The following types of Humana members are covered by the rewards program: Humana MA Private-Fee-for-Services (MA PFFS), MA Preferred Provider Organization (MA PPO) and any MA Health Maintenance Organization covered patients for whom Humana makes payment solely on a fee-for-service basis (MA HMO-FFS). Results for MA PFFS, MA PPO and MA HMO-FFS covered patients will be aggregated for each measure.
A practice will be eligible for rewards payment if the targeted goals for at least six of the nine measures are met for all attributed MA PFFS and MA PPO covered patients and assigned MA HMO-FFS covered patients. If eligible, a practice will receive a rewards payment equal to ten percent of the total primary care allowed Humana claims payment amounts for calendar year 2010 for all the practice’s MA PFFS, MA PPO and MA HMO-PFFS covered patients. Rewards payments, if any, will be paid in June 2011.
The measures are nationally recognized HEDIS (Healthcare Effectiveness Data and Information Set) quality metrics. They are:
● Breast Cancer Screening ● Osteoporosis Medication Management
● Glaucoma Screening ● Spirometry Testing for COPD Patients
● Colorectal Cancer Screening ● Monitoring Patients on Persistent Medication
● Cholesterol Management ● Anti-rheumatic drugs for patients with Rheumatoid Arthritis
● Diabetes Management
The targets originate relative to national standards of practice by the National Committee for Quality Assurance (NCQA) and the National Quality Forum (NQF). Humana receives the target percentages from the Centers for Medicare & Medicaid Services (CMS) on an annual basis.
Beginning in 2011, practices with larger numbers of Humana-covered MA PPO, PFFS and HMO-PFFS patients may qualify for additional rewards opportunities. If your practice qualifies, you will receive a notification letter in January 2011.
If you have any questions about this program, please call Humana Provider Relations at 1-800-626-2741.