Care Decision Insights

If you are a primary care physician or specialist making specialty care or outpatient facility referrals for your patients, there is a new resource to help you determine the best fit for your patients with Humana coverage.

The information is to be used to begin a conversation about the opportunities you may have to affect your patients’ care beyond your walls. As you are provided our claims-based episodes-of-care data, we would 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 provides 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.

To learn more, watch this Humana video (link opens in new window) or contact your Humana representative.