Humana launches heart, shoulder payment models: 6 things to know


Humana is creating two national programs that will reward providers for better outcomes for heart and shoulder procedures.

Six things to know:

1. The models are the coronary artery bypass grafting episode-based model and the total shoulder specialist rewards program.

2. The CABG bundled payment model is designed to improve care for certain members undergoing heart bypass surgery. Under the model, providers will receive financial incentives for controlling the cost of care and minimizing readmissions and complications across surgery and post-discharge.

3. Six providers have already committed to Humana's CABG program: 

  • Infirmary Health Cardio-Thoracic and Vascular Surgical Associates (Mobile, Ala.)
  • Cardiothoracic and Vascular Surgical Associates (Jacksonville, Fla.)
  • Ballad Health CVA Heart Institute (Kingsport, Tenn.)
  • Christus Health (Irving, Texas)
  • Christus Trinity Clinic (Tyler, Texas)
  • WVU Heart and Vascular Institute (Morgantown, W.V.)

4. The total shoulder specialist rewards program aims to better coordinate care for certain members undergoing total shoulder arthroplasty, or replacement. 

5. The program offers providers additional payment for achieving two goals: improved outcomes and lower costs derived from site-of-care selection. Humana said the second goal incentivizes independent surgeons to perform shoulder replacements at less-expensive ambulatory surgical centers.

6. The program's first six participants are: 

  • Florida Orthopaedic Institute (Tampa)
  • OrthoCincy Orthopaedics & Sports Medicine (Locations in Indiana, Kentucky and Ohio)
  • EmergeOrtho (Durham, N.C.)
  • OrthoCarolina (Charlotte, N.C.)
  • OrthoTennessee (Knoxville) 
  • Tennessee Orthopaedic Clinics (Knoxville)

Read more about the models here.

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