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Humana expands orthopedic bundled payment model to 7 more states

Humana more than doubled the number of states where it offers a bundled payment program for Medicare Advantage members undergoing total hip or knee joint replacement procedures. The model is now available in about 40 provider locations in 13 states.

Here are five insights.

1. Humana's Total Joint Replacement Episode-Based Model was deployed in Ohio and Tennessee in 2016 and expanded into Indiana, Kentucky, North Carolina and Virginia in 2017.

It has now been introduced in Alabama, Florida, Georgia, Illinois, Louisiana, Mississippi and Texas.

2. Humana's newest provider agreements are with the following orthopedic specialty groups:

  • Alabama Orthopaedic Clinic (Mobile, Ala.)
  • Florida Medical Clinic (Tampa)
  • OrthoAtlanta Orthopedic and Sports Medicine Specialists; Peachtree Orthopedics (Atlanta); and Resurgens Orthopaedics (Atlanta)
  • Illinois Bone & Joint Institute (Chicago) and OrthoIllinois (Rockford)
  • Bone & Joint Clinic of Baton Rouge (La.)
  • Bienville Orthopaedic Specialists (Biloxi, Miss.) and Mississippi Sports Medicine and Orthopaedic Center (Jackson)
  • TSAOG Orthopaedics (San Antonio, Texas)

3. Humana also announced agreements with one additional group in Indiana, one in Tennessee and three in Virginia:

  • Ascendant Orthopedic Alliance (Goshen, Ind.)
  • Center for Sports Medicine & Orthopaedics (Chattanooga, Tenn.)
  • Atlantic Orthopaedic Specialists (Virginia Beach, Va.); OrthoVirginia (Richmond); and Riverside Medical Group (Newport News, Va.)

4. The payment model is designed to incentivize orthopedic surgeons for better outcomes.

5. As of Dec. 31, 2017, Humana had 1.9 million individual Medicare Advantage members and approximately 140,000 commercial members. By the end of 2017, Humana reached its goal of having 66 percent of its 2.9 million Medicare Advantage members seeing primary care physicians in value-based payment relationships.

Humana's total Medicare Advantage membership is approximately 3.3 million.

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