Overview
In an effort to provide beneficiaries with additional information in their selection of healthcare providers, clinical quality and cost-efficiency ratings may appear next to certain providers. These ratings represent the clinical quality and cost-efficiency delivered by providers. Absence of clinical quality and cost-efficiency ratings means a provider does not meet the criteria to receive a rating.
These ratings take into account a provider’s specialty and compares them to a peer group of providers with the same specialty who deliver care in the same state.
Some providers do not have clinical quality or cost-efficiency ratings associated to them. Reasons for this may include:
- Not all specialties are evaluated by Humana Military
- Minimum requirements, such as data volume, statistical credibility or minimum peer volume, are not met
A provider receives ratings when their specialty is one of the specialties evaluated by Humana Military, and when they meet minimum evaluation requirements. There are instances where a provider appears with a clinical quality rating and no cost-efficiency rating, and vice versa, as the clinical quality and cost-efficiency ratings are independent of each other.