Humana Military shares clinical quality and cost-efficiency ratings (represented by icons under the provider’s name). You can see these ratings when you use the Find Care tool, which helps beneficiaries search for in-network providers. These ratings should be used only as information when choosing care.
You won’t be able see a rating for these reasons:
TRICARE beneficiary feedback does not affect a provider’s rating.
Efficiency, or cost-efficiency, measures a provider's total cost for treatment that TRICARE beneficiaries received compared to treatment provided by other providers in the same specialty type and geography. Treatment could include services such as doctor's visits, lab test, related medications and hospital surgeries.
Effectiveness, or clinical quality, measures a provider’s adherence to evidence-based medicine when treating TRICARE beneficiaries as compared to a peer group in the same specialty type and geography.
Other insurance companies may use similar methods, but each payer's program could yield different results since ratings are based on a unique set of claims data for a unique group of beneficiaries.
There are instances where a provider may not receive a rating and the message “Not enough information to measure” will appear. There could be several reasons a provider does not receive a rating, such as: the specialty may not be among those evaluated, the provider’s geographic location may not be in scope, the data may not be statistically credible or not enough data is available to complete a full evaluation.
A better cost-efficiency rating does not correlate with beneficiaries out of pocket cost experienced per visit.
While a better cost-efficiency rating does not correlate with beneficiaries out of pocket experience per visit, it does impact overall cost of care by avoiding unnecessary visits, unnecessary procedures, etc.
