Humana Launches National Value-Based Model for Maternity Care

Leading health and well-being company Humana Inc. is teaming up with OB-GYN practices to launch a national, value-based care maternity bundled payment model for Humana commercial group members with low-to-moderate-risk pregnancies.


Humana’s Maternity Episode-Based Model is designed to improve quality, outcomes, and cost across a member’s entire perinatal episode of care – involving the mother’s prenatal, labor and delivery, and post-delivery care and financially incentivizes OB-GYNs who achieve better outcomes. Humana provides robust data and analytics designed to enhance patient care; deliver a more coordinated care experience; and reduce duplicative services, readmissions, and complication rates.

Humana’s inaugural maternity bundled payment agreements are with five voluntarily-participating practices: Ob/Gyn Associates of Southern Indiana (Indiana); Mid America Physician Services (Kansas); Seven Hills Women’s Health Centers and TriHealth (Ohio); and Consultants in Women’s Health (Texas).

“Because quality maternity care is important for many of our members and a significant focus of specialty care services in our country, we’re very pleased to launch Humana’s newest specialty-care bundled payment model,” said Caraline Coats, Vice President of Humana’s Provider Development Center of Excellence. “Humana is dedicated to working with OB-GYNs across the country to provide a better patient experience and improve patient outcomes, while also tackling the cost challenges inherent in perinatal care.”

The maternity payment model is Humana’s second specialty-care payment model, following its total joint replacement episode-based model for Humana Medicare Advantage members undergoing total hip or knee joint replacement procedures. Since its launch in 2016, that program has expanded its footprint and is now offered at approximately 40 orthopedic groups in 13 states across America.

Specialty-care bundled payment programs are part of Humana’s longstanding commitment to value-based care, which emphasizes:

  • More personal time with health professionals and personalized care that is tailored to each person’s unique health situation;
  • Access to proactive health screenings and programs that are focused on preventing illness;
  • Improved care for people living with chronic conditions with a focus on avoiding health complications (watch Humana’s “Better Chronic Management Through Value-Based Care” video);
  • Leveraging technologies, such as data analytics, that connect physicians and help them work as a team to coordinate care around the patient; and
  • Reimbursement to physicians linked to the health outcomes of their patients rather than solely on the quantity of services they provide (fee-for-service).

Humana has an extensive and growing value-based care presence. As of December 31, 2017, Humana has 1.9 million individual Medicare Advantage members and approximately 140,000 commercial members who are cared for by 52,000 primary care physicians in more than 1,000 value-based relationships across 43 states and Puerto Rico. Humana reached its 2017 calendar year goal of having 66 percent of Humana’s 2.9 million total individual Medicare Advantage members seeing primary care physicians in value-based payment relationships. Humana’s total Medicare Advantage membership is approximately 3.3 million members, which includes members affiliated with providers in value-based and standard Medicare Advantage settings. For more information, visit humana.com/valuebasedcare.

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