Provider performance ratings
To help our beneficiaries make more informed choices about their healthcare, our new performance ratings recognizes providers that meet certain clinical quality and cost-efficiency guidelines. You can find a provider’s ratings on the Humana Military find care tool when there is enough information to measure a provider’s clinical quality and cost-efficiency. These performance ratings promote transparency and empowers beneficiaries to make informed decisions about the management of their health and where they receive services.
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.
For providers
More detailed information on the methodology used to determine these ratings is available for providers.
View program methodology
Clinical quality
The clinical quality rating metric is derived from Humana Military’s provider clinical quality rating, which is a quality measure set encompassing preventive and specialty care to help identify providers who offer higher quality care.
Evaluated specialties
- Allergy and immunology
- Family practice
- General practice
- Internal medicine
- Midwife
- Psychiatry and neurology
- Nurse practitioner
- Obstetrics and gynecology
- Physician assistant
- Pediatrics
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Clinical quality
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Description
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|---|---|
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Highest rating
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Lowest rating
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Not enough information to measure
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There is not enough information to rate provider
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Cost-efficiency
The cost-efficiency rating metric is derived from Humana Military’s provider cost-efficiency rating, which identifies providers who efficiently manage costs across specialty-specific episodes of care.
Evaluated specialties
- Allergy and immunology
- Anesthesiology
- Counselor
- Dermatology
- Emergency medicine
- Family practice
- General practice
- Internal medicine
- Marriage and family therapist
- Neurological surgery
- Nurse practitioner
- Obstetrics and gynecology
- Occupational therapist
- Ophthalmology
- Optometrist
- Orthopedic surgery
- Otolaryngology
- Pediatrics
- Physical medicine and rehabilitation
- Physical therapist
- Physician assistant
- Podiatrist
- Psychiatry and neurology
- Psychologist
- Social worker
- Speech-language pathologist
- Surgery
- Urology
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Cost-efficiency
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Description
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Highest rating
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Lowest rating
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Not enough information to measure
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There is not enough information to rate provider
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