Quality Resources
Increasingly, state and federal governments are moving toward a health care industry driven by quality. Health care providers have likely noticed increased activity among Medicare Advantage payers, regarding quality initiatives.
Humana has developed the resources below to help health care providers navigate the new quality landscape. We'll add to this list as additional materials are completed, so we encourage health care providers to check back often.
Quality Improvement (QI) Program
Humana's quality improvement program includes clinical care, preventive care and member services. View Humana's Quality Improvement Progress Report for information about our quality improvement program and progress toward our goals.
Health care providers may also obtain a written quality improvement (QI) program description by calling 1-800-4-HUMANA (1-800-448-6262). We welcome health care providers’ input regarding our QI Program. Feedback can be provided in writing to the following address:
Humana Quality Management Department
321 West Main, WFP 20
Louisville, KY 40202
Sample screenings letter available
There are many reasons patients miss the medical screenings and tests that are valuable to their health.
Humana has developed a tool that physicians can use to help Medicare patients keep current with their tests. The letter provides a checklist of the recommended health screenings and tests for Medicare members, including preventive screenings, tests for respiratory and cardiovascular conditions and diabetes care.
Physicians can:
- Download and customize the letter for their letterheads, their communication styles and patients' needs
- Distribute to their Medicare patients regardless of the patients' health benefits plan membership
- Member Outreach Template Letter
- (284 KB) Download PDF
- English
Healthcare Effectiveness Data and Information Set (HEDIS) Measures and Codes
The following 12 documents introduce specific Healthcare Effectiveness Data and Information Set (HEDIS) quality measures. They also list codes from several coding systems that can be used to document diagnosis and treatment.
- Comprehensive Diabetes Care-LDL Screening & LDL Control (CDC-LDL)
- (151 KB) Download PDF
- English
- Colorectal Cancer Screening (COL)
- (181 KB) Download PDF
- English
- Osteoporosis Management in Women Who Had a Fracture (OMW)
- (160 KB) Download PDF
- English
- Care of Older Adults (COA)
- (141 KB) Download PDF
- English
- Adults' Access to Preventive/Ambulatory Health Services (AAP)
- (217 KB) Download PDF
- English
- Comprehensive Diabetes Care-A1c Control & Poor Control (CDC-A1c)
- (137 KB) Download PDF
- English
- Comprehensive Diabetes Care-Medical Attention for Nephropathy (CDC-Neph)
- (163 KB) Download PDF
- English
- Controlling High Blood Pressure (CBP)
- (138 KB) Download PDF
- English
- Breast Cancer Screening (BCS)
- (143 KB) Download PDF
- English
- Disease-Modifying Antirheumatic Drug Therapy for Rheumatoid Arthritis (ART)
- (148 KB) Download PDF
- English
- Adult BMI Assessment (ABA)
- (154 KB) Download PDF
- English
- Cholesterol Management for Patients with Cardiovascular Conditions (CMC)
- (142 KB) Download PDF
- English
Additional Health Care Provider Resources
- LifeKeeper Advance Care Planning Guide
- (53 KB) Download PDF
- English
- What is HEDIS, CAHPS & HOS?
- (282 KB) Download PDF
- English
- Quality Indicator Physician HEDIS, HOS, CAHPS, and Part D Safety Measures Guide for 2012
- (403 KB) Download PDF
- English
- HEDIS 2012 (Measurement Year 2011) Adult Measures and Codes Guide
- (371 KB) Download PDF
- English
- 2012 (Measurement Year 2011) Primary Care Physician Office Only
- (328 KB) Download PDF
- English
- 2012 (Measurement Year 2011) OB/GYN measures and Codes Guide
- (157 KB) Download PDF
- English
- 2012 (Measurement Year 2011) Opthalmic Measures and Codes Guide
- (165 KB) Download PDF
- English
- 2012 (Measurement Year 2011) Behavioral Health Measures and Codes Guide
- (152 KB) Download PDF
- English
- 2012 (Measurement Year 2011) Pediatric Measures and Codes Guides
- (228 KB) Download PDF
- English
- Provider Tool for Gaps in Care
- (341 KB) Download PDF
- English
- Physician Guidance for Member Quick Health Check/Member Quick Health Check
- (329 KB) Download PDF
- English
- What Are Star Ratings?
- (323 KB) Download PDF
- English
- Centers for Medicare & Medicaid Services (CMS) Star Ratings Measures
- (293 KB) Download PDF
- English
- Star Checklist
- (302 KB) Download PDF
- English
- Practitioner Assessment Form
- (94.04 KB) Download PDF
- English
Medications to Avoid in the Elderly
HEDIS Spotlight: Breast Cancer and Colorectal Screening
HEDIS Spotlight: Diabetes Care
HEDIS Spotlight: Glaucoma Screening and Rheumatoid Arthritis Management
HEDIS Spotlight: Use of Spirometry Testing in the Assessment and Diagnosis of COPD and Use of High-risk Medications in the Elderly
HEDIS Spotlight: Antidepressant Management and Osteoporosis
Blood Pressure Basics
Questions
Health care providers who have questions about these materials may contact their provider representative.
More information
National Committee for Quality Assurance (NCQA) – HEDIS & Quality Measurement
The Centers for Medicare & Medicaid Services (CMS) – Part D Performance Data
