Doctors reviewing files

Payment models

Humana recognizes that each physician’s need is different, that every practice is unique. We listen to physicians and other healthcare professionals, and we understand there are many factors that can affect their readiness to transition to a value-based care model. Awareness of these differences drove the design of our value-based continuum.

Our value-based care continuum is tailored for primary care physicians (PCPs) who are focused on increasing their population health management capabilities. As a PCP increases these capabilities, he or she gains additional opportunities to advance along the continuum.

Star Rewards program

The Humana Star Rewards program is an integral part of Humana’s value-based continuum. As the first level of our pay-for-value programs, the Star Rewards program focuses on achievements for specific quality measures. The 2018 Star Rewards program provides incentives to PCPs who meet six out of nine quality metrics. Practices that meet these metrics receive an annual rewards payment. Participating Humana PCPs who are in good standing automatically receive an invitation to participate in our Star Rewards program (unless they are already contracted for Humana’s Model Practice, Medical Practice or Shared Savings programs). Physicians contracted in a full-value arrangement at the end of the reporting period are not eligible for Star Rewards.

Model Practice program

The second level on the continuum is our Model Practice program. Physicians earn incentives for each quality metric they meet. Additionally, groups can earn incentives for meeting specific clinical initiative targets. Rewards for achievements in the Model Practice program are paid out on a quarterly basis. Physician practices that see at least 75 percent of their attributed patients two or more times a year will receive an additional annual bonus. Participating PCPs with 250 or more Humana-covered patients are eligible to participate in Humana’s Model Practice program. This is a Humana-contracted program.

Medical Home program

The next level of Humana’s value-based care continuum is the Medical Home program, which is offered to practices that are either patient-centered-medical-home (PCMH) recognized or in the process of gaining recognition. These practices have taken certain steps necessary to ensure they fulfill the role of 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 using a care coordinator in the practice.

Medical Home program participants have the same quality measures to meet as those in the Model Practice program. However, the Medical Home program offers a per-member-per-month (PMPM) payment for providing necessary care coordination services to achieve quality metrics and maintain PCMH certification. To remain eligible for the care coordination fee, practices must complete the reward measures on a quarterly basis. Participating PCPs with 250 or more Humana-covered patients 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.

Full Value program

Humana’s Full Value model offers shared savings opportunities, with physicians taking full accountability and managing a patient’s total cost of care with a set capitation.

Additional opportunities include a global arrangement in which the physician is 100 percent accountable for the surplus or deficit related to a patient’s total cost of care. Global arrangement offers potentially higher compensation for taking on increased accountability.

The Full Value model and global arrangement opportunity require a broad set of capabilities (technology and infrastructure) and is the most advanced model within our value-based continuum.

Episode-based models

Humana developed its first episode-based models (EBMs) for total joint replacement (TJR) in Ohio’s and Tennessee’s TJR programs.

Visit our episode-based models page to learn more about the program and the states into which we are expanding.