Humana has developed episode-based models (EBM) for total hip or knee joint replacement and maternity episodes of care.

Total Joint Replacement Episode-of-care Model

In 2016, Humana developed its first episode-based model (EBM) for elective total hip or knee joint replacement (TJR) in select states. As of 2018, the program is available nationwide. 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 total joint replacement 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 total joint replacement EBM:

TJR EBM Training, PDF opens new window

TJR EBM Configuration Code Set, PDF opens new window

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 (MEBM). Highlights of the MEBM 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 physicians with sufficient perinatal 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 MEBM:

Maternity EBM Training, PDF opens new window

Maternity EBM Configuration Code Set, PDF opens new window

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 delivering physician(s) as the principal accountable provider(s) (PAPs) under one tax identification number (TIN)
  • Offer of voluntary participation to physicians with sufficient spinal fusion (lumbar and 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:

Spinal Fusion EBM Training, PDF opens new window

Lumbar Spinal Fusion Configuration Code Set, document opens new window

Cervical Spinal Fusion Configuration Code Set, document opens new window