Independent research supports the premise that certain specialists consistently achieve improved clinical outcomes and higher quality of care with lower costs.1,2 Humana’s Care Decision Insights can help you identify those specialists, so that you can determine the best referral opportunities for your patients who need specialist care.
Using sophisticated claim analysis, Care Decision Insights provides profiles of specialist groups based on their effectiveness and efficiency, as well as referral pattern information. Specialists are evaluated on clinical quality measures that assess the effectiveness of treatment Humana-covered patients received, while efficiency is determined by comparing the cost of treatment Humana-covered patients received to treatment provided by similar doctors. The evaluation process for both is the same as for Care Highlight™. (For more information about Care Highlight, contact your Humana representative or visit Humana.com/CareHighlight.)
If you are a referring physician:
Care Decision Insights data can reassure you that the specialist who will see your patient next not only is in our network, but also is recognized for delivering quality care and improved patient outcomes.
If you are a specialist:
You will get an in-depth look at your effectiveness and efficiency performance measures, as determined by claim data. You also will see site-of-service referral information that could help you identify which in-network facilities might be the right fit for your patients.
To learn more
For more information about Care Decision Insights, contact your Humana representative.
Sources
- Katherine Baicker and Amitabh Chandra, , opens new window accessed April 2021.
- Centers for Medicare & Medicaid Services. , opens new window accessed April 2021.