Episode-Based Models

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:

Maternity Episode-of-care Model

In 2018, Humana expanded its episode-of-care programs into perinatal services and developed the Maternity Episode-of-care Model (MECM). Highlights of the MECM include:

  • Designation of the delivering physician(s) as the principal accountable provider(s) (PAPs) under one tax identification number (TIN).
  • Multiyear program with gain-share opportunity and an option to pursue risk sharing
  • 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

Learn more about the MECM: