Humana Launches Oncology Model to Reward Integrated Care

April 2019 ~

Humana has announced plans to launch a value-based oncology program, with the intention to reward providers for more integrated cancer care for Medicare Advantage and commercial members.

The insurer says it plans to provide compensation based on an incremental evaluation of the quality and cost in several key areas: inpatient admissions; emergency room visits; medical and pharmacy drugs; laboratory and pathology services; and radiology. State providers will get analytics and compensation determined by metrics on access to care, clinical status assessments, and patient education.

Humana states its Oncology Model of Care (OMOC) initiative has been designed to reward integration of care that results in better outcomes and lower costs, the basis of value-based care. The newly designed specialty-care payment programs emphasize more personal time with health professionals and personalized care; access to proactive health screenings and programs that are focused on preventing illness; improved care for people living with chronic conditions with a focus on avoiding health complications; leveraging technologies, such as data analytics, that connect physicians and help them work as a team to coordinate care around the patient; and reimbursement to physicians linked to the health outcomes of their patients rather than on the quantity of services they provide.

“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 Dr. Bryan Loy, corporate medical director of Humana’s Oncology, Laboratory, and Personalized Medicine Strategies Group. “Humana is committed to providing physician support and working together to improve coordination across the continuum of care for our members with cancer.”

The OMOC program’s inaugural practices are:

  • Southern Cancer Center, Alabama;
  • Arizona Oncology Associates;
  • Highlands Oncology Group, Arkansas;
  • Cancer Specialists, North Florida;
  • Baptist Health Medical Group and St. Elizabeth Healthcare, Kentucky;
  • Pontchartrain Cancer Center and Slidell Memorial Hospital Physicians Network, Louisiana;
  • Michigan Healthcare Professionals;
  • Minnesota Oncology;
  • Comprehensive Cancer Centers of Nevada;
  • TriHealth and University of Cincinnati Physicians Company, Ohio;
  • The Center for Cancer and Blood Disorders, The START Center for Cancer Care, and Texas Oncology.


Source(s): Humana; Healthcare Finance News; HealthcareDIVE;