Humana Simplifies Clinical Quality Metrics to Ease Growing Reporting Demands Placed on Physicians
December 14 2016 - 12:45PM
Business Wire
Humana has streamlined the number of quality
metrics it uses, seeking to reduce care administration for
physicians, eliminate inconsistencies, and prioritize metrics tied
to health outcomes
Humana Inc. (NYSE: HUM) today announced it has implemented a
Clinical Quality Metrics Alignment (CQMA) program to streamline and
standardize the set of clinical quality metrics used for
physicians.
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Humana Quality Metrics (Graphic: Business
Wire)
The program will support physicians who are participating in
value-based payment relationships with Humana. In addition, the
reduction of clinical measures will also help physicians, currently
in fee-for-service agreements with Humana, in their transition to
value-based care.
According to a 2015 survey conducted by the American Academy of
Family Physicians and sponsored by Humana, 61 percent of family
physicians receive payment from seven or more health plans, which
can lead to excessive, inconsistent and overlapping quality
reporting requirements. These requirements may contribute in part
to the fact that 49 percent of U.S. physicians meet the standard
definition of professional burnout. To reduce the burden on
physician practices, which spend more than $15 billion annually on
quality reporting, greater standardization of metrics and more
efficient reporting processes are needed.
To address this issue, Humana’s CQMA program collected 1,116
quality metrics from 29 different data sources across the company,
and vetted these metrics for duplicates, inconsistencies, and
clinical relevance. Following extensive refinement and analysis,
which included input from physician stakeholders, Humana has
consolidated the 1,116 metrics previously used into a set of 208
key quality metrics—an 80-plus percent reduction. The streamlined
set of metrics emphasizes improving patient health outcomes, and is
aligned with broader industry efforts to standardize measures used
to evaluate clinical quality.
This coordinated effort follows the February 2016 introduction
of Core Quality Measures by America’s Health Insurance Plans
(AHIP), in collaboration with its member plan chief medical
officers, leaders from the Centers for Medicare and Medicaid
Services (CMS) and the National Quality Forum (NQF), as well as
national physician organizations. These were introduced to ensure
the adoption of meaningful, efficient, payer-agnostic quality
measures across the industry. Humana’s CQMA program has
consolidated metrics in alignment with such efforts to address
physician pain points around quality reporting, lower reporting
costs and maximize the impact of metrics on improving patient
health.
“At Humana, we are committed to helping physicians succeed in
their transition from fee-for-service to value-based care,” said
Roy Beveridge, MD, Chief Medical Officer at Humana. “Metrics that
are not connected to patient health can serve as obstacles in their
transition and distract from the intent of care tied to quality.
Through our CQMA program, we hope to greatly simplify quality
reporting and alleviate physician burdens.”
“Measuring and managing quality is key in Iora Primary Care's
work to continually improve the value of care delivered to our
older adult patients,” said David Gellis, MD, Vice President of
Clinical Performance and Development for Iora Health. “Humana's
leadership in this area allows us to focus on measures that
matter to patients and clinical outcomes, rather than the
measurement system. Overall, this initiative recognizes the value
of Iora's relationship-based care model.”
In 2015, Humana members cared for by physicians in value-based
relationships experienced healthier outcomes, including 6 percent
fewer emergency room visits than members in standard Medicare
Advantage settings, as well as higher screening rates for
colorectal cancer screening (+8 percent), breast cancer screening
(+6 percent) and osteoporosis management (+13 percent).
Approximately 1.8 million of Humana’s individual Medicare
Advantage members are cared for by approximately 49,600 primary
care physicians in more than 900 value-based payment relationships
across 43 states and Puerto Rico. For more information, visit
humana.com/valuebasedcare.
About Humana
Humana Inc., headquartered in Louisville, Ky., is a leading
health and well-being company focused on making it easy for people
to achieve their best health with clinical excellence through
coordinated care. The company’s strategy integrates care delivery,
the member experience, and clinical and consumer insights to
encourage engagement, behavior change, proactive clinical outreach
and wellness for the millions of people we serve across the
country.
More information regarding Humana is available to investors via
the Investor Relations page of the company’s web site at
www.humana.com, including copies of:
- Annual reports to stockholders
- Securities and Exchange Commission
filings
- Most recent investor conference
presentations
- Quarterly earnings news releases
- Calendar of events
- Corporate Governance information
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version on businesswire.com: http://www.businesswire.com/news/home/20161214005909/en/
Humana Corporate CommunicationsAlex Kepnes,
502-580-2990akepnes@humana.com
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