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Care Highlight®

To help our members, as well as prospective Humana customers, make more informed choices about their healthcare, Care Highlight® recognizes doctor practices that meet quality and cost-efficiency guidelines. You can find a doctor’s ratings on the Humana find a doctor tool when we have enough information to measure a doctor’s quality and cost-efficiency. Care Highlight promotes transparency and empowers consumers to make informed decisions about the management of their health and where they receive services. By sharing information regarding physicians, this program supports Humana’s ongoing effort at driving value in healthcare administration.

A doctor listens to a patient as he explains his symptoms.

Overview

When assessing doctors, Humana uses administrative and claims information over a 3-year period. Ratings are provided at the physician group level in each specialty type so that we can provide ratings for more doctors. Our method for evaluating these ratings is consistent with national standards and was developed using feedback from doctors.

Care Highlight ratings are only a guide to choosing a doctor. Members should discuss with their existing doctors before making a decision, and given that such ratings have a risk of error, they should not be the sole basis for selecting a doctor. Humana does not give performance-based payments to doctors based on these ratings.

The meaning of hearts and badges

Clinical quality

The effectiveness of treatment that members received may be measured qualitatively.

Clinical quality Description four hearts Highest rating one heart Lowest rating Not enough information to measure. There is not enough information to rate the doctor.

Here are some examples of how we determine the rating:

  • How often are patients readmitted after a hospital stay?
  • How often do patients develop complications after surgery?
  • How often are appropriate testing and treatment ordered by the doctor?

Cost-efficiency

Cost efficiency is the cost of treatment that members received compared to treatment provided by similar doctors. Treatment could include services such as doctor's visits, lab tests, related medication, surgeries done in hospitals, etc.

Cost efficiency Description four badges Highest rating one badge Lowest rating Not enough information to measure. There is not enough information to rate the doctor.

Here are some examples of how we determine the rating:

  • The total cost for services
  • The number and types of services performed
  • Resources used to treat the doctor's patients

Doctors that are evaluated

Doctors in the following specialties are included:

Evaluated specialty types

  • Allergy and immunology
  • Cardiology
  • Colon and rectal surgery
  • Endocrinology
  • Family/general practice
  • Gastroenterology
  • General surgery
  • Internal medicine
  • Neurology
  • Neurosurgery
  • Obstetrics and gynecology
  • Oncology
  • Ophthalmology
  • Orthopedic surgery
  • Pediatrics
  • Plastic surgery
  • Psychiatry
  • Pulmonology
  • Rheumatology
  • Thoracic surgery
  • Urology
  • Vascular surgery

Your feedback is valuable

We would like to hear what you have to say. If you have feedback regarding the Care Highlight ratings, please take this brief survey, opens new window. For all other questions or feedback, please call the toll free number on the back of your Humana ID card.

We want to ensure that the program is useful to our members and fair to our doctors. Your feedback will be reviewed by Humana and considered in making program enhancements.

For detailed information about the program, please see the Physician Effectiveness and Efficiency of Care page.

NCQA seal representing the PQ Certification of the program

“By earning Physician Quality Certification, Humana has shown its commitment to quality includes transparent, rigorous review of the physicians with whom it works. That measurement, transparency and collaboration between organizations are cornerstones of better care.” Margaret E. O’Kane, NCQA President

Frequently asked questions

For additional information, please read our Care Highlight® member FAQ, PDF opens new window