Florida Medicaid: Measuring our performance

Learn about the tools we use to measure our performance to make sure you have the care you need. Check out how we’re doing in our annual reports.

The tools we use

We use a tool called Healthcare Effectiveness Data and Information Set (HEDIS^®) to track the performance of your Florida Medicaid plan. More than 90% of health plans in America use this tool. Having this large amount of data makes comparing plans easier. Officials check this data using a process created by the National Committee for Quality Assurance (NCQA).

What is measured?

To make sure we give our members the care they need, we measure the performance of many important health issues, including:

• Antidepressant medication management
• Asthma medication use
• Breast cancer screening
• Child and adolescent immunization status
• Child and adult weight/body mass index (BMI) assessment
• Comprehensive diabetes care
• Continuing use of beta blocker treatment after a heart attack
• High blood pressure control

These measurements

• Help us see that our Humana Healthy Horizons^® in Florida plan meets our members’ needs
• Show us any areas that need improvement and how we can better serve our members

Check our scores

You can see for yourself how we score each year. We want you to feel confident that you have made the right choice in your plan. Members can view the data that HEDIS tracks in a yearly report card that shows a complete view of a health plan’s performance. These report cards are often published by national magazines and newspapers.

View the State of Health Care Quality report opens in new window

View the guide to HEDIS measurements opens in new window

Learn more about the quality measures on the NCQA website opens in new window

Annual physician reviews

We review our in-network physicians each year to make sure they’re:

• Providing appropriate care for our members
• Following Humana guidelines and requirements

We encourage our members to let us know about their experience(s) with their physicians. We use member feedback during these annual physician reviews.

Learn more about how to submit feedback about your physician(s)

Quality improvement program

To help us provide you with quality care, we developed a program to make sure we are always improving. To receive a copy of the quality improvement (QI) program description overview, write to:

Humana Quality Operations Compliance and Accreditation     
Department - QI Progress Report
321 W Main St., WFP 20
Louisville, KY 40202

Healthy behaviors yearly program review

View/download a copy of this report pdf opens in new window

Overview

Go365 for Humana Healthy Horizons^® is a wellness program that offers members who are enrolled in either an MMA Plan (Medical), Comprehensive (MMA and long-term care), SMI or HIV/AIDS Specialty Plan the opportunity to earn rewards for taking healthy actions. We know living and aging well is important, and our healthy behaviors program was designed to:

• Encourage and reward healthy behaviors.
• Help members take steps toward being in their best health.
• Help members reach their health and wellness goals.

It is easy to participate in healthy activities and earn rewards through our Go365 for Humana Healthy Horizons wellness program.

 To earn rewards, members must:

• Download the Go365 for Humana Healthy Horizons app, available on the Apple App Store^® or Google Play^™ on a mobile device.ⁱ
  • Members who have a MyHumana account,  can use the same login information to access Go365 for Humana Healthy Horizons.
• Create an account to access and engage in the program.
  • Members who are 18 and older can register to create a Go365 account. Members must have their Medicaid member ID.
  • Members under the age of 18 must have a parent or guardian register on their behalf to participate and engage with the program. The person completing the registration process on behalf of a minor must have the minor’s Medicaid member ID.

Our Healthy behaviors program includes 10 types of activities that eligible members can complete to earn a reward.

• Health Risk Assessment (HRA): Rewards all members when they complete the HRA.
• Well-child visit: Rewards members under 18 years old when they complete a wellness visit with their primary care provider (PCP).
• Adult well visit: Rewards members 18 years and older when they have a wellness visit with their PCP.
• HumanaBeginnings^®: Rewards members 13 years and older who enroll and complete our HumanaBeginnings program, offering them prenatal and postpartum education and care management to help lower the risk of pregnancy complications (such as preterm delivery) associated with high-risk pregnancies. In addition, members are also rewarded when they get a prenatal care visit and a postpartum care visit.
• Weight management: Rewards members 12 years and older who enroll in the program and complete six (6) telephonic coaching sessions with a health coach. Members must complete a well-being visit with their PCP before enrolling in the program. 
• Tobacco cessation: Rewards members 12 years or older who complete eight (8) telephonic coaching sessions to help them quit smoking or vaping. Complimentary nicotine replacement therapy (NRT), like patches, gum, and lozenges, is only available to eligible members 18 years and older.
• Substance abuse: Rewards members 18 years or older who complete six (6) telephonic coaching sessions with a substance abuse coordinator or actively participate in an outpatient program for 28–30 days to help them live a life free of drugs and/or alcohol. Members have a choice to participate in one or both programs. 
• Mammogram screening: Rewards female members 40 years and older when they get an annual mammogram screening. Members younger than 40 years old and at high-risk are also encouraged to have an annual screening. A physician-written order (referral) may be required for a mammogram screening. Members are encouraged to check with their PCP or OB-GYN.
• Cervical cancer screening: Rewards female members 21 years and older when they get an annual cervical cancer screening. Members have open access for OB-GYN visits and do not require a referral from their PCP.
• Colorectal cancer screening: Rewards members 45 years and older when they get an annual colorectal cancer screening. A physician-written order (referral) may be required for colorectal screening. Members are encouraged to check with their PCP.

The below clinical success measures reflect program and/or activity completion dates between July 1, 2024, and June 30, 2025 (and rewards paid through July 31, 2025). 

Health Risk Assessment (HRA)

Overall, 75,671 HRAs were completed for members of all ages; of these 19,152 were for members diagnosed with diabetes, asthma, serious mental illness (SMI), pregnancy, HIV/AIDS, specialty plan SMI, specialty plan HIV/AIDS, Cancer, iBudget Waiver or identified with depression. Results are reported to AHCA on a quarterly basis.

• Eligible members identified with asthma, cancer, HIV/AIDS and/or diabetes were referred to Humana’s disease management programs with the goal of improving health outcomes by assessing their needs and implementing interventions to assist members with complex medical needs.
• Eligible members identified as pregnant were referred to our HumanaBeginnings^® program, where they engage with case managers to help improve birth outcomes and encourage prenatal and postpartum visits.
• Eligible members diagnosed with SMI are referred to behavior health specialists who assess their needs and implement interventions and services to assist in managing behavioral health and mental health needs.
• Eligible members diagnosed with depression are referred to Humana’s disease management programs with the goal of listing and describing planned interventions and how to help achieve target goals. Interventions may include, but are not limited to, provider education, member education, medication adherence, rewards and incentives program, care coordination, member outreach, caregiver engagement, outreach to providers, home visits, case management, promotion of lifestyle changes, and community partnerships.
• Eligible members diagnosed with HIV and AIDS who are enrolled in Humana’s HIV/AIDS Specialty Program work with Case Managers to help improve their health outcomes by assessing needs/issues, developing goals, and implementing interventions aimed at members who have complex medical needs/issues related to specific disease processes, high utilization of services, intensive health needs, and/or who consistently access high level of care services.
• Eligible members identified with SMI and enrolled in Humana’s SMI specialty program work with Care Managers, who assess member needs through various assessments including Health Risk Assessment (HRA) and social determinants of health (SDOH). The goal is to increase the members knowledge and promote effective management of their behavioral health conditions. Care Managers also perform medication reconciliation and ongoing care monitoring to improve health-related outcomes.
• Eligible members enrolled in iBudget waiver program work with Care Coordinators who provide necessary support and services to help prevent placement in a nursing home. Services are eligible for children three years or older with a development disability. Services include home modifications, vehicle modifications, consumable medical supplies and residential habilitation.

Well-child visit program

• The well-child visit program is designed to encourage and reward all members who are under 18 years to visit their PCP for an annual/wellness check-up, preventive screening, and necessary immunizations.
  • When comparing Fiscal Year 2023–2024 vs. Fiscal Year 2024–2025 well-child visit per thousand, there was a 5% increase (383.91 vs. 401.22) in enrollment and completion rate.

Adult well-visit program

• The adult well-visit program is designed to encourage and reward members who are 18 years and older to visit their PCP for screening, examination and assessment of their medical needs.
  • When comparing Fiscal Year 2023–2024 vs. Fiscal Year 2024–2025 adult well-visit per thousand, there was an 18% increase (100.67 vs. 118.91) in enrollment and completion rate.

HumanaBeginnings Program^v

• The HumanaBeginnings program is designed to provide health education and care management to pregnant members 13 years and older to decrease the likelihood of pregnancy complications, including preterm delivery associated with high-risk pregnancy.
  • In Fiscal Year 2024–2025, members who engaged in the HumanaBeginnings program were found to have a lower pre-term delivery rate than members who did not participate (11.2% compared to 12.7%). However, members who engaged in the HumanaBeginnings program were found to have a higher c-section delivery rate than members who did not participate (37.3% compared to 34.3%).
  • When comparing Fiscal Year 2023–2024 vs. Fiscal Year 2024–2025 HumanaBeginnings Program per thousand, there was a 36% increase (14.58 vs. 19.85) in enrollment and a 24% increase (10.12 vs. 12.53) in completion rate.

Mammogram screening

• The mammogram screening program is designed to increase compliance and identify potential risk for breast cancer. Finding breast cancer early reduces your risk of dying from the disease by 25% - 30% or more^vi 
  • When comparing Fiscal Year 2023–2024 vs. Fiscal Year 2024–2025 mammogram screening per thousand, there was a modest 1% decline (93.37 vs. 92.45) in enrollment and completion rate

Cervical cancer screening

• The cervical cancer screening program is designed to increase compliance with testing to identify potential risk for cervical cancer. When cervical cancer is diagnosed at an early stage, the five-year relative survival rate is around 91%, according to the University of Colorado School of Medicine.^vii
  • When comparing Fiscal Year 2023–2024 vs. Fiscal Year 2024–2025 cervical cancer screening per thousand, there was a 6% decline (85.38 vs. 79.86) in enrollment and completion rate

Colorectal cancer screening

• The colorectal cancer screening program is designed to increase compliance with testing to identify potential risk for colorectal cancer. Many colorectal cancers can be prevented through regular screening and when found early, colorectal cancer is highly treatable.^viii
  • When comparing Fiscal Year 2023–2024 vs. Fiscal Year 2024–2025 colorectal cancer screening per thousand, there was a 4% increase (66.33 vs. 69.11) in enrollment and completion rate 

Tobacco cessation/Weight management programs/Substance use

Smoking, substance use, and weight management can cause adverse health outcomes and complications years or even decades after the successful completion of a program. To encourage long-term behavior change and sustainability of efficacy, we increased health outcome education regarding the consequences of these conditions for members as they enroll and complete any one of these three programs. 

Tobacco cessation program^xi

The tobacco cessation program is designed to treat tobacco/nicotine dependence through counseling and/or the use of medications (nicotine replacement products) as part of the overall therapeutic process.

• When comparing Fiscal Year 2023–2024 vs. Fiscal Year 2024–2025 tobacco cessation program per thousand, there was a 19% increase (0.11 vs. 0.14) in enrollment rate
• 60 Members completed the tobacco cessation program in Fiscal Year 2024–2025. Of the 60 members, 38 members participated in a telephone survey. The findings of the survey included: 
  • 29 (76%) of the 38 members reduced the number of cigarettes smoked daily by an average of 10 per day
    • Of the 38 members who participated in a final survey, 46% quit entirely.
  • 55.3% indicated they gained more tools and skills needed to achieve their tobacco cessation goals.
  • 26.3% reported an increase in their confidence and ability to reach/stay smoke-free or vape-free because of the program.
  • 13.2% reported an increase in motivation to become smoke-free or vape-free because of the program

Weight management program

The weight management program offers comprehensive, physician-led supervision throughout the duration of care. Depending on each member’s individual needs and goals, the program may incorporate prescription medications or supplements, in addition to tailored guidance on nutrition, physical activity, and overall lifestyle modifications.

• 70 members completed the weight management program in Fiscal Year 2024–2025. Of the 47 members who completed a final survey, 27 members were focused on losing weight. The findings of the survey included: 
• 61% of weight-loss focused members lost weight.
  • 28 weight-loss focused members lost an average of 17 pounds.
• 53.2% of the members surveyed reported they have gained more tools and skills needed to achieve their weight management goals because of the program.
• 44.7% reported an increased confidence level in their ability to reach/stay at a healthy weight because of the program.
• 29.8% reported increased motivation to reach a healthy weight because of the program.

Substance abuse program

• The medically approved alcohol or substance abuse recovery program is an evidence-based approach to provide effective treatments and methods such as medically assisted detoxification, medication and behavioral therapy, and treatment and relapse prevention as part of the overall therapeutic process.
  • When comparing Fiscal Year 2023–2024 vs. Fiscal Year 2024–2025 Substance Abuse Program per thousand, there was an 18% decline (0.21 vs. 0.17) in enrollment rate and an 11% decline (0.054 vs. 0.048) in completion rate

Next steps

To continuously promote member engagement and improve health outcomes, we have increased efforts to promote and enroll members into the healthy behaviors program via a year-round, robust, multi-media approach, including a member welcome kit, email, text, social media, webpage, outbound calls, educational flyers and videos. We also continue to collaborate with the Agency for Health Care Administration (AHCA), vendors, and other community engagement programs to help improve the health and well-being of our members.

At Humana Healthy Horizons in Florida, we continuously look for opportunities to help our members live and lead healthier lives. We do this by incorporating members’ feedback into existing healthy behaviors programs and adding new programs. 

i All product names, logos, brands, and trademarks are property of their respective owners, and any use does not imply endorsement.

ii Chart Program Performance reflects program enrollment and completion between July 1, 2024 , thru June 30, 2025(the Agency for Health Care Administration’s fiscal year).

iii Completion percentages are calculated using the member’s original program enrollment date, which could occur in a prior reporting period.

iv Humana Healthy Horizons in Florida is required to ensure that health risk assessments are completed within sixty (60) days of enrollment for members who are identified as being pregnant or diagnosed with a serious mental illness, asthma, diabetes, HIV/AIDS, Specialty Plan SMI, Specialty Plan HIV/AIDS, Cancer, iBudget Waiver, or Depression. Required percentages vary by diagnosis.

v Members enrolled in the HumanaBeginnings program have higher comorbidities, such as hypertension and behavioral health issues, than those who are not enrolled. In addition, enrollment in the HumanaBeginnings program increases members’ timeliness of prenatal and postpartum visits which is noted above, helps to close gaps with social determinants of health, assesses behavioral health needs and provides access to behavioral health providers.

vi Mammography: Benefits, Risks, What You Need to Know (breastcancer.org) opens in new window

vii Cervical Cancer opens in new window (University of Colorado)

viii Colorectal Cancer | Early Detection and Screening | CancerCare opens in new window

ix Humana Wellness Coaching Internal Analysis based off members who completed the program and answer survey questions during the first and last call of their coaching.