Provider performance ratings FAQs

for beneficiaries

How can I use the ratings?

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.

Why can’t I see a provider’s rating?

You won’t be able see a rating for these reasons:

  • If a provider’s specialty or geographical area is out of scope
  • If there is not enough data to complete a comprehensive evaluation, “Not enough information to measure” will be displayed

Does my feedback have any bearing on the provider’s rating?

TRICARE beneficiary feedback does not affect a provider’s rating.

What is efficiency?

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.

What is effectiveness?

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. 

Are the provider review methods used to determine ratings the same across all health insurance companies?

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.

Why wouldn’t a provider have a rating?

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.

How does this impact the out of pocket cost of my visit?

A better cost-efficiency rating does not correlate with beneficiaries out of pocket cost experienced per visit.

How does this impact my overall cost of care to treat a condition?

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.