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From the Desk of the CMO (Article 2) |
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John E. Crum, MD, Chief Medical Officer, Humana Military Healthcare Services, Inc. |
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In the fall of 2007, Humana Military Healthcare Services, Inc., (Humana Military) plans to make information about relative affordability and quality of care available to network providers. Individual providers will be able to access their own measures and
underlying data through our secure Provider Web portal.
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This pilot initiative represents a proposal by Humana Military in support of Presidential Executive Order 13410, “Promoting Quality
and Efficient Health Care in Federal Government Administered or Sponsored Health Care Programs.” The Order calls for making relevant information available to beneficiaries and providers regarding health care quality and price in a readily useable
manner.
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In 2007, we propose to make this information available to the staff of military treatment facilities in the South Region. In 2008, Humana Military and the TRICARE Management Activity will consider whether the information should be
made available online to beneficiaries. Our approach will reflect only positive information about providers. For each provider and office location, we will assign zero, one or two stars for each of two measurement categories: quality and relative
affordability.
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Quality measures are based on two subsets: |
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- Administrative quality, including the percentage of claims submitted electronically and the return of consultation reports; and
- Clinical quality issues, includingbeneficiary complaints about attitude, access, and care. We will aggregate these quality measures to create a single score, or star rating. When there are no data for return of consultation reports or clinical
quality, maximum scores for these measures will be assigned.
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Relative affordability compares a provider’s average allowed charges for episodes of care to those of other providers in the same state. Charges for professional services surrounding specific events of care will be used to calculate each provider’s average. The
effects of discounts and the intensity and volume of services rendered will be taken into consideration. Providers whose average allowed charges are significantly above the mean are assigned zero stars, those with charges significantly below the mean are assigned two stars, and those at or near the mean are assigned one star.
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A complete explanation of the transparency initiative will be on the Humana Military Web site prior to the start of the program. You will be able to “opt out” of this initiative altogether if you choose, in which case no stars will be assigned.
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We are striving to keep this initiative simple and accurate and to promote quality and the efficient delivery of health care. We welcome feedback from you about your individual measures.
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For more information please visit the Provider portal of our web site. Thank you for participating in the care of
our deserving TRICARE beneficiaries. We look forward to your feedback on these measures. |
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Created: October 15, 2007
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