- Humana announced a new value-based program that pays hospitals for improvements in quality metrics related to patient experience, safety and outcomes.
- Under the Hospital Incentive Program, participating hospitals will get compensation based on quality measures, including two certification program established by The Joint Commission, such as infection rates, palliative care and others.
- Separately, Blue Cross Blue Shield Association said doctors, hospitals and clinical care teams in its value-based Blue Distinction Total Care program outperformed other providers in 96% of quality measures tracked.
The programs reflect payer interest in and success with value-based care programs.
According to BCBS, Total Care providers had 10% fewer emergency department visits, 7% better HbA1c testing for diabetes patients, 5% better compliance with medications for patients with cardiovascular disease and 15% fewer hospitalizations year over year.
Total Care — which focuses on prevention and wellness, disease management and care coordination — also saw a 35% decline in costs versus nonparticipating providers, the organization said.
Currently, more than 19 million BCBS plan members receive care through the Total Care program, up 50% from the program’s launch in 2015.
Humana’s Hospital Incentive Program, which launched in January and targets inpatient admissions, builds on earlier value-based programs such as a total joint replacement episode-of-care model for primary and specialty care. The HIP is available to general acute care hospitals with active commercial contracts with Humana.
News of the program comes as Humana and other insurers are strengthening alliances with retail pharmacies. Earlier this month, The Wall Street Journal reported that Walmart is in early talks to acquire Humana. The companies already partner on Medicare Part D plans and a merger could boost Humana’s group market offerings to compete on the national stage with other major insurers.
Several other mega-mergers are also underway. CVS Health and Aetna’s $69 billion merger is expected to close in the second half of this year. Also on track to close this year is Cigna’s $67 billion purchase of Express Scripts.
And there is Amazon, J.P. Morgan and Berkshire Hathaway’s still-emerging plan to create a company to address rising healthcare costs for their employees.