Humana Announces Value-Based Primary Care Services MA Model

Humana has announced a new value-based primary care services model for Medicare Advantage members using the CMS Primary Care First model.

“The creation of this model comes at a critical time. Primary care is always important, but especially so as the nation continues to navigate the disruptive effects of the coronavirus pandemic,” said Oraida Roman, vice president of value based strategies at Humana.

Through the model, Humana will offer monthly, capitated payments to participating providers based on provider performance regarding certain quality measures and patient outcomes.

Humana’s new model seeks to boost quality of care and control healthcare spending. It will serve as a stepping stone for provider organizations that are interested in transitioning from fee-for-service payment to value-based care arrangements.

“It’s important to us to provide support and resources for primary care groups that seek greater financial stability and wish to transition from fee-for-service to value-based care,” Roman expounded. “Humana is more committed than ever to innovation in value-based care toward helping clinicians do their work in spite of challenging circumstances.”

The model will extend coordinated care in primary care services to Medicare Advantage plans across 48 states plus Washington, DC. Humana is the only payer to have a Primary Care First model in all of the contiguous states and the nation’s capitol.

Humana will partner with their in-network Medicare Advantage preferred provider organizations (PPOs) and health maintenance organizations (HMOs) for the model. Provider organizations must center on primary care and serve over 125 Humana Medicare Advantage members in HMO or PPO agreements.

The capitated payment model which Humana plans to leverage may be particularly useful during the pandemic as such a payment method ensures consistent revenue for providers.

“We welcome payer participation in the effort to support primary care physicians in their journey to a more patient-centered, advanced approach to care,” said Shawn Martin, chief executive officer of American Academy of Family Physicians.

“It’s essential that Americans have access to the best possible primary care now and in the future, and it is through this kind of physician-payer collaboration that we can advance this goal toward sustainability during the pandemic and beyond.”

The model will launch July 1, 2021.

This announcement comes a couple of months after the payer revealed two value-based programs for specialty care, specifically heart and shoulder surgeries. The heart surgery model is an episode-based model for bypass heart surgery. The Total Shoulder Specialist Rewards Program is a value-based orthopedic payment program.

“Humana is proud to further diversify our value-based program offerings in support of clinicians who share our vision for the future of health care,” Roman said at the time.

The major payer has also reported that two-thirds of its Medicare Advantage members are under a value-based care agreement for their primary care services.

Humana’s value-based care efforts have successfully decreased hospitalizations as well as healthcare spending, Humana’s annual value-based care report discovered. Bruce Broussard, president and chief executive officer at Humana, attributed this to Humana’s primary care provider partners.

“Our collaboration with primary care physicians and their care teams is helping to deliver simpler and more convenient care and reducing avoidable hospitalizations,” Broussard said.

Studies have shown that primary care services are key in controlling healthcare spending.

In the months leading up to this announcement, other major payers have also launched initiatives that focus on centering primary care services.

For example, UnitedHealthcare’s new concierge-style plan will offer free primary care services for employer-sponsored health plans. Likewise, Anthem Blue Cross recently announced an exclusive provider organization that promotes a culture of advocacy around the primary care provider.