Humana Names First Participants in Hospital-Improvement Program

Humana has selected the first four participating organizations in its hospital-improvement program, which focuses on general acute-care hospitals and ways to better integrate care for Humana members. The participating organizations include: Cleveland Clinic Florida; Jackson Health System in Florida; TriHealth in Ohio; and the WellStar Health System in Georgia.

The value-based program recognizes a hospital’s continuous-quality efforts via earned annual rate increases. The earned annual rate increase is based on a participating hospital’s performance in three key areas — patient experience, patient safety and patient outcomes — as determined by seven individually weighted, core measures that address the health care-associated infection rate, 30-day risk-adjusted readmission rate, care coordination, palliative care and more.

The insurer hopes that by focusing on more proactive and personalized care, such as giving consumers greater access to health screenings and providing more coordinated care for people living with chronic conditions, health outcomes will improve and costs will be reduced.

Where this improvement program stands apart, says Ben Lunsford, associate vice president of Humana’s value-based strategies, is its focus on acute-care inpatient hospital admissions, rather than primary care or specialty care services. “Many hospitals understand the importance of and embrace value-based care in the inpatient setting as it creates a more holistic and collaborative approach to care that physicians, patients and payers alike truly value. Pairing that focus with the opportunity for aligned incentives creates a win-win for the hospitals, patients and Humana,” Lunsford says.