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;

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