New national value based treatment programme in USA


Humana has expanded its value-based programme portfolio with the creation of two national programmes for customers with Humana Medicare Advantage plans.

Humana’s Coronary Artery Bypass Grafting (CABG) Episode-Based Model provides coordinated care for those undergoing heart bypass surgery. The CABG model is being used in six hospitals.

CABG is a cardiac procedure performed on patients with coronary artery disease in which arteries are narrowed or blocked due to plaque build-up. The procedure involves grafting a separate artery or vein, typically from the patient’s chest wall or leg, to the obstructed artery, circumventing the blocked portion and routing blood flow to the heart.

Humana also has a new orthopaedic payment programme for customers undergoing total shoulder arthroplasty (shoulder replacement). The surgery is typically for people with arthritis or rotator cuff problems.

The Total Shoulder Specialist Rewards Programme provides clinicians with data and analytics, and offers the opportunity for additional payment for achievement of two programme goals. One goal is better health outcomes. The other is lower cost derived from site of care selection, which incentivises independent surgeons to perform shoulder replacement procedures at ambulatory surgical centres when clinically appropriate. Six clinics are on the programme.

Humana already has similar programmes for total hip and knee joint replacement surgeries, and for spinal fusion procedures.



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