Humana is working with physician-led care organization Heritage Provider Network on a value-based care agreement for the health insurer’s Medicare Advantage members in Southern and Central California.
Under the terms of the deal, select Humana Medicare Advantage HMO plan and dual-eligible members in the region will have in-network access to Heritage Provider Network’s facilities and physician practices including Bakersfield Family Medical Center, Desert Oasis Health Care, Coastal Communities Physician Network and High Desert Medical Group.
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On the other end, Heritage is able to widen its prospective pool of patients and take advantage of Humana’s technology tools, real-time data and support staff for better care coordination from primary to acute care.
Michael Abrams, managing partner of healthcare consultancy Numerof & Associates, said that provider organizations have generally struggled for profitability under traditional Medicare due to administrative burden and care processes that didn’t fit with outcome-based care models.
Louisville, Kent.-based Humana has signed a number of value-based partnerships with provider organizations like University of Chicago Medicine and Iora Health for Medicare Advantage members.
The growing popularity of payer-provider collaborations in Medicare Advantage gives more flexibility in innovation around care coordination and treatment design lowering the barrier of entry to value-based care.
“Medicare Advantage collaborations like this one have been serving as a pathway for provider organizations to enter into a value-based arrangement with less trepidation,” Abrams said in an email.
Heritage, based in Marina del Rey, Calif., features a network consisting of 3,600 primary care physicians and 10,000 specialists.
“Working with Humana brings together two highly respected, experienced organizations committed to providing better care, better health and lower costs,” Heritage’s CEO and president Richard Merkin said in a statement.“
“We will be able to coordinate care needs across our entire system and tailor healthcare services proactively that will bring added value to Humana Medicare Advantage members by increasing their access to healthcare services in all of our medical provider groups throughout Southern and Central California, creating a robust care network.”
Humana has been growing its presence in the Medicare Advantage space with approximately two million individual Medicare Advantage members in 2018, and around 70,000 members in California.
The company said that the partnership with Heritage will provide patients with more personalized care from clinicians, access to preventative health programs and data analytics for care coordination.
“We are excited to offer our southern California Medicare Advantage members additional access to value-based care through our new relationship with Heritage,” Humama’s California Medicare President Rick Beavin said in a statement.
“By working together with Heritage, we are able to better serve Humana Medicare Advantage members and offer them high-quality care with the goal of improving their health and well-being.”
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