Encourage Patients with Diabetes to
Seek Preventive Eye Care

A recent Healthcare Effectiveness Data Information Set (HEDIS) survey found that many Humana members with diabetes are not receiving the preventive care services recommended by the American Diabetes Association. For example, less than 25 percent of Humana members with diabetes in Georgia indicated that they had a comprehensive dilated eye exam in the past year.

This annual screening is critical because diabetic retinopathy often has no early warning signs or symptoms. However, through regular exams, the disease can be detected early, and, in most cases, the damage can be halted or minimized by targeted treatment.

For that reason, Humana is urging physicians to discuss the importance of an annual eye exam with their patients with diabetes. An annual eye exam is a covered benefit for all Humana members with diabetes. Ophthalmology offices are also reminded to forward results of annual eye exams to the patient’s primary care physician.

Humana members can learn more about diabetic eye disease at the MyHumana’s Condition Centers on Humana.com. After log in, select a topic from the “Visit the Condition Centers” drop-down menu. Members can also learn more from the following Web sites:

• The American Diabetes Association, Diabetes.org

• The National Eye Institute, www.nei.nih.gov

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HEDIS Reviews Begin in March

The 2009 Healthcare Effectiveness Data Information Set (HEDIS) medical records data abstraction process will begin in March and continue through June 2009. The National Committee for Quality Assurance (NCQA) requires the use of HEDIS data to measure compliance for certain prevention services, such as childhood immunizations, mammograms and comprehensive diabetes care.

In the 2009 review, Humana-Georgia 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 “Business Associate,” required to protect, preserve and maintain the confidentiality of any Protected Health Information (PHI) it gleans from clinical records provided by medical practice locations pursuant to its contractual obligations to Humana.

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 Lynn Trujillo, quality manager, at ltrujillo1@humana.com or 770-350-2153.

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Focus on Hypertension Risk

Healthcare Effectiveness Data and Information Set (HEDIS) measure results for Humana’s Georgia market consistently highlight controlling blood pressure as an area for improvement. Humana-Georgia’s 2007 HEDIS results reported that 56.9 percent of HMO members had blood pressure readings of 140/90 mmHg or less. The national average for all health plans is 62.2 percent. The National Committee for Quality Assurance set its goal at 70.3 percent.

Humana is doing its part to educate members about high blood pressure and steps they can take to reduce their risks. In addition, members who have been diagnosed with hypertension and prescribed antihypertensive medications but have not seen a physician in a year are receiving voice activated technology (VAT) calls to help identify barriers and encourage an office visit.

Physicians can foster this effort by focusing attention on national guidelines for the diagnosis and management of hypertension. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure (commonly known as the JNC7) includes some specific recommendations to help physicians prevent and manage hypertension among their patients. The JNC7 guidelines include:

• Patients with systolic blood pressure between 120 mmHg and 139 mmHg or a diastolic blood pressure between 80 mmHg and 89 mmHg should be considered prehypertensive. Prehypertensive patients should receive counseling on health-promoting lifestyle modifications to prevent cardiovascular disease (CVD).

• The treatment goal for blood pressure should be lower than 140/90 mmHg or lower than 130/80 mmHg for patients with diabetes or chronic kidney disease.

The JNC7 also explains the high stakes involved for patients’ health — an increase in blood pressure as little as 20/10 mmHg can double a patient’s risk of CVD, even when readings are still within the goal range. A patient with normal blood pressure at age 55 still has a 90 percent lifetime risk of developing hypertension.

The Joint National Committee has announced the review and revision of the JNC7 with a new report to be released this year. Look for more information about the Eighth Report (the JNC8) in the coming months. Early indicators suggest that the JNC8 recommendations on target blood pressure levels will be lower than the present levels. The HEDIS measure for controlling blood pressure has not changed, but future adjustments to blood pressure goals are possible.

For more information about the JNC7, visit www.nhlbi.nih.gov/guidelines/hypertension/express.pdf. For more information about HEDIS, visit www.ncqa.org/tabid/59/Default.aspx.

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Importance of Mammography and Colorectal Screenings

Healthcare Effectiveness Data and Information Set (HEDIS) measure results for Humana’s Georgia market consistently highlight mammography and colorectal cancer screening as areas for improvement. Humana-Georgia’s 2007 HEDIS results reported that 63 percent of female HMO members over age 40 had a mammogram in the last two years and 46 percent of adult HMO members received appropriate colorectal cancer screening.

Physicians are reminded that the U.S. Preventative Services Task Force (USPSTF) and the American Cancer Society (ACS) call for screening mammography, with or without clinical breast examination (CBE), every one to two years for women 40 years or older. For colorectal screening, the ACS recommends regular screening for both women and men beginning at 50 years old. Any one of the four criteria below defines appropriate screenings for colorectal cancer for patients at average risk:

• A fecal occult blood test once a year (three consecutive specimens needed)
  
• A flexible sigmoidoscopy every five years
  
• A double contrast barium enema every five years
  
• A colonoscopy every 10 years

Humana-Georgia’s Quality Department is implementing initiatives aimed at improving member compliance with these published screening recommendations. At-risk members are being contacted to educate and remind them about their risks and appropriate screening procedures.

For more information about Humana’s Quality Initiatives in Georgia, contact the local quality department at 770-350-2153. For more information about the USPSTF guidelines for mammography, visit www.ahrq.gov/clinic/uspstf/uspsbrca.htm. For more information about ACS guidelines on colorectal screening, visit www.cancer.org.

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MyChoice Tools Support Transparency

In recent years, members have asked for more information to help them make choices about their health care coverage and treatment. Humana has responded with a number of initiatives to make information about the health care process more accessible — or as it is often referred to, more “transparent.”

Members can access all of Humana’s transparency resources through one suite of tools known as Humana’s MyChoice Tools^SM. MyChoice Tools makes it easier for members to locate the information they need and to understand how to use the data provided. The tools also can help providers distinguish their practice and possibly build their referral base.

MyChoice Tools is separated into the following three categories:

• “Compare Doctors”
  
• “Compare Hospitals”
  
• “Compare Outpatient Facilities”

The “Compare Doctors” tool allows members to view cost estimates for physicians in primary care (pediatricians, family medicine and internal medicine) and a number of specialties, including allergy, cardiology, dermatology, endocrinology, ENT, emergency, gastroenterology, gynecology, neurology, ophthalmology and orthopedics. The physician types most likely to treat the selected condition are the only physicians displayed on the tool.

Enhancements also were made to the transparency tools, including:

• Side-by-side presentation of cost and quality measures for hospitals
  
• Expanded number of procedures for hospital and outpatient facilities

Physician practices are encouraged to tell their Humana-insured patients about these tools. MyChoice Tools is accessed via the secure MyHumana area of Humana.com. Members need to be registered on Humana.com to log in to access the tools.

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