Humana uses HEDIS to help track the performance of our health plans and ensure we`re giving you the care and services you need to manage your health.


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Measuring Performance

How Humana Measures the Performance of Our Health Plans

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Florida Medicaid: Measuring our performance

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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

View the guide to HEDIS measurements

Learn more about the quality measures on the NCQA website

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

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.iMembers 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, 2025, and June 30, 2026 (and rewards paid through July 31, 2026). 

Health Risk Assessment (HRA)

Overall, 44,706 HRAs were completed for members of all ages; of these 9,396 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 2024-2025 vs. Fiscal Year 2025-2026, the Well-Child Visit enrollment and completion rate per 1,000 members increased by 6.86% (401.22 vs. 428.75)



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 2024-2025 vs. Fiscal Year 2025-2026, the Adult Well Visit enrollment and completion rate per 1,000 members increased by 29.36% (118.91 vs. 153.18)



HumanaBeginnings Programv

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.During Fiscal Year 2025-2026, members who participated in the HumanaBeginnings Program had a slightly higher preterm delivery rate compared to non-participants (11.5% vs. 11.1%), representing a 0.4 percentage point difference. Similarly, HumanaBeginnings participants had a higher cesarean section (C-section) delivery rate than non-participants (38.2% vs. 34.6%), a difference of 3.6 percentage points.

When comparing Fiscal Year 2024-2025 vs. Fiscal Year 2025-2026, the HumanaBeginnings Program enrollment rate per 1,000 members increased by 16% (19.85 vs. 23.02), and the completion rate increased by 25.84% (12.53 vs. 15.76) per 1,000 members 

When comparing Fiscal Year 2024-2025 vs. Fiscal Year 2025-2026, the Prenatal Care Visit enrollment and completion rate per 1,000 members decreased by 5.75% (46.83 vs. 44.14) 

When comparing Fiscal Year 2024-2025 vs. Fiscal Year 2025-2026, the Postpartum Care Visit enrollment and completion rate per 1,000 members increased by 22.32% (16.77 vs. 20.52)



Mammogram screening

The Mammogram Screening Program is designed to increase compliance and identify potential risk for breast cancer. A 27-year study of nearly 1.2 million women found that people who had a mammogram every other year were 30%–50% less likely to die from breast cancer than people who didn’t.vi When comparing Fiscal Year 2024-2025 vs. Fiscal Year 2025-2026, the Mammogram Screening enrollment and completion rate per 1,000 members increased by 7.53% (92.45 vs. 99.41)



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.viiWhen comparing Fiscal Year 2024-2025 vs. Fiscal Year 2025-2026, the Cervical Cancer Screening enrollment and completion rate per 1,000 members increased by 9.15% (79.86 vs. 87.17)



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.viiiWhen comparing Fiscal Year 2024-2025 vs. Fiscal Year 2025-2026, the Colorectal Cancer Screening enrollment and completion rate per 1,000 members increased by a modest 0.17% (69.11 vs. 69.23) 



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 programxi

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 2024-2025 to Fiscal Year 2025-2026, the Tobacco Cessation Program enrollment rate per 1,000 members declined by 3.97% (0.43 vs. 0.42), and the completion rate per 1,000 members declined 15.41% (0.14 vs. 0.12)

44 Members completed the Tobacco Cessation Program in Fiscal Year 2025-2026. Of the 44 members, 33 members participated in a telephone survey during their last coaching session. The findings of this final survey included: 27 (82%) of the 33 members reduced the number of cigarettes smoked daily by an average of 11 per dayOf the 33 members who participated in a final survey, 46% quit entirely.



62.1% indicated they gained more tools and skills needed to achieve their tobacco cessation goals.

24.1% reported an increase in their confidence and ability to reach/stay smoke-free or vape-free because of the program.

13.8% reported an increase in motivation to become smoke-free or vape-free because of the program



Weight management programIX

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.

When comparing Fiscal Year 2024-2025 to Fiscal Year 2025-2026, the Weight Management Program experienced an 80.51% (0.25 vs. 0.44) increase in enrollment rates per 1,000 members and a 5.47% (0.16 vs. 0.17) increase in completion rates per 1,000 members

64 members completed the Weight Management Program in Fiscal Year 2025-2026. Of the 49 members who completed a final survey, 27 members were focused on losing weight. The findings of the survey included:

62% of weight-loss focused members lost weight.17 weight-loss focused members lost an average of 13 pounds.



42.9% of the members surveyed reported they have gained more tools and skills needed to achieve their weight management goals because of the program.

34.7% reported an increased confidence level in their ability to reach/stay at a healthy weight because of the program.

22.4% 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 2024-2025 to Fiscal Year 2025-2026, the Substance Abuse Program enrollment rate per 1,000 members declined by 42.32% (0.17 vs. 0.10), while the completion rate declined by 76.50% (0.05 vs. 0.01) per 1,000 members



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, 2025, thru June 30, 2026 (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)

vii Cervical Cancer (University of Colorado)

viii Colorectal Cancer | Early Detection and Screening | CancerCare

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.  

Program	Enrollment	Completion	Completing rateⁱⁱⁱ
Medically approved tobacco cessation program	159	44	28%
Medically directed weight management program	169	64	38%
Medically approved substance abuse program	27	3	11%
Health Risk Assessment	44,706	44,706	100%
Adult well visit program	41,259	41,259	100%
Child-well visit program	175,596	175,596	100%
Cervical cancer screening	13,479	13,479	100%
Colorectal cancer screening	6,289	6,289	100%
Mammogram screening	6,890	6,890	100%
HumanaBeginnings program	5,134	5,134	68%
Prenatal care visit	9,843	9,843	100%
Postpartum care visit	4,575	4,575	100%

Diagnosis	AHCA benchmark requirement	Humana completion rate
Pregnancy	80%	67%
iBudget waiver	80%	54%
SMI	80%	51%
HIV/AIDS	80%	43%
SP SMI	90%	56%
SP HIV/AIDS	90%	62%
Cancer	80%	56%
Depression	80%	65%
Diabetes	80%	63%
Asthma	80%	45%