Humana Launches Payment Model to Improve Patient Experience, Outcomes in Cancer Care

April 18, 2019

Humana has launched their Oncology Model of Care to improve patient experiences and outcomes for its Medicare Advantage and commercial members being treated for cancer.

Adding a new specialty care payment model to its portfolio, Humana has launched their Oncology Model of Care (OMOC) to improve patient experiences and outcomes for its Medicare Advantage (MA) and commercial members being treated for cancer. According to the insurer, the payment model is designed to provide more integrated and cost-effective care.

Under the model, Humana will offer financial incentives for providers to improve care for their patients based on measures that take into account access to care, clinical status assessment, and patient education. Practices will be evaluated on these quality and cost measures across several aspects of care, including inpatient admissions, emergency department visits, medical and pharmacy drugs, laboratory and pathology services, and radiology.

“With the field of oncology rapidly evolving, we’re very pleased to announce the launch of a quality-based program specifically focused on the delivery of cancer care,” said Bryan Loy, MD, MBA, corporate medical director of Humana’s Oncology, Laboratory, and Personalized Medicine Strategies Group, in a statement. “Humana is committed to providing physician support and working together to improve coordination across the continuum of care for our members with cancer.”

The model has kicked off with 16 participating practices, including several members of the US Oncology Network, Highlands Oncology Group, and Cancer Specialists of North Florida. According to Julie Royalty, the director of oncology and lab strategies at Humana, the insurer has paid each practice a care coordination fee to help them implement the reporting requirements and infrastructure under the model. Practices will be evaluated over a 1-year period and Humana will meet with the practices twice a year to go over metrics and performance.

OMOC marks the fourth specialty care payment program for Humana. The insurer also has bundled payment models for spinal fusion surgeries, total hip or knee joint replacement procedures, and maternity outcomes and cost.

These types of payment models have gained traction in recent years with the continued shift toward value-based care. While CMS continues to work with practices under the voluntary Oncology Care Model, HHS Secretary Alex Azar indicated that the administration will revisit mandatory payment models in oncology care, including radiation oncology. However, although organizations have expressed excitement for additional payment models, they have also expressed concern with the models being mandatory from the start.