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Quality Improvement

Your care means a lot to us, and we aim to make a difference in your health and well-being. Learn how we measure our progress in improving quality.

We have a Quality Improvement (QI) Program that aims to:

  • Improve the health of all members
  • Ensure positive outcomes
  • Lower the cost of care
  • Organize care
  • Promote Value
  • Improve the quality and safety of clinical and nonclinical care and services
  • Meet national quality standards
  • Receive high customer and provider satisfaction
  • Achieve top enrollee health outcomes

Our QI Program conducts the following activities:

  • Assess the unique needs of members
  • Assess the availability of providers for members in every region of the state
  • Ensure we are serving members with diverse cultural and language needs
  • Ensure we are serving members with complex health needs
  • Establish safe clinical practices with all of our providers
  • Manage all quality of care and quality service complaints
  • Provide quality oversight of all clinical services
  • Meet the quality requirements of the Centers for Medicare and Medicaid Services (CMS)
  • Monitor and evaluate enrollee and provider satisfaction

The tools we use

We use a tool called HEDIS® (Healthcare Effectiveness Data and Information Set) to track the performance of your PathWays plan. More than 90 percent 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
  • Comprehensive diabetes care
  • Continuing use of beta-blocker treatment after a heart attack
  • High blood pressure control

Helping us improve

These measurements:

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

Annual provider reviews

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

  • Providing appropriate care for our members
  • Complying with Humana guidelines and requirements

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

Learn more about how to submit feedback about your provider

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 Program Description Overview, write to:

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

Cost of healthcare

Humana Healthy Horizons is committed to providing you with the information needed for you to make informed decisions about your health care. This is the reason we are sharing some of the most common healthcare services and what they cost, but may not be owed by the member.

CPT Code Procedure Description Cost 99203 Routine Visit $105.12 99341 Home Health Visit $46.88 92521 Speech Therapy $128.12 97165 Occupational Therapy Evaluation $96.67 92019 Eye Exam and Treatment $68.50 97161 Physical Therapy Evaluation $96.67 45378 Hearing Aid Exam Both Ears $64.38 S0613 Annual Breast Exam $32.34 93000 EKG $13.49
Source: The information provided above is based on the fee schedule provided by the Indiana Family and Social Services Administration (FSSA) and is subject to change. Your individual healthcare needs may be different and should be discussed with your provider.

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