Managed care programs

Blue Button Care Considerations Case Management Disease Management HEDIS

Blue Button

Blue Button enhances communication between TRICARE beneficiaries and their providers. Blue Button allows beneficiaries to access their Electronic Health Records (EHR) through self-service. This information can be printed and shared with you and other members of the beneficiary’s healthcare team. Blue Button maintains information such as diagnoses, medications, Care Considerations, medical procedures, lab results and referrals and authorizations in one convenient location.

Care Considerations

Using data tools from medical claims, lab results, and self-reported data, Humana Military partners with ActiveHealth Management® to identify potential clinical risks, gaps in care and opportunities for improved clinical outcomes, known as Care Considerations.*

Once an improvement opportunity is identified, both the beneficiary and provider are contacted with the data to encourage actions to improve their healthcare. The physician-focused Care Consideration explains the issue discovered, includes the evidence-based citation to medical literature and suggests a recommendation.

Care Considerations are available for TRICARE Prime beneficiaries only.

Case Management

Humana Military nurses provide case management services to TRICARE beneficiaries with intricate health needs. If you have a patient with a complex case whom you think may benefit from case management, please refer them for services through provider self-service.

Disease Management

Humana Military assists beneficiaries with managing chronic diseases to improve their health. Eligible beneficiaries in the TRICARE East Region are under age 65, not eligible for Medicare and living with heart failure, asthma, chronic obstructive pulmonary disease, diabetes, major depression or anxiety disorders. Registered nurses work with the beneficiaries and their physicians to identify problems, establish goals and monitor progress through regular follow-up care.

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Healthcare Effectiveness Data and Information Set (HEDIS)

HEDIS is a widely used set of performance measures in the managed care industry. Humana Military works with providers to improve the HEDIS scores of TRICARE beneficiaries.

Breast cancer
Breast cancer is the most common invasive cancer in women. The five-year survival rate of breast cancer is over 90% when caught early.

Cervical cancer
By getting regular Pap tests, cervical cancer can be found early and sometimes prevented entirely. If detected early, cervical cancer is one of the most successfully treated cancers.

Colorectal cancer
Colorectal cancer usually develops from precancerous, abnormal growths in the colon or rectum. Screening tests can find these abnormal growths so they can be removed before they turn into cancer.

Diabetes test
More than 30 million people in the United States have diabetes, and one in four of them don’t know they have it. Over 1/3rd of adults have prediabetes and 90% of those are unaware they have it.

Low back pain
This measure calculates the rate of adults between the ages of 18-50 enrolled in TRICARE Prime/Plus with a primary diagnosis of low back pain who did not have an imaging study within 28 days of the diagnosis. A higher rate reflects appropriate treatment and better performance.

Appropriate Treatment for Upper Respiratory Infection (URI)
Assesses the percentage of episodes for beneficiaries three months of age and older with a diagnosis of Upper Respiratory Infection (URI) that did not result in an antibiotic dispensing event. A higher rate indicates appropriate treatment for URI (i.e., the percentage of episodes that were not prescribed an antibiotic).

Appropriate testing with pharyngitis (CWP)
Assesses the percentage of episodes for beneficiaries three years of age and older with a diagnosis of pharyngitis, dispensed an antibiotic and received a group A streptococcus test for the episode. A higher rate indicates completion of the appropriate testing required to merit antibiotic treatment for pharyngitis.