News: Humana launches value-based hospital compensation program

CMS has paid hospitals based on the quality of care they provide for several years and, as mentioned in the note from the instructor and last week’s news brief, now and the agency is now looking to cut back on those quality care measures. Other insurers, however, are jumping onto the value-based reimbursement bandwagon. Recently, Humana, Inc. launched a value-based Hospital Incentive Program (HIP) that will pay general acute care hospitals more money for delivering on key quality and efficiency metrics, HealthLeaders Media reported.

The new nationwide program is designed to encourage more integrated care, reduce duplicative services, readmissions, and complication rates in acute care inpatient settings, much like its CMS predecessor.

HIP will base compensation on quality improvements in three areas:

• Patient experience
• Patient safety
• Patient outcomes

The program is voluntary and open to hospitals with an active commercial contract with Humana, HealthLeaders Media reported.

Within the three core areas of focus are seven individually weighted measures totaling 100% of the eligible incentive, recognizing the hospital's continuous improvement efforts via earned annual rate increases. Healthcare-associated infection rates, care coordination, and palliative care metrics will help gauge the improvements, and the program will incorporate two care certification programs developed by The Joint Commission.  

“This program expands Humana’s reach in value-based care as we broaden our efforts to provide a better experience for our members and help them achieve their best health,” said Caraline Coats, vice president of Humana's Provider Development Center of Excellence.

Humana said that HIP is the latest addition to its commitment to value-based care, which emphasizes:

• Personal time with clinicians and personalized care
• Access to proactive health screenings and preventive services
• Improved care for the chronically ill
• Using technologies, such as data analytics, that connect physicians and coordinate care
• Reimbursement to physicians linked to the patient outcomes rather than fee-for-service

“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,” Humana said in their announcement. “Pairing that focus with the opportunity for aligned incentives creates a win-win for the hospitals, patients, and Humana.”

Editor’s note: This article originally appeared in HealthLeaders Media. For information regarding CDI’s role in reporting for quality measures, click here.