Humana Expands Relationship with Baylor and its New ACO

Humana’s Medicare Advantage health plan members will have broad in-network access to services provided by Baylor Health Care System beginning Dec. 15, 2012, in a new deal struck between the two parties. The agreement covers inpatient, outpatient, and emergency services provided by Baylor in Dallas, Tarrant, Denton, and Ellis counties.

Seniors and other eligible Medicare beneficiaries who enroll in a Humana Medicare Advantage HMO or PPO plan during the annual election period ending Dec. 7, 2012, will have in-network benefits during the 2013 plan year. Enrollees in Humana’s other commercial and individual plans already have such access.

According to a Humana press release, the agreement involves coverage at:

• 30 hospitals that are owned, operated, joint ventured or affiliated with Baylor Health Care System

• 26 ambulatory surgical/endoscopy centers

• 193 HealthTexas locations

• 83 satellite outpatient facilities – imaging, rehabilitation and pain

• 3 senior health centers

• 3 retail pharmacies

Humana also inked a deal with Baylor Quality Alliance, a recently launched ACO that includes 600 HealthTexas physicians and 900 independent physicians. The agreement, says Humana, “aligns incentives under a new contract structure that rewards physicians affiliated with Baylor Quality Alliance for improved quality and efficiency outcomes” for its Medicare Advantage members.

The insurer has about 200,000 Medicare Advantage members in Texas, along with 465,000 commercial plan members and 1.2 million specialty benefits policy holders.