Quality Resources

State and federal governments increasingly are moving toward a health care industry driven by quality. Providers have likely noticed increased activity among Medicare Advantage payers, regarding quality initiatives.

Humana has developed the resources below to help health care providers navigate the new quality landscape.

Provider Medicare Quality Rewards Program

Provider Medicare Quality Rewards Program

Humana’s support of value-based reimbursement is the foundation on which we developed our Accountable Care Continuum. We offer financial rewards for improvements in cost, quality and outcomes. We created a continuum of programs to encourage primary care physicians in their development of population health management capability and focus.

Quality Improvement (QI) Program

Humana's quality improvement program includes clinical care, preventive care and member services. View Humana's Quality Improvement Progress Report (390Kb) for information about our quality improvement program and progress toward our goals.

Health care providers may also obtain a written quality improvement (QI) program description by calling
1-800-4-HUMANA (1-800-448-6262). We welcome health care providers’ input regarding our QI Program. Feedback can be provided in writing to the following address:

Humana Quality Management Department
321 W. Main St., WFP 20
Louisville, KY 40202

Sample screenings letter available

There are many reasons patients miss the medical screenings and tests that are valuable to their health.

Humana has developed a tool physicians can use to help Medicare patients keep current with their tests. The sample screenings letter provides a checklist of the recommended health screenings and tests for Medicare members, including preventive screenings, tests for respiratory and cardiovascular conditions and diabetes care.

Physicians can:
1. Download and customize the letter for their letterheads, their communication styles and patients' needs.
2. Distribute it to their Medicare patients. regardless of the patients' health benefits plan membership.

Sample Screenings Template Letter (284Kb)

Healthcare Effectiveness Data and Information Set (HEDIS®) Measures and Codes

The following 12 documents introduce specific Healthcare Effectiveness Data and Information Set (HEDIS) quality measures. They also list codes from several coding systems that can be used to document diagnosis and treatment.

Additional Health Care Provider Resources

Humana Provider Quality Review Process (497 Kb)

LifeKeeper Advance Care Planning Guide

Questions

Health care providers who have questions about these materials may contact their provider representative.

More information

National Committee for Quality Assurance (NCQA)-HEDIS & Quality Measurement

The Centers for Medicare & Medicaid Services (CMS)-Part D Performance Data