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Humana Health Plan of Texas uses the Consumer Assessment of Healthcare Providers and Systems (CAHPS®) survey to help assess its performance in satisfying members' needs. Separate surveys are conducted for HMO/POS plans and PPO plans. The 2007 results identified successes and opportunities for improvement in both plan types. The 2007 survey marked the first year that Humana used the new CAHPS format, known as CAHPS 4.0. CAHPS 4.0 was designed to be more flexible, more useful for improving quality and more specific to health plans' responsibilities. The revised structure includes a shorter core questionnaire and an array of supplemental item sets. The new survey also includes items that can be used to generate the specific and detailed data required for quality improvement. The CAHPS 4.0 survey covers a variety of areas, including the following:
The Austin market conducted the 2007 survey with HMO/POS members. In the HMO/POS survey, the results showed significant improvements over the 2006 survey results in the following areas:
The HMO/POS survey also identified the following areas for improvement:
The PPO survey was conducted statewide. The Texas results showed strength in "How Well Doctors Communicate." More than 95 percent of all respondents said their doctors explain things in an understandable way, and 96 percent said their doctors show respect for what they say. The PPO survey also identified the following areas for improvement:
Humana analyzes the survey results annually to identify opportunities to impact member satisfaction in areas such as customer service and claims processing. Physicians are asked to share these results with their office staff and discuss strategies to improve member satisfaction, particularly in the areas highlighted for improvement. For more information on the 2007 CAHPS results for Humana's Austin market, contact Kathie Bacque at kbacque@humana.com or (502) 338-6120. CAHPS is a standardized consumer survey that evaluates plan performance in areas such as customer service, access to care and claims possessing. CAHPS is sponsored, supported and maintained by the NCQA. For more information about CAHPS, visit www.cahps.ahrq.gov/default.asp. HEDIS Reviews Begin Next Month The 2008 Healthcare Effectiveness Data Information Set (HEDIS) medical records data abstraction process will begin in March and continue through June 2008. The National Committee for Quality Assurance (NCQA) requires the use of HEDIS data to measure compliance for certain prevention services, such as childhood immunizations, colon cancer screening and comprehensive diabetes care. During the 2008 review, Humana Health Plan of Texas quality management nurses will perform medical record data abstraction. Before conducting any on-site review, Humana nurses will contact physician offices to schedule a visit. Humana may also request copies of chart components via mail or fax for off-site review. Please be aware that Humana's role is defined and covered by the Health Insurance Portability and Accountability Act (HIPAA) of 1996. As defined by HIPAA, Humana's role is as a "Covered Entity." As such, Humana is required to protect, preserve and maintain the confidentiality of any Protected Health Information (PHI) it gleans from clinical records. Remember that the findings of these reviews reflect the overall health plan's percentage of compliance with each measure, not that of an individual office. When the reviews are completed, overall HEDIS results will be available by contacting Kathie Bacque, Humana's Austin market quality management director, at kbacque@humana.com or 502-338-6120. Humana Active Outlook Available to Humana Medicare Members Humana Active OutlookSM is a lifestyle enrichment program that provides Humana's Medicare members with active living programs that address the physical, psychological and social aspects of healthy aging. The program is available at no additional cost to Medicare Advantage members. Humana Active Outlook provides information on optimal living and the essentials of health and well-being through the following modules:
Humana Active Outlook members receive information in the quarterly newsletter Live It Up! Digest, as well as HAO Magazine, an award-winning quarterly publication that features inspiring stories for active, healthy living. HumanaActiveOutlook.com also provides a wealth of senior health information and interactive Web tools. Humana Active Outlook offers a variety of additional benefits, including health and wellness seminars and classes, discounts and money-saving product offers, and national health education events. Members can also take advantage of QuitNet, a tobacco cessation program, and LifeWorks, Humana's senior member assistance program that offers phone and Web counseling and information to help members face age-related issues. Some Medicare Advantage members may also be eligible for Meals On Wheels meal delivery services, depending on the specific benefits of their plan. Physicians are asked to encourage Humana Medicare Advantage members to take advantage of the wide range of benefits that Humana Active Outlook offers. For more information about Humana Active Outlook or any of the features of Humana's Medicare Advantage plans, contact Humana Medicare provider relations at (866) 291-9714 or visit www.HumanaActiveOutlook.com. Humana Offers Cardiac Disease Management Humana offers two disease management programs to adult commercial members with cardiac conditions. Both programs are provided through an agreement with Matria Healthcare. The programs are as follows:
To refer a Humana-insured patient to either of these cardiac programs, call (866) 676-0740. For more information about Matria, visit www.matria.com. All of Humana's clinical programs are designed to support physicians' treatment plans and help improve members' quality of life, while reducing complications, hospitalizations and emergency room visits. Humana network physicians are asked to support Humana's clinical programs and encourage their Humana-insured patients to take advantage of these free resources. To view a complete list of Humana's clinical programs, visit Humana.com. On the home page, click on "Providers" on the right side of the page, and then select "Health & Wellness." Humana Expands Medicare Advantage HMO Offerings As of January 1, 2008, Humana Gold Plus HMO, a Medicare Advantage HMO, became available to Medicare-eligible Humana members in Dallas and Rockwall counties. This plan has previously been available only in the counties surrounding Corpus Christi and San Antonio. In addition, Humana-Texas is now offering the Humana Gold Plus HMO Special Needs Plan. This plan is available to individuals who are eligible for both Medicare and Medicaid. The Special Needs Plan provides medical care with no copayment or coinsurance for most covered services. This plan also provides for up to 24 one-way nonemergency transports through Medical Transportation Management, Inc. Both plans require members to select a primary care physician (PCP) and obtain a referral or prior authorization to see a specialist. Both plans include additional health and wellness benefits, such as the Forever Fit exercise program, the QuitNet smoking cessation program and Meals On Wheels. Physicians who are interested in joining the Humana Gold Plus HMO and/or Humana Gold Plus HMO Special Needs Plan networks should contact their local Humana contracting representative. For
more information about these plans, contact Renee Freeman, director
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