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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;
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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;
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Suggestions to motivate small practices or practices with smaller patient panels to engage in Triple Aim-focused care coordination;
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Characteristics of high-functioning physician practices and strategies for succeeding under a full accountability reimbursement structure;
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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
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Physician Quality Rewards for Population Health Management
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Defining Population Health
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Humana’s 4-Tiered Accountable Care Continuum
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Patient Experience Ratings
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Value-Based Full Accountability
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Program Outcomes and Results
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Q&A: Ask the Experts
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Engaging Community Physicians
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Managing PCP-Specialist Interactions
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ACO Medical Care Management Responsibilities
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Risk in ACO Reimbursement Strategies
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Humana at Home Program
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Motivating Smaller Providers
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Participation Across Care Continuum
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Fee-for-Value Support and Training
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Sharing Population Data
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Engaging Physicians in Triple Aim Initiatives
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Preparing for Medicare Chronic Care Management
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Characteristics of High-Functioning Physician Practices
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Cost Improvements for Chronic Patients
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Support and Training
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Role of Care Coordination
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Glossary
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For More Information
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About the Contributor
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