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Accountable Care Continuum

Value-based reimbursement is the foundation on which we developed our accountable care continuum (202 Kb) - physicians are paid based on patient health outcomes and experiences instead of receiving fee-for-service reimbursement. Value-based reimbursement offers financial rewards for improvements in outcomes, quality and cost.

The continuum recognizes practice complexity by offering several levels of participation in Humana's Provider Quality Rewards Program, including Star Rewards, Model Practice and Medical Home.

In 2014, Humana paid $77.2 million to physicians participating in the program, in addition to their normal reimbursements.

"The continued success of Humana's Provider Quality Rewards Program reflects the importance of providing physicians support as they embrace a value-based model of care," said Roy A. Beveridge, M.D., Humana's chief medical officer. "The holistic approach to patient care, which is driven by value-based models, not only helps primary care physicians focus on the total health of their patients, but also reflects the importance of moving from sick care to health care."

Hear from doctors (link opens in new window) who have made the transition from sick care to healthcare.

Humana Star Rewards Program

Humana's Star Rewards Program is an integral part of Humana's accountable care continuum. As the first level of our pay-for-value programs, the Star Rewards Program focuses on achievements for specific National Committee for Quality Assurance (NCQA) Healthcare Effectiveness Data and Information Set (HEDIS®) measures. The Star Rewards Program provides an annual reward payment to physicians who meet four of five HEDIS metrics. Humana-contracted primary care physicians (PCPs) may participate in Humana's Star Rewards Program unless contracted for Humana’s Model Practice, Medical Home or Shared Savings programs. Physicians contracted in full-value arrangements as of Dec. 31, 2016, are not eligible for Star Rewards.

Participating PCPs serving 250 or more Humana members are eligible to participate in Humana's Model Practice and Medical Home Programs.

Model Practice Rewards program

The next level on the continuum is our Model Practice Program. Physicians earn incentives for each HEDIS measure they achieve. Additionally, physicians can earn incentives for achieving specific clinical initiative targets. They receive reward payments for achievements on a quarterly basis and also are eligible for shared-savings opportunities. Physician practices that see at least 70 percent of their patients two or more times a year will receive an additional annual bonus. This is a program for Humana-contracted physicians.

Medical Home Program

The next level of Humana's rewards programs is the Medical Home Program. This program is offered to practices that are certified as a patient-centered medical home (PCMH) or are in the certification process. These practices have made progress in addressing some of the requirements necessary to become successful population health managers. For example, PCMH program participants have implemented electronic medical records and likely use electronic prescribing systems. Additionally, they have made other infrastructure changes, including the use of a care coordinator in their practices.

Medical Home Program participants have the same reward measures as a model practice. However, the medical home program offers a care coordination payment to address the cost of infrastructure development and PCMH certification. To remain eligible for the care coordination fee, practices must meet the reward measures on a quarterly basis. Participating PCPs with 250 or more members who are medical home-certified or are in the process of becoming certified may be eligible to participate in Humana’s Medical Home Program. This is a program for Humana-contracted physicians.

For more information about our rewards programs, contact your Humana representative or send an email to providerengagement@humana.com.