Cost And Payments: Bundled Payments Article
Breaking down Humana’s bundled program
Delivering efficient and effective care to patients is the simple idea behind Humana’s value-based bundled programs. While the focus of value-based care delivery may be on primary care, the bundles program recognizes the critical role specialists play in patient well-being.
Humana’s bundled payments are retrospective, episodic, total cost-of-care models that offer value-based opportunities to specialists. These care arrangements focus on reducing costs across a patient’s entire episode of care while, at the same time, maintaining or improving quality outcomes.
They offer physicians the opportunity to share in the savings they create with no risk obligation. Simply stated, if the episode cost of care is below the allotted amount, the practice shares in the savings. If it’s above, the practice incurs no financial penalty. In 2021 Humana’s bundle physicians saw considerable success integrating a value-based structure as 83% of bundle participants received shared savings.
Humana’s bundles encompass 4 different programs: total joint replacement (TJR), spinal fusion (cervical and lumbar), coronary artery bypass grafting (CABG) and maternity. TJR, spinal fusion and CABG bundles are Medicare Advantage-only offerings, and maternity is commercial only. TJR continues to represent Humana’s largest bundled payment effort, accounting for more 70% of total participants.
While bundled programs help manage costs, the quality of care delivered by physicians working in a bundle structure provides considerable benefits to their patients, both short- and long-term. Those receiving care from a TJR-participating physician in 2021 experienced a 15% lower readmission rate within 30 days of surgery and saw fewer common complications — 5% fewer incidences of deep vein thrombosis/pulmonary embolisms, 10% fewer dislocations and fractures and 19% fewer wound infections.
This is indicative of participating specialists developing expertise around how to refine their approaches to best manage total episodes of care and leverage support from an integrated care team.
Humana’s local value-based care teams work closely with physician practices to overcome barriers and share actionable patient data that helps physicians identify opportunities best suited for their patients. More than 80% of 2021 participants electronically accessed the comprehensive reporting regularly made available to them.