in-Value-Based-Orthopedic-Specialty-Care-Launching-Bundled-Paymen-28152113/