Humana has developed episode-based models (EBM) for episodes of care related to total joint replacement (hip and/or knee), maternity, spinal fusion (lumbar and/or cervical) and coronary artery bypass grafting.
Total Joint Replacement Episode-of-care Model
In 2016, Humana piloted its first episode-based model (EBM) for elective total hip or knee joint replacement (TJR) in select states. The program has been available nationwide since 2018. Highlights of the TJR EBM include:
- Designation of the orthopedic surgeon(s) as the principal accountable provider(s) (PAPs) under one Tax Identification Number (TIN)
- Offer of voluntary participation to orthopedic surgeons with sufficient episode volume
- Exclusively for TJR episodes of patients with Humana Medicare Advantage (MA) health maintenance organization (HMO) or preferred provider organization (PPO) coverage
- Multiyear program with gain-share opportunity and an option to pursue risk sharing
Learn more about the total joint replacement EBM:
Maternity Episode-of-care Model
In 2018, Humana expanded its national episode-of-care programs into perinatal services and developed the maternity episode-based model (EBM). Highlights of the maternity EBM include:
- Designation of the delivering physician(s) as the principal accountable provider(s) (PAPs) under one Tax Identification Number (TIN)
- Offer of voluntary participation to obstetricians with sufficient episode volume
- Exclusively for perinatal episodes of patients with Humana commercial coverage
- Designed for perinatal episodes with low- to medium-risk pregnancies
- Multiyear program with gain-share opportunity and an option to pursue risk sharing
Learn more about the maternity EBM:
Spinal Fusion Episode-of-care Model
In 2019, Humana further expanded its national episode-of-care programs into spinal fusion services and developed the spinal fusion episode-based model (EBM). Highlights of the spinal fusion EBM include:
- Designation of the orthopedic surgeon(s) as the principal accountable provider(s) (PAPs) under one Tax Identification Number (TIN)
- Offer of voluntary participation to orthopedic surgeons with sufficient spinal fusion (lumbar and/or cervical) episode volume
- Separate programs for lumbar and cervical spinal fusions
- Exclusively for spinal fusion episodes of patients with Humana Medicare Advantage (MA) HMO or MA PPO coverage
- Multiyear program with gain-share opportunity and an option to pursue risk sharing
Learn more about the spinal fusion EBM:
Coronary Artery Bypass Grafting (CABG) Episode-of-care Model
In 2020, Humana added a national cardiac episode-of-care program and developed the coronary artery bypass grafting (CABG) episode-based model (EBM). Highlights of the CABG EBM include:
- Designation of the cardiothoracic surgeon(s) as the principal accountable provider(s) (PAPs) under one Tax Identification Number (TIN)
- Offer of voluntary participation to cardiothoracic surgeons with sufficient episode volume
- Exclusively for CABG episodes of patients with Humana Medicare Advantage (MA) HMO or MA PPO coverage
- Multiyear program with gain-share opportunity and an option to pursue risk sharing