Humana Announces New Primary Care Value-Based Model

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The FINANCIAL — Leading health and well-being company Humana Incopens new window. Humana announced an expansion of its value-based program portfolio with the forthcoming launch of the Primary Care First (PCF) model. It will 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., and aims to improve care quality and health outcomes, lower the cost of care, and ease financial stress for primary care groups.

“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. “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. Humana is more committed than ever to innovation in value-based care toward helping clinicians do their work in spite of challenging circumstances.”

Rewarding Excellence in Primary Care Delivery

The PCF model was establishedopens new window by the Innovation Center at the Centers for Medicare & Medicaid Services (CMS) to encourage primary care practices to shift to value-based care and test whether this new payment model will improve quality and reduce costs in Original Medicare. As a newly-approved CMS payer partneropens new window – and the only insurer to offer its own version of the PCF model in all 48 contiguous states and Washington, D.C. – Humana will offer a similar model to qualifying primary care groups currently in-network for Humana Medicare Advantage Preferred Provider Organization (PPO) and Health Maintenance Organization (HMO) plans.

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“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, American Academy of Family Physicians CEO. “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 Humana PCF model is scheduled to launch July 1, 2021. Each month, it will offer participants a prospective capitated payment, which takes into account achievement of quality and outcomes-based measures. Such payments also will provide revenue stabilization, which is of particular importance for primary care practices during these uncertain times.

The model will be available to qualifying groups that focus chiefly on primary care services, and have more than 125 Humana MA HMO and/or PPO members aligned to them.

Value-Based Care and Patient Outcomes

Two-thirdsopens new window 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 visitsopens new window when compared to patients in Humana MA non-value-based arrangements.

Humana has an extensive and growing value-based care presence. As of Sept. 30, 2020, Humana has more than 2.7 million individual Medicare Advantage and commercial members cared for by more than 67,000 primary care physicians in more than 1,000 value-based relationships across 43 states and Puerto Rico. Humana’s total Medicare Advantage membership is more than 4.5 million members, which includes members affiliated with providers in value-based and standard Medicare Advantage settings.

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Humana’s PCF model is the latest value-based payment model launched by the organization, which in September announced the creation of programs for coronary artery bypass grafting and total shoulder replacement procedures.opens new window

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