Humana Launches Value-Based Orthopedic Specialty Care Model in Ohio

The new care model is designed to improve quality, outcomes and cost across a person’s entire joint replacement episode of care, and it financially rewards orthopedic surgeons for better outcomes. Humana will also provide the orthopedic practices with robust data and analytics needed to better manage all aspects of their patients’ care, from diagnosis to recovery. For the patient, this is expected to deliver a more coordinated care experience and reductions in readmission and complication rates.

The program is based upon the model of care standards developed for total joint replacement as part of the State of Ohio’s State Innovation Model (SIM) Grant through the Centers for Medicare and Medicaid Services (CMS). The grants provide funding and guidance to help transform the health care system from a fee-for-service model to a value-based system, which aligns health care provider incentives with quality measures and rewards better outcomes.

Humana will be working with Beacon Orthopaedics & Sports Medicine and Reconstructive Orthopaedics and Sports Medicine in Cincinnati; Orthopaedic Institute of Dayton, Ohio; Orthopaedic Associates of Zanesville, Ohio; and Wooster Orthopaedic & Sports Medicine Center in Wooster, Ohio.

Humana’s population health capabilities, including patient data and analytics as well as chronic disease-management and wellness programs, will complement the integrated care approach that each of the selected orthopedic specialists will employ with Humana members. The goal, according to Humana Vice President of Payment Innovation Chip Howard, is to place the orthopedic surgeon in the quarterback role of total hip or knee replacement procedures.

“The orthopedic surgeon is the key to creating more effective health care for patients undergoing total hip or knee replacement,” explained Howard. “Value-based care allows physicians to spend more time with patients, arms them with the tools they need to truly manage their patients’ health, and aligns the health care system to be more responsive to the people it serves.”

Howard says Humana will evaluate results from the Ohio program and plans to expand to other states if the new model generates the expected outcomes improvement, coordinated member experience and cost savings.

Humana has 30 years of experience partnering with primary care physicians in value-based/accountable care arrangements. In November 2015, the company released value-based care data indicating that patients cared for through value-based models experienced healthier outcomes and lower costs. Humana is now moving to apply the approach to specialties, such as orthopedics, where highly coordinated care supported by population health data has the ability to improve outcomes, lower cost and deliver a better health care experience for patients.

Humana has 1.6 million individual Medicare Advantage members and 200,000 commercial members today who are cared for by more than 45,000 primary care physicians, in more than 900 value-based relationships across 43 states and Puerto Rico. For more information, visit

About Humana

Humana Inc., headquartered in Louisville, Ky., is a leading health and well-being company focused on making it easy for people to achieve their best health with clinical excellence through coordinated care. The company’s strategy integrates care delivery, the member experience, and clinical and consumer insights to encourage engagement, behavior change, proactive clinical outreach and wellness for the millions of people we serve across the country.

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Humana Inc.
Jeff Blunt, 513-826-7094
Corporate Communications