The health plan moves into maternity after bundling joint replacements. Five OB-GYN practices will kick off the maternity bundling program.
Humana is launching a national, value-based care maternity bundled payment model for commercial group members with low-to-moderate-risk pregnancies, hoping to improve quality, outcomes, and cost across a member's entire perinatal episode of care.
The Maternity Episode-Based Model incudes all facets of the woman's prenatal and postnatal care, providing financial incentives for OB-GYNs to achieve better outcomes. Humana will provide maternity bundled payment agreements with five voluntarily participating practices: Ob/Gyn Associates of Southern Indiana, Mid America Physician Services in Kansas; Seven Hills Women's Health Centers and TriHealth in Ohio, and Consultants in Women's Health in Texas.
The maternity payment model is Humana's second specialty-care payment model, following its total joint replacement episode-based model for Humana Medicare Advantage members undergoing total hip or knee joint replacement procedures. That program was launched in 2016 and is now offered at about 40 orthopedic groups in 13 states across America.
Humana says its specialty-care bundled payment programs are part of the company's commitment to value-based care, which emphasizes more personal time with health professionals and personalized care that is tailored to each person's unique health situation; access to proactive health screenings and programs that are focused on preventing illness; and improved care for people living with chronic conditions with a focus on avoiding health complications.
The company also focuses on data analytics to help connect physicians and encourage them to work as a team to coordinate care around the patient. Reimbursement to physicians is linked to the health outcomes of their patients rather than solely to a fee-for-service model.
The maternity model follows that pattern, depending on data and analytics designed to enhance patient care and a more coordinated care experience, Humana reports. Participating physicians and patients should experience fewer duplicative services, readmissions, and complication rates, says Caraline Coats, vice president of Humana's Provider Development Center of Excellence.
"Humana is dedicated to working with OB-GYNs across the country to provide a better patient experience and improve patient outcomes, while also tackling the cost challenges inherent in perinatal care," Coats says.
Humana has an extensive and growing value-based care presence, Coats notes, with 1.9 million individual Medicare Advantage members at the end of 2017. That includes approximately 140,000 commercial members who are cared for by 52,000 primary care physicians in more than 1,000 value-based relationships across 43 states and Puerto Rico.
Humana reached its 2017 calendar year goal of having 66% of Humana's 2.9 million total individual Medicare Advantage members seeing primary care physicians in value-based payment relationships.
Gregory A. Freeman is a contributing writer for HealthLeaders.