Humana Medical Home Program

Description: 

This program is offered to practices that are either patient-centered medical home (PCMH) certified or in the certification process. These practices must meet HEDIS and clinical initiative targets and have made progress addressing some of the requirements necessary to transform their practice in order to become successful population health managers. For example PCMH program participants have implemented electronic medical records and likely use electronic prescribing systems. Additionally, they have made other infrastructure changes, including the use of a care coordinator in the practice. This program offers a care coordination fee to address the cost of infrastructure development and PCMH certification.  

Payment Model: 

This program offers a care coordination fee to address the cost of infrastructure development and PCMH certification.

Fewer ED / Hospital Visits: 
  • 7% fewer emergency room visits
  • 4% fewer inpatient admissions 
Improved Health: 
  • Results show that ACO providers under a value-based reimbursement model had an average HEDIS Star score of 4.25 compared with providers not in an ACO, who averaged 3.65.
Cost Savings: 
  • Overall Humana's Medicare Advantage ACO reduced costs by 19% 
Increased Preventive Services: 
  • 8% increase in providing medication reviews for older patients
  • 16% increase in screening osteoporosis management in women with fractures
  • 7% increase in colorectal cancer screening
  • 5% increase in adult BMI assessment 
  • "Other screening compliance improvements included cholesterol control, eye exams and diabetic blood sugar (up 7%), and cholesterol screening for cardiovascular care (up 5%)"
Last updated December 2014
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