- Humana is launching a national oncology payment model for its Medicare Advantage and commercial customers. Under the new value-based program announced Tuesday, the payer is partnering with physician groups across the U.S. to in an effort to coordinate cost-effective cancer care.
- The model is Humana's fourth specialty-care payment model. It financially rewards providers for exceeding certain quality benchmarks over a one-year period. Sixteen practices are participating in the inaugural test of the model, which began in January across 11 states.
- The Louisville, Kentucky-based insurer has sold episode-based MA programs for total hip and knee joint replacements or spinal fusion procedures since 2016 and March 2019, respectively, along with a maternity episode-of-care bundled payment program for commercial members since April 2018.
Specialty care payment programs are an offshoot of the larger push to value-based care rippling across the industry. Payers, including CMS, are increasingly turning away from traditional fee-for-service payments and toward bundled and capitated payment models to foster high-quality, low-cost care.
The Center for Medicare and Medicaid Innovation, CMS' innovation arm, is currently testing an episode-based oncology payment model around chemotherapy treatment in Medicare and commercial plans. Under the program, called the Oncology Care Model, physician practices aim to provide highly coordinated cancer care at equal or lower cost to Medicare.
HHS Secretary Alex Azar also teased a CMS mandatory payment model for Medicare cancer patients in November. Though nothing concrete has materialized, oncologists lashed out against any changes to one of the most expensive service lines in healthcare — especially if those changes are mandatory.
All providers, not just oncologists, are wavering in their support of risk-based models. Though a majority agree they're important, many providers drop out of value-based programs before they're forced to assume downside risk, according to a Government Accountability Office report published earlier this year.
Humana's oncology model is structured to combat some of those worries, offering technology and data analytics to help providers manage patients and organize care. Participating providers will receive an increase in compensation for improving treatment over one year across a slew of care components — including inpatient admissions, emergency room visits, medical and pharmacy prescriptions, laboratory and pathology services and radiology — as determined by quality metrics.
"With the field of oncology rapidly evolving, we're very pleased to announce the launch of a quality-based program specifically focused on the delivery of cancer care," Bryan Loy, Humana's corporate medical director of oncology, laboratory and personalized medicine strategies, said in a statement.
The large insurer introduced a payment program in April that incentivizes hospitals to improve patient experience, safety and outcomes. The Hospital Incentive Program is available to general acute care hospitals with active commercial contracts with Humana, and added four additional participants in December.
Humana had a strong Q4, mostly driven by a surge in MA membership, and is on solid footing to advance more value-based care initiatives. More than 2 million of Humana's 3.6 million MA members were in value-based care arrangements at the end of last year, according to the company, along with about 115,000 commercial members.