Reimbursement News

Humana Pays Physician Groups $77M for Value-Based Outcomes

“The sheer volume of payments ... shows that many physician groups are experiencing success as part of their shift toward value-based care.”

By Jacqueline DiChiara

- As the fee-for-service realm dissipates and the value-based reimbursement model nears its completed transition in coming years, Humana is granting sizable financial rewards for those physician groups yielding quality care outcomes.

Medicare Advantage members Provider Quality Rewards Program value-based reimbursement

Humana will pay over $77 million to physician groups nationwide for their participation in Humana’s Provider Quality Rewards Program, confirms Humana’s recent press release.

Financial rewards bolster the value-based shift

Nearly 59 percent of all Humana individual Medicare Advantage members are directly tied to primary care physicians partaking in value-based endeavors, says Humana.

  • 74% of Providers See Increased Patient Financial Responsibility
  • Palliative Care Reduces Hospital Costs by Over $3K Per Patient
  • Revenue Cycle Management a Post-ICD-10 Implementation Focus
  • With its nearly 1.6 million individual Medicare Advantage members and 200,000 commercial members, Humana says its leading objective is to expand upon such programs until this percentage of individual Medicare Advantage members reaches 75 percent by 2017’s end.

    Approximately 3,700 physician groups received payments from Humana in recognition of improved outcomes for Humana’s Medicare members made during 2014. Reward settlement finalization takes place in 2015 for the 2014 Rewards Program to allow time for final claims and submission and supplemental data submission.

    Humana paid these physician groups for their focus on improved outcomes based on their ability to effectively manage and handle a slew of preventative and chronic conditions, such as breast cancer screenings, diabetes treatment management, high-risk medications, and colorectal cancer screening. 

    The finalization of reward settlements takes place this year once final claims, supplemental data submissions, and the like are finalized, says Humana.

    “The sheer volume of payments distributed through this year’s Provider Quality Rewards Program shows that many physician groups are experiencing success as part of their shift toward value-based care,” says Chip Howard, Humana’s Vice President of Payment Innovation in the Provider Development Center of Excellence.

    “Humana commends our participating physicians on their success and we are committed to continue supporting their journey to value-based care with the population health management solutions to help them make this transition and ultimately improve the patient care experience,” Howard adds.

    Humana CEO: the system was built for one-and-done

    As RevCycleIntelligence.com reported, Humana’s CEO and President, Bruce D. Broussard has been vocal about how more focus is needed on chronic care within the healthcare industry. Consumer choice, he said, must be a critical facet within the value-based reimbursement conversion.

     “What’s happened over the years is that the consumer is at the middle of the problem.  The provider is at the middle of the problem.  They’re the ones that are enabling the system to work and connecting the system together,” Broussard said.

    “Today it takes two weeks for a patient to get in to see a primary care doctor. If you’re diagnosed with an illness, that’s a long two weeks,” Broussard stated. “[The system] was built for one-and-done, bill, and move on to the next patient,” he added.

    “Value-based reimbursement along with integration is so powerful,” stated Broussard. “We see today when information is flowing freely through the system, it creates better efficiency, better decision making, and a significantly better consumer experience.”