Reminder: Flu Vaccines

Don't forget to remind your patients that it's not too late to get a flu vaccine. According to the Centers for Disease Control and Prevention (CDC), flu season can continue through March and can last as late as May.

Physicians play a significant role in curbing the flu and other illnesses by encouraging their patients to practice healthy habits, such as hand washing and use of tissues.

Based on the Advisory Committee on Immunization Practices of the CDC, the following people are at highest risk for developing flu complications:

• Adults 50 and older
• Adults and children with chronic conditions, immunosupression or a condition that compromises respiratory function
• Women who are pregnant during flu season
• Children ages 6 months to 59 months
• Anyone six months to 18 years old who is receiving long-term aspirin therapy
• Residents of nursing homes or other chronic care facilities

Have you and your office staff gotten a flu vaccine? The CDC encourages health care professionals to get vaccinated because they are on the front lines of battling the flu.

For more information, visit the CDC Web site at www.cdc.gov/flu. You can direct your Humana-insured patients to MyHumana at Humana.com where they can find additional information on the flu and pneumonia condition center.

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How Humana Develops Clinical Policy

When it comes to new clinical policy, Humana has carefully established procedures to create the right policy — and monitor it once it's implemented.

Humana's staff is alerted to a need for new clinical policy by one of several developments:

• A new technology
• A new indication for an older technology
• Multiple requests from providers for a decision on a certain technology
• Research by Humana's medical directors and staff

Humana's policy review process is one of several processes that are certified by the Utilization Review Accreditation Commission (URAC). The internal policy review process includes the following steps:

1. Once a decision is made to create a policy, a team of research nurses reviews the published literature and consults with three different industry policy research companies. These consultants scan industry best practices, research various topics and produce a white paper for Humana to review.
2. A draft policy is reviewed by one of the medical directors who have an interest in that topic, along with Lou Hochheiser, M.D., Humana's medical director for clinical policy development.
3. Topics are presented in-depth at a monthly policy meeting of about 15 Humana medical directors. This group makes final policy decisions.

Decisions are made based on the published peer-reviewed medical evidence. The committee does not consider costs in making its decisions, Hochheiser emphasized. In addition, Humana writes policy with the needs of consumers and providers in mind. Policies are written in clear English and provide for alternatives to certain treatments, where feasible.

"Another important nuance of our process is that FDA approval of a product does not mean it's proven," Hochheiser said. "Our review, or Medicare's review, of an FDA-approved product may determine that insufficient information is available relative to safety and efficacy, and therefore, that product may be deemed experimental or investigational, even though it's FDA approved."

Implementing policy
A finalized policy may go to an implementation committee. This team looks at claims processing and communications.

"We work to promote correct implementation of a policy across the organization," Hochheiser said. "Later, we also follow up to see that we are paying claims appropriately and to discover what the utilization and costs associated with those policies are over time."

Recently, Humana initiated an information policy that includes a section in YourPractice notifying physicians about new policies (see that update for steps to access policies on the Web site).

Timing
Hochheiser and Humana's policy group reviews all policies on a yearly basis. Any new literature is reviewed, and changes are made if appropriate.

"However, if new information comes in before the year is up, whether from the literature, from the provider network or another source, we will review that policy sooner," Hochheiser noted. "Internally, we work constantly reviewing literature in our medical pipeline so we understand the need for new policy, and we strive to keep providers up to date, as well."

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