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Humana Expands Availability of Value-Based Orthopedic Specialty Care to Improve Patient Experience in Seven Additional States
[April 12, 2018]

Humana Expands Availability of Value-Based Orthopedic Specialty Care to Improve Patient Experience in Seven Additional States


Leading health and well-being company Humana Inc. (NYSE: HUM) is expanding the availability of its value-based care bundled payment model for Humana Medicare Advantage members undergoing total hip or knee joint replacement procedures, by teaming up with orthopedic specialty groups in seven additional states. With these agreements, Humana has more than doubled the number of states in which its Total Joint Replacement Episode-Based Model is offered, encompassing more than one-quarter of the nation.

Initially launched in 2016 with orthopedic groups in Ohio and Tennessee, the model was expanded into Indiana, Kentucky, North Carolina, and Virginia in 2017. Along with additional agreements in Indiana, Tennessee, and Virginia, the program will expand to another seven states - Alabama, Florida, Georgia, Illinois, Louisiana, Mississippi, and Texas - for a total program footprint of approximately 40 provider locations in 13 states across America.

Humana's newest provider agreements are with Alabama Orthopaedic Clinic in Alabama; Florida Medical Clinic in Florida; OrthoAtlanta Orthopedic and Sports Medicine Specialists, Peachtree Orthopedics, and Resurgens Orthopaedics in Georgia; Illinois Bone & Joint Institute and OrthoIllinois in Illinois; Ascendant Orthopedic Alliance in Indiana; Bone & Joint Clinic of Baton Rouge in Louisiana; Bienville Orthopaedic Specialists and Mississippi Sports Medicine and Orthopaedic Center in Mississippi; Center for Sports Medicine & Orthopaedics in Tennessee; TSAOG Orthopaedics in Texas; and Atlantic Orthopaedic Specialists, OrthoVirginia, and Riverside Medical Group in Virginia.

"We're excited to accelerate this innovative value-based care model into additional markets, significantly growing the reach of a program specifically tailored for orthopedics," said Caraline Coats, Vice President of Humana's Provider Development Center of Excellence. "Humana is dedicated to building relationships with physicians and providing the support they need as we work together to create a more seamless, patient-centered experience and help members achieve their best health."

The orthopedic specialty-care model is designed to improve quality, outcomes, and cost across a member's entire joint replacement episode of care, and it financially incentivizes orthopedic surgeons for better outcomes. Humana provides participating orthopedic practices with robust data and analytics to enhance patient care - from diagnosis to recovery, and the program is designed to deliver a more coordinated care experience for the patient, with reductions in readmission and complication rates.


The orthopedic specialty-care bundled payment program is in keeping with Humana's longstanding 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;
  • Improved care for people living with chronic conditions with a focus on avoiding health complications (watch Humana's "Better Chronic Management Through Value-Based Care" video);
  • Leveraging technologies, such as data analytics, that connect physicians and help them work as a team to coordinate care around the patient; and
  • Reimbursement to physicians linked to the health outcomes of their patients rather than solely on the quantity of services they provide (fee-for-service).

Humana has an extensive and growing value-based care presence. As of December 31, 2017, Humana has 1.9 million individual Medicare Advantage members and 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 percent of Humana's 2.9 million total individual Medicare Advantage members seeing primary care physicians in value-based payment relationships. Humana's total Medicare Advantage membership is approximately 3.3 million members, which includes members affiliated with providers in value-based and standard Medicare Advantage settings. For more information, visit humana.com/valuebasedcare.

About Humana

Humana Inc. is committed to helping our millions of medical and specialty members achieve their best health. Our successful history in care delivery and health plan administration is helping us create a new kind of integrated care with the power to improve health and well-being and lower costs. Our efforts are leading to a better quality of life for people with Medicare, families, individuals, military service personnel, and communities at large.

To accomplish that, we support physicians and other health care professionals as they work to deliver the right care in the right place for their patients, our members. Our range of clinical capabilities, resources and tools - such as in-home care, behavioral health, pharmacy services, data analytics and wellness solutions - combine to produce a simplified experience that makes health care easier to navigate and more effective.

More information regarding Humana is available to investors via the Investor Relations page of the company's web site at www.humana.com, including copies of:

  • Annual reports to stockholders
  • Securities and Exchange Commission filings
  • Most recent investor conference presentations
  • Quarterly earnings news releases and conference calls
  • Calendar of events
  • Corporate Governance information

Additional Information

Humana is a Medicare Advantage HMO, PPO, and PFFS organization with a Medicare contract. Enrollment in a Humana plan depends on contract renewal. The benefit information provided is a brief summary, not a complete description of benefits. For more information, contact the plan. Limitations, copayments and restrictions may apply. Benefits, premium and member cost-share may change on January 1 of each year. You must continue to pay your Medicare Part B premium.

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