Humana's Your Practice

The National Committee for Quality Assurance (NCQA) has proposed several changes to the Healthcare Effectiveness Data and Information Set (HEDIS^®). These measures are currently under review, but are expected to be part of the HEDIS review that will take place in the spring of 2010.

Addition of questions on aspirin to the Consumer Assessment of Healthcare Providers and Systems (CAHPS^®) survey. The responses would be used to calculate the following rates:
- Current Aspirin Use measure, which will be reported as the percentage of members who are currently taking aspirin.
- Discussing Aspirin Risks and Benefits measure, which will be reported as the percentage of members who discussed the risks and benefits of using aspirin with a doctor or other health care provider.
Rename the Medical Assistance with Smoking Cessation measure as Medical Assistance with Tobacco Use Cessation. This is intended to include cessation of use of other types of tobacco products.
Change the screening age range for the Colorectal Cancer Screening (COL) measure from 50-80 years to 50-75 years.
Add an additional competing diagnosis of acne to the Appropriate Treatment for Children with Upper Respiratory Infection (URI) measure.
Add the following additional exclusions to the Use of Appropriate Medications for People with Asthma (ASM) measure:
- Cystic Fibrosis
- Acute Respiratory Failure
- Bronchitis
- In addition, the Upper Age Limit for this measure will be lowered from 56 years to 50 years, and the age stratifications will be amended to: 5-11 years, 12 and older, and Total

Humana will continue to keep network physicians informed throughout the approval process. Please familiarize all clinical staff with these new measures and revise office protocols to be in line with the recommended actions. For more information about HEDIS reviews, contact Darlene Holzbach in Humana's Corporate Quality Management department at dholzbach@humana.com or 502-580-5840.