Leading health and well-being company Humana Inc. (NYSE: HUM) today announced that it is contracting with health care providers to offer coordinated care for patients who are not Humana Medicare Advantage members, but rather are Original Medicare beneficiaries. Through the launch of the Direct Contracting Model (DCM), Humana, under Humana Direct Contracting Entity, Inc. and operating as Humana Care Solutions, is participating in a model that aims to improve care quality, health outcomes, and the patient experience, while lowering the cost of care for these Medicare beneficiaries.
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“We’re honored that Humana Care Solutions is one of only 53 organizations selected to participate in this innovative value-based model, which strives to accelerate the shift away from fee-for-service across the nation while providing greater financial consistency for providers,” said Oraida Roman, Vice President of Value Based Strategies at Humana. “This is important and exciting work, to collaborate with clinicians and expand the availability of value-based care beyond Humana’s membership, and in a way that supports physician organizations during uncertain times.”
Newly-Approved CMS Direct Contracting Entity
The DCM was established by the Innovation Center at the Centers for Medicare & Medicaid Services (CMS) to encourage physician organizations, and other types of health organizations, to voluntarily transition from fee-for-service to value-based care and test whether the model will improve quality and reduce costs in Original Medicare, while reducing organizational administrative burden. With more than 30 years of experience in value-based care, Humana is newly-approved by CMS as a Direct Contracting Entity (DCE).
To date, Humana Care Solutions has partnered with about 420 primary care providers for participation in the model, which launched on April 1, 2021. Humana Care Solutions will take on quality and cost accountability for the care of aligned Original Medicare beneficiaries. Furthermore, Humana Care Solutions will support providers with clinical and analytical capabilities to improve care coordination and drive a more holistic approach to patient care that goes beyond traditional clinical treatment.
The statements contained in this document are solely those of the authors and do not necessarily reflect the views or policies of CMS. The authors assume responsibility for the accuracy and completeness of the information contained in this document.
Humana’s Role in Expanding the Availability of Value-Based Care
This is the third time in recent months that Humana has been authorized to participate in a CMS value-based payment model:
- In December 2020, Humana was named an approved payer partner in CMS’s Primary Care First (PCF) model, designed to expand the availability of coordinated primary care for members of certain Humana Medicare Advantage plans in the nation’s 48 contiguous states and Washington, D.C.
- In February 2021, Humana was named an approved participant in CMS’s Medicare Hospice Value-Based Insurance Design (VBID) demonstration, created to determine whether hospice benefits provided within the Medicare Part A benefits package allow for a better patient experience.
Humana has an extensive and growing value-based care presence. Two-thirds of Humana’s individual Medicare Advantage (MA) members seek care from primary care physicians with some form of a value-based care agreement with Humana. Humana MA members who sought care from physicians in value-based care arrangements in 2019 experienced fewer hospital admissions and ER visits when compared to patients in Humana MA non-value-based arrangements.
As of Dec. 31, 2020, Humana has more than 2.7 million individual Medicare Advantage and commercial members who are cared for by more than 67,000 primary care physicians in more than 1,000 value-based relationships across 43 states and Puerto Rico. As of January 2021, Humana’s total Medicare Advantage membership is more than 4.8 million members, which includes members affiliated with providers in value-based and standard Medicare Advantage settings. For more information, visit www.humana.com/valuebasedcare.
- Providers interested in contacting Humana Care Solutions about the DCM can send an email to HumanaCareSolutionsDCE@humana.com or may contact their Humana representative.
- The statements contained in this document are solely those of the authors and do not necessarily reflect the views or policies of CMS. The authors assume responsibility for the accuracy and completeness of the information contained in this document.
Humana Inc. is committed to helping our millions of medical and specialty members achieve their best health. Our successful history in care delivery and health plan administration is helping us create a new kind of integrated care with the power to improve health and well-being and lower costs. Our efforts are leading to a better quality of life for people with Medicare, families, individuals, military service personnel, and communities at large.
To accomplish that, we support physicians and other health care professionals as they work to deliver the right care in the right place for their patients, our members. Our range of clinical capabilities, resources and tools – such as in-home care, behavioral health, pharmacy services, data analytics and wellness solutions – combine to produce a simplified experience that makes health care easier to navigate and more effective.
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 and conference calls
- Calendar of events
- Corporate Governance information
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