Humana collaborating with providers to offer value-based care for those with original Medicare

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Health insurer Humana will begin contracting with healthcare providers to offer coordinated care for patients who are beneficiaries of original Medicare.

Humana is known for offering Medicare Advantage plans.

The new program will be facilitated through a value-based model called the Direct Contracting Model, in which the Humana Direct Contracting Entity will operate as Humana Care Solutions. The goal of the model is to improve care quality, health outcomes and the patient experience, while lowering the cost of care for Medicare beneficiaries.

The DCM was established by the Innovation Center at the Centers for Medicare and Medicaid Services 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.

The model was launched on April 1 and, to this point, Humana has partnered with about 420 primary care providers for participation in the model. Humana Care Solutions will take on quality and cost accountability for the care of aligned original Medicare beneficiaries. The entity has also pledged to support providers with clinical and analytical capabilities to improve care coordination and drive a more holistic approach to care.

WHAT'S THE IMPACT?

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 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.

Then in February, Humana was named an approved participant in CMS's Medicare Hospice Value-Based Insurance Design demonstration, which was created to determine whether hospice benefits provided within the Medicare Part A benefits package allow for a better patient experience.

Humana's presence in the value-based care space has been growing. According to an internal Humana report, two-thirds of its individual Medicare Advantage members seek care from primary care physicians with some form of a value-based care agreement with the company. 

THE LARGER TREND

On April 8, CMS announced 53 direct contracting participants were participating in the first performance year from April 1 through December 31.

Dozens of provider groups, including America's Physician Groups, American Academy of Home Care Medicine and VillageMD, signed onto a letter later in April imploring the Biden Administration to open up one more chance for providers to sign up for the Direct Contracting Payment model.

In the letter to Elizabeth Fowler, deputy administrator and director of the Center for Medicare and Medicaid Innovation, providers lamented the fact that, while CMS promised a second application period to sign up for the model, there was, in fact, none.

Last year, the innovation center created a new type of direct contracting entity that allows Medicaid managed care organizations to participate in the global and professional options of the direct contracting model. Currently, Medicaid MCOs have no incentive to coordinate care for their dually eligible beneficiaries in a way that reduces Medicare fee-for-service costs.

CMS believes that creating this incentive opportunity will help dually eligible individuals get access to a full scope of care, including primary, acute, long-term, behavioral and social care.
 

Twitter: @JELagasse
Email the writer: jeff.lagasse@himssmedia.com