Humana, Heritage partner on Medicare Advantage value-based care

Humana and Heritage Provider Network on Wednesday unveiled a new value-based agreement that will bring the physician-led care organization into Humana's Medicare Advantage network.

Members of Humana's Medicare Advantage HMO plans and dual-eligibles in several central and southern California counties will be able to select Heritage providers as their primary-care physicians, giving them access to the network's integrated healthcare system and more than 10,000 specialists. Heritage would take on that patient's coordinated care, from primary services to acute care.

"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," Heritage President and CEO Dr. Richard Merkin said in a statement.

In all, Humana has 70,300 Medicare Advantage members in California. It's unclear how many will use the Heritage partnership. Heritage serves more than 1 million patients in Arizona, California, Missouri and New York.

The value-based agreement was announced during Humana's open-enrollment period. While Humana wouldn't elaborate on the financial details of the agreement, the insurer's California Medicare president, Rick Beavin, told Modern Healthcare that the organizations believe they have "aligned the incentives to do what we both want to do."

"Our members that have been a part of value-based agreements, they have better quality outcomes than those members who receive care through your more traditional fee-for-service arrangement," Beavin said, citing the insurer's 2017 value-based care report. "They have fewer hospital admissions, fewer ED visits. To me, it's the right thing for us all to do."