Humana Inc. (NYSE: HUM), one of the nation’s leading health and well-being companies, distributed $60 million to physicians across the U.S. who participate in Humana’s Provider Quality Rewards Program.
Humana’s Provider Quality Rewards Program is part of Humana’s Accountable Care Continuum, which is a pay-for-value system focused on promoting evidence-based, high quality care. The program recognizes practice complexity by offering several levels of participation through pay-for-value programs including: Star Rewards, Model Practice, Medical Home and bonus programs for risk providers.
Humana recently announced its Star ratings for its Medicare Advantage (MA) plans. The company has 18 MA plans that achieved a rating of 4.0 stars or greater, a 50 percent increase in the number of 4.0 or greater rated plans from the previous year. Nine of the Humana plans achieved a 4.5 star rating.
Approximately 3,000 physician practices received payments from Humana in recognition of performance improvements their practices made during 2012 related to improved outcomes for Humana’s Medicare members. Reward settlement finalization takes place in 2013 for the 2012 Rewards Program to allow time for final claims submission and supplemental data.
“Humana’s Provider Quality Rewards Program has helped improve the health and well-being of our members,” said Dr. Roy A. Beveridge, Humana’s Chief Medical Officer. “By focusing our efforts around the primary care physician, we can help them transition from volume to value, where they are rewarded for improvements in patient outcomes, quality and costs.”
Humana’s 2012 payments to physician practices were based on the practices’ ability to improve quality for many National Committee for Quality Assurance (NCQA) preventive and chronic-condition management Healthcare Effectiveness Data and Information Set (HEDIS) measures including, but not limited to the following:
- Breast cancer screening
- Glaucoma screening
- Colorectal cancer screening
- Diabetes treatment management
- LDL control
- A1C control
- Nephropathy screening
- Diabetic retinal eye exam
- High risk medications
“The focus on improving quality through these pay-for-value programs will not only support more physician practices as they move into value-based relationships, but also help improve the member experience,” said Renee Buckingham, Humana’s Vice President of the Provider Development Center of Excellence.