Humana, Inc. is expanding its value-based program portfolio with the upcoming launch of the Primary Care First (PCF) model for certain Humana Medicare Advantage plans in the 48 contiguous states and Washington, D.C. Participation will be open to primary care groups currently in-network for Humana Medicare Advantage Preferred Provider Organization (PPO) and Health Maintenance Organization (HMO) plans and that have more than 125 Humana members aligned to the group. Humana plans to launch the PCF model on July 1, 2021. Each month, the participating PCF primary care professionals will receive a prospective capitated payment, which takes into account achievement of quality and outcomes-based measures.

The PCF model was established by the Innovation Center at the Centers for Medicare & Medicaid Services (CMS) to encourage primary care practices to shift to value-based care and test whether this new payment model will improve quality and reduce costs in Original Medicare. As a newly-approved CMS payer partner– and the only insurer to offer its own version of the PCF model in all 48 contiguous states and Washington, D.C. – Humana will offer a similar model to qualifying primary care groups currently in-network for Humana Medicare Advantage Preferred Provider Organization (PPO) and Health Maintenance Organization (HMO) plans.

Two-thirds of Humana’s individual Medicare Advantage (MA) members seek care from primary care physicians with some form of a value-based care agreement with Humana. In 2019, Humana MA members who sought care from physicians in value-based care arrangements experienced fewer hospital admissions and ER visits when compared to consumers in Humana MA non-value-based arrangements.

Humana has an extensive and growing value-based care presence. As of September 30, 2020, Humana has more than 2.7 million individual Medicare Advantage and commercial members cared for by more than 67,000 primary care physicians in more than 1,000 value-based relationships across 43 states and Puerto Rico. Humana’s total Medicare Advantage membership is more than 4.5 million members, which includes members affiliated with value-based and standard Medicare Advantage settings.

This was reported by Humana on December 10,2020.

Contact Information: Humana, Inc., 500 West Main Street, Louisville, Kentucky 40202; 800-486-2620; Website: www.humana.com