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Physician Value-Based Reimbursement: Quality Rewards for Population Health
Physician Value-Based Reimbursement: Quality Rewards for Population Health
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With more than a quarter-century of experience with value-based reimbursement models, Humana is ideally positioned to help physician practices navigate the transition from fee for service to fee for value.

The payor's multi-level Accountable Care Continuum rewards physician practices for care coordination of Medicare beneficiaries along the population health spectrum.

Physician Value-Based Reimbursement: Quality Rewards for Population Health describes the four tiers of Humana's Physician Quality Rewards program as well as the support, training, technologies and outcomes associated with these pay-for-value relationships.

In this 25-page resource, Chip Howard, Humana's vice president of payment innovation in the provider development center of excellence, breaks down the payor's value-based approach supporting physician practices in their mastery of population health management.

In 2014, Humana paid $76.8 million in rewards payments to provider practices that participated in the quality rewards program in 2013.

In Physician Value-Based Reimbursement: Quality Rewards for Population Health, Howard reviews the following:

  • Four quadrants of Humana's population health approach;
  • The four tiers of Humana's Accountable Care Continuum;
  • Snapshots of population health interventions keeping Humana members healthy at home and out of the hospital, such as the "Humana At Home" program, "Transitions" program, telephonic case management, and others;
  • Tactics for engaging physicians in quality-based population health initiatives that result in financial rewards;
  • Impact of the Physician Quality Rewards initiative on NCQA HEDIS® scores, emergency room visits, inpatient admissions, 30-day readmissions, clinical management, screening compliance, and patient experience ratings;
  • Comparison of population health outcomes within Humana's primary care-centric model versus results from non-accountable care settings;
  • Suggestions to motivate small practices or practices with smaller patient panels to engage in Triple Aim-focused care coordination;
  • Characteristics of high-functioning physician practices and strategies for succeeding under a full accountability reimbursement structure;
  • Blueprint for future engagement of specialists in population health management;
and much more, including support and training for each of the four Physician Quality Reward levels, and the contribution of care coordination in Humana's value-based models.

Table of Contents

  • Physician Quality Rewards for Population Health Management
    • Defining Population Health
    • Humana’s 4-Tiered Accountable Care Continuum
    • Patient Experience Ratings
    • Value-Based Full Accountability
    • Program Outcomes and Results
  • Q&A: Ask the Experts
    • Engaging Community Physicians
    • Managing PCP-Specialist Interactions
    • ACO Medical Care Management Responsibilities
    • Risk in ACO Reimbursement Strategies
    • Humana at Home Program
    • Motivating Smaller Providers
    • Participation Across Care Continuum
    • Fee-for-Value Support and Training
    • Sharing Population Data
    • Engaging Physicians in Triple Aim Initiatives
    • Preparing for Medicare Chronic Care Management
    • Characteristics of High-Functioning Physician Practices
    • Cost Improvements for Chronic Patients
    • Support and Training
    • Role of Care Coordination
  • Glossary
  • For More Information
  • About the Contributor
Publication Date: February 2015
Number of Pages: 25
ISBN 10: 1-941329-58-6 (Print version); 1-941329-59-4 (PDF version)
ISBN 13: 978-1-941329-58-0 (Print version); 978-1-941329-59-7 (PDF version)
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