We’re striving for clinical excellence and quality through coordinated care.
Pivoting during a pandemic
In 2020, Humana took critical steps and extra precautions to make necessary modifications to keep our members, providers, and other employers safe, healthy and able to navigate the pandemic. , opens new window about how Humana provided work environment flexibility, resources, and important information related to the virus, telehealth, and the vaccine as part of our efforts to simplify access to quality care, reduce financial barriers and address social determinants of health.
Quality and Plan Performance
At Humana, we are committed to quality and have a corporate Quality Improvement (QI) program—with practicing network physicians as members of various quality subcommittees—to monitor, evaluate and facilitate improvement in the quality of health care services provided to our members. The development of the QI Program Description is based upon contractual, governmental, accreditation, and organizational requirements and guidelines. Humana’s QI program is aligned with The National Quality Strategy (NQS), which was published by the Agency for Healthcare Research and Quality (AHRQ) on behalf of the U.S. Department of Health and Human Services (HHS). The NQS serves as a catalyst and compass for a nationwide focus on quality improvement efforts. The NQS established a set of 3 overarching aims that build on the Institute for Healthcare Improvements (IHI) Triple Aim: Better Care, Healthy People/Healthy Communities and Affordable Care. IHI evolved the Triple Aim to include improving the work life of health care providers, including clinicians and staff. This has become known as the quadruple aim. The Centers for Medicare and Medicaid Services (CMS) Quality Strategy was built on the foundation of the HHS NQS to optimize health outcomes by leading clinical quality improvement and health system transformation. By incorporating the CMS Quality Strategy, the HHS NQS and IHI Quadruple Aim into the QI program description, Humana is supporting the delivery of consistent high-quality care, promoting efficient outcomes in the healthcare system and ensuring that healthcare remains affordable for all members.
In 2020, Humana received a 5-star rating on Centers for Medicare and Medicaid Services’ 5-star rating system for its CarePlus Health Plans, Inc. Medicare Advantage (MA) plan in Florida for the third consecutive year, which currently covers approximately 164,300 members. The Medicare 5-star rating system rates the excellence of Medicare plans nationally based on member-satisfaction surveys, health plans, and healthcare providers. The rating system uses more than 40 different quality measures across 9 categories. Also in 2020, Humana received a 4.5-star rating for 3 MA contracts offered in 7 states. In all, Humana has 4.1 million members in 4-star or above rated contracts to be offered in 2021, representing 92% of its existing MA membership in rated contracts as of Sept. 2020. Over 99% of retirees in Humana’s Group Medicare Advantage plans remain in 4-star or above contracts for 2021. With these results, Humana’s star ratings continue to reflect the company’s focus on quality in both member experiences and health outcomes. , opens new window.
The , opens new window details how Humana uses a holistic approach to provide affordable healthcare and help members manage numerous physical, behavioral and social challenges. In particular, the report examines a few social determinants of health, such as food insecurity and social isolation, and looks at how physicians are managing and engaging patients to promote better chronic disease management and improve health outcomes.
- Humana individual Medicare Advantage (MA) members benefitted from preventive screenings. Humana MA members seeking care from physicians in value-based agreements received screenings between 8% and 19% more often for colorectal screenings, diabetic eye exams, osteoporosis management and controlling blood sugar than those Humana MA members who received care from physicians in MA non-value-based arrangements.
- More Humana MA members stayed in their homes, not the hospital. Humana MA members receiving care from physicians in value-based care arrangements with Humana collectively spent 211,000 fewer days as hospital inpatients and less time seeking care in emergency rooms in 2019, compared to those Humana MA members receiving care from physicians in non-value-based care models. More broadly, Humana MA members served by physicians/practices in value-based agreements visited emergency rooms 10.3% less often (90,500 fewer visits) and had a 29.2% lower rate of hospital admission (165,000 fewer admissions) compared with Fee-For-Service Medicare.
- Care costs are lower for MA members. An estimated $4 billion in plan-covered medical expenses would have been incurred by Humana MA members if they had they been under Fee-For-Service Medicare’s model instead of in value-based agreements.
At Humana, we are committed to advancing public policy that moves us toward a future in which everyone can enjoy lifelong health and well-being. Humana’s voice is active about healthcare and , opens new window that matter most to the people we serve.
Governance and Accountability
Our Standards of Excellence
Throughout our operations, we are dedicated to ensuring that every business decision we make reflects our commitment to improving the health and well-being of our members and patients, our employees, the communities we serve, and our environment. We view suppliers as an extension of Humana. To that end, we hold that these Standards of Excellence are applicable to our suppliers, vendors, contractors, consultants, agents, partners and other providers of goods and services who do, or seek to do, business with Humana entities worldwide.
Ethics and Compliance
Our employees are integral to running our company responsibly and key to our ethics and compliance practices. That’s why all Humana employees and contractors are required to complete an ethics and compliance course each year, and why our Enterprise Compliance team places an emphasis on communicating with their colleagues about ethics, compliance and risk in an intentional way, throughout the year.
We require all employees (including executive officers and independent directors) and contractors to complete an engaging annual training course on ethics and compliance matters. Additionally, we enforce Standards of Conduct and a Compliance Policy, specifically designed for our contracted healthcare providers and third parties in effort to deter fraud, waste and abuse.
Using Data and Technology, Responsibly
Humana is an industry leader in the adoption of principles and governance to guide its implementation of emerging technologies.We govern our use of Artificial and Augmented Intelligence according to industry-leading principles, and we have interdisciplinary committees that establish governance over the deployment and quality of Artificial and Augmented Intelligence models. We have also signed the EqualAI pledge committing to ensuring our Artificial and Augmented Intelligence tools do not incorporate unintentional bias, and require all of our Artificial or Augmented Intelligence models that inform decisions about individuals to be reviewed to detect inadvertent bias. Humana is also asking our vendors who utilize Artificial and Augmented Intelligence tools to sign the EqualAI pledge or another similar pledge.
We are committed to continuously enhancing our processes and strengthening our technology in order to protect company data by:
- Employing best-practice precautions to safeguard information and protect our members’ data. We use proactive defense practices against the ever-evolving cyber threat landscape—measuring and maturing our cybersecurity capabilities and actively monitoring risks posed by threat actors.
- Establishing formal data governance, which includes accountability, oversight, processes, and controls to ensure data usage transparency and non-repudiation.
- Refreshing our data privacy and security policies at least annually.
- Providing annual company-wide data privacy and security training to all employees. Our employees are trained on topics such as data sensitivity, privacy requirements and how to avoid security vulnerabilities. We also test their knowledge through internal phishing campaigns—tracking and reporting aggregated outcomes to leadership.
- Reporting data breaches, as required by law, to the U.S. Department of Health and Human Services (HHS), Office of Civil Rights (OCR). Our reports are publicly available, free of charge and can be obtained through , opens new window.
For more information about how we guard information, see the Information Protection section of our , opens new window guide.