Mountain sun set

Care Decision Insights: Cost and Evidence-based Metrics to Support Physicians

If you’re a primary care physician (PCP) or specialist making specialty care or outpatient facility referrals for your patients, we’d like to share a new resource to help you determine the best fit for your Humana-covered patients.

The information is to begin a conversation about the opportunities you may have to affect your patients’ care beyond your walls. As you’re provided our claims-based episodes-of-care data, we’d like to hear what your experience has been and see what more you might want from us to improve episodic care.

For PCP groups (in select markets for select specialties):

  • The Care Decision Insights program will provide referral pattern information, as well as profiles of specialist groups based on efficiency and effectiveness.1 You may find this information helpful as you make care decisions for your patients.

For specialty groups (in select markets for select specialties):

  • You will get an in-depth look at your performance measures for efficiency and effectiveness based on Humana claims data. And, you will see “site of service” referral information so you can determine which in-network facilities might be a better fit for your patients.

Why this matters

  • Independent research supports the premise that certain specialists consistently have improved clinical outcomes, higher quality of care and lower costs.2,3,4
  • For PCP groups, Care Decision Insights data may provide reassurance that the specialist who will see your patient next not only is in-network, but also is recognized for delivering quality care and improved patient outcomes. For specialists, the Care Decision Insights program gives details around how their performance compares to that of their peers.

Ask your Humana representative for more information about Care Decision Insights. If you need help locating your representative, please email

1When developed and available for Care Decision Insights 2“The Productivity of Physician Specialization; Evidence from the Medicare Program,” Baicker and Chandra 3“Medicare Payments to Providers in 2012,” Centers for Medicare & Medicaid Services 4Humana proprietary internal analysis, 2014