Summit and Humana Announce Accountable Care Agreement for Medicare Advantage Members in East Tennessee

Accountable care is a fast-growing model for health care service delivery and health care provider payment. The model focuses on creating health in addition to treating sickness, utilizes the primary care physician to coordinate care for the patient, offers treatment options based on proven standards of care, and better controls costs through integrated care and reimbursement based on adherence to standards of care. 

Summit is East Tennessee’s leading primary care organization with a physician-directed care coordination program that works with Summit patients who have Humana Medicare Advantage to arrange and coordinate medical services. Some of the activities performed include:

Perform individual assessments to understand patient’s needs;

Provide assistance with transportation or caregiver support;

Help those with chronic illnesses, such as diabetes, asthma and heart failure, to learn to manage their illnesses in order to achieve better health;

Identify programs that help patients reduce the costs of services;

Help patients set goals and solve problems for improved self-management;

Apply evidence-based strategies to reduce complications, optimize disease control and assist patient well-being.

On top of this, Humana offers members an array of health and wellness programs including health coaching, disease management services, and mail order and specialty pharmacy services.  Humana also offers physicians a host of powerful analytics tools including real-time identification of gaps in care at the point of service.

“As a Medicare enrollee’s needs become more complex, the number of needed services and service providers increases,” said Tim Young, Summit Medical Group Chief Executive Officer. “This is when Summit’s Care Coordination staff can intervene and act as the facilitator for the patient, family and the physician, ultimately increasing quality of life and containing costs associated with aging.”

Humana, one of the country’s leading health and well-being companies, has quickly grown its membership here in recent years.  Humana has become a strong national accountable care player in recent years by working closely with doctors and hospitals through its Accountable Care Continuum. The continuum is a stepped approach to pay-for-value reimbursement that allows Humana to implement different accountable care approaches with physicians based on each groups’ practice complexity and infrastructure capabilities.

“Humana offers highly rated Medicare Advantage plans, with STAR ratings second to none in East Tennessee,” Young said. “We’ve long had a strong relationship with Humana and now we’re further enhancing it by entering into a contractual partnership through which Summit will provide clinical services for participants in Humana’s Medicare Advantage products.”

The new seven-year agreement becomes effective January 1, 2015 and includes pay-for-results incentives based on improved clinical outcomes, a better patient experience and reduced costs. The value-based arrangement emphasizes quality outcomes with a focus on care coordination and leverages measures as defined by the National Committee for Quality Assurance (NCQA) Healthcare Effectiveness Data and Information Set (HEDIS) like diabetes care and treatment, breast cancer screenings, colorectal cancer screenings and high-risk medication.

“Summit’s vision for coordinated care and a better patient experience is so closely aligned with our own, it makes them a perfect partner to create a better care delivery system for Medicare members in East Tennessee,” said Doug Haaland, Humana’s Regional President for Senior Markets in Tennessee. “These kinds of partnerships are changing the nature of care delivery and reimbursement, and they’re how we’re going to create a health system that closes the gap between health and care.”

Humana has a 26-year accountable care relationship history with more than 1.2 million members that are cared for by 38,000 primary care physicians, in more than 900 Accountable Care relationships across 43 states and Puerto Rico.