Humana Inc. (NYSE: HUM) is teaming up with 11 orthopedic specialty groups in North Carolina and Virginia on an orthopedic value-based care model for Humana Medicare Advantage members undergoing total hip or knee joint replacement procedures.

Humana’s Total Joint Replacement Episode-Based Model is designed to improve quality, outcomes and cost across a person’s entire joint replacement episode of care. Humana will provide the orthopedic 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 to reduce complication rates and unnecessary readmissions after surgery.

In North Carolina, Humana will work with EmergeOrtho (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 and Wake Forest University Health Sciences.

In Virginia, Humana will work with Appalachian Orthopaedic Associates, Hampton Roads Orthopedic Center, and Jordan-Young Institute.

Humana has 30 years of experience partnering with primary care physicians in value-based care arrangements. By focusing on quality and health, Humana experienced 20 percent lower costs in total in 2015 for members who were treated by doctors and other health care professionals in a value-based reimbursement model setting versus an estimation of original fee-for-service Medicare costs using the Centers for Medicare and Medicaid Services (CMS) Limited Data Set Files. Humana is now moving to apply the approach to specialties, such as orthopedics, where highly coordinated care supported by population health data has the ability to potentially improve outcomes, lower cost and deliver a better health care experience for patients.

The participating North Carolina and Virginia orthopedic groups join the 12 orthopedic groups in Ohio and Tennessee who joined Humana’s orthopedic value-based care model in 2016 and the eight groups in Indiana and Kentucky that were announced by Humana last month.

Humana’s model is similar to the State of Tennessee’s Innovation Model (SIM) Grant through the CMS for Medicaid beneficiaries.

Through the new agreement, 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 orthopedic group will employ with Humana members.

“Humana has made great strides when it comes to value-based care in the primary care space so it’s exciting to see where we can take value-based care when we apply it to more involved medical procedures like total joint replacement,” said Chip Howard, Humana’s Vice President of Payment Innovation. “Humana’s approach is to provide orthopedic surgeons the tools they need to coordinate all aspects of their patients’ diagnosis, treatment, recovery and rehabilitation to in turn improve quality, lower cost and create a better experience for our members.”

As of March 31, 2017, Humana has 1.8 million individual Medicare Advantage members and 160,000 commercial members who are cared for by 51,300 primary care providers, in more than 900 value-based relationships across 43 states and Puerto Rico. For more information, visit humana.com/accountable-care or www.humana.com/valuebasedcare.

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:

  • Annual reports to stockholders
  • Securities and Exchange Commission filings
  • Most recent investor conference presentations
  • Quarterly earnings news releases
  • Calendar of events
  • Corporate Governance information

More Information
Humana is a Medicare Advantage HMO, PPO and PFFS plan with a Medicare contract. Enrollment in any Humana plan depends on contract renewal. This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments and restrictions may apply. Benefits may change each year. Other providers are available in our network.

Humana Inc. and its subsidiaries (“Humana”) do not discriminate on the basis of race, color, national origin, age, disability or sex.

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