Humana’s Episode-based Models
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). 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.
In 2017, Humana expanded the TJR EBM into four additional states and continues to scale into other markets.
Find more information about the total joint replacement episode-based model:
- Humana’s TJR EBM training
- TJR EBM program details: