Learn about the tools we use to measure our performance to make sure you have the care you need. Check out how we’re doing in our annual reports.

The tools we use

We use a tool called HEDIS^® (Healthcare Effectiveness Data and Information Set) to track the performance of your Florida Medicaid plan. More than 90 percent of health plans in America use this tool. Having this large amount of data makes comparing plans easier. Officials check this data using a process created by the National Committee for Quality Assurance (NCQA)

What is measured?

To make sure we give our members the care they need, we measure the performance of many important health issues, including:

• Antidepressant medication management
• Asthma medication use
• Breast cancer screening
• Child and adolescent immunization status
• Child and adult weight/ body mass index (BMI) assessment
• Comprehensive diabetes care
• Continuing use of beta blocker treatment after a heart attack
• High blood pressure control

These measurements

• Help us see that our Humana Healthy Horizons in Florida^® plan meets our members’ needs
• Show us any areas that need improvement and how we can better serve our members

Check our scores

You can see for yourself how we score each year. We want you to feel confident that you have made the right choice in your plan. Members can view the data that HEDIS tracks in a yearly report card that shows a complete view of a health plan’s performance. These report cards are often published by national magazines and newspapers.

View the State of Health Care Quality report

View the guide to HEDIS Measurements

Learn more about the quality measures on the NCQA website

Annual physician reviews

We review our in-network physicians each year to make sure they’re:

• Providing appropriate care for our members
• Following Humana guidelines and requirements

We encourage our members to let us know about their experience(s) with their physicians. We use member feedback during these annual physician reviews

Learn more about how to submit feedback about your physician(s)

Quality Improvement (QI) program

To help us provide you with quality care, we developed a program to make sure we are always improving. To receive a copy of the Quality Improvement Program Description Overview, write to:

Humana Quality Operations Compliance and Accreditation     
Department - QI Progress Report
321 W Main St., WFP 20
Louisville, KY 40202

Healthy Behaviors yearly program review

View/ download a copy of this report

Overview

Go365 for Humana Healthy Horizons^® is a wellness program that offers members who are enrolled in either an MMA (Medical) or Comprehensive (MMA and Long-Term Care) Plan the opportunity to earn rewards for taking healthy actions. We know living and aging well is important, and our Healthy Behaviors program was designed to:

• Encourage and reward healthy behaviors
• Help members take steps toward being in their best health
• Help members reach their health and wellness goals

It is easy to participate in healthy activities and earn rewards through our Go365 for Humana Healthy Horizons wellness program.

 To earn rewards, members must:

• Download the Go365 for Humana Healthy Horizons app, available on the Apple App Store^® or Google Play^® on a mobile device.ⁱ
  • Members who have a MyHumana account, can use the same login information to access Go365 for Humana Healthy Horizons.
• Create an account to access and engage in the program.
  • Members who are 18 and older can register to create a Go365 account. Members must have their Medicaid Member ID.
  • Members under the age of 18 must have a parent or guardian register on their behalf to participate and engage with the program. The person completing the registration process on behalf of a minor must have the minor’s Medicaid Member ID.

Our Healthy Behaviors Program includes 10 types of activities that eligible members can complete to earn a reward.

• Health risk assessment (HRA): Rewards all members when they  complete the HRA.
• Well-Child Visit: Rewards members under 18 years old when they complete a wellness visit with their primary care physician (PCP).
• Adult well visit: Rewards members 18 years and older when they have a wellness visit with their PCP.
• HumanaBeginnings™: Rewards members 13 and up who enroll and complete our HumanaBeginnings Program, offering them prenatal and postpartum education and care management to help lower the risk of pregnancy complications (such as preterm delivery) associated with high-risk pregnancies. In addition, members are also rewarded when they get a prenatal care visit and a postpartum care visit.
• Weight management: Rewards members 12 years and older who enroll in the program and complete 6 telephonic coaching sessions with a health coach. Members must complete a well-being visit with their PCP before enrolling in the program.
• Tobacco Cessation: Rewards members 12 years or older who complete 8 telephonic coaching sessions to help them quit smoking or vaping. Complimentary Nicotine Replacement Therapy (NRT), like patches, gum, and lozenges, is only available to eligible members 18 years and older.
• Substance Abuse: Rewards members 18 or older who complete  6 telephonic coaching sessions with a substance abuse coordinator or actively participate in an outpatient program for 28–30 days to help them live a life free of drugs and/or alcohol. Members have a choice to participate in one or both programs.
• Mammogram Screening: Rewards members 40 years and older when they get an annual mammogram screening. Members less than 40 years old and at high-risk are also encouraged to have an annual screening. A Physician written order (referral) may be required for mammogram screening. Members are encouraged to check with their PCP or OB/GYN.
• Cervical Cancer Screening: Rewards female members 21 years and older when they get an annual cervical cancer screening. Members have open access for OB/GYN visits and do not require a referral from their PCP.
• Colorectal Cancer Screening: Rewards members 45 years and older when they get an annual colorectal cancer screening. A physician-written order (referral) may be required for colorectal screening. Members are encouraged to check with their PCP.

 

The below clinical success measures reflect program and/or activity completion dates between July 1, 2023, and June 30, 2024 (and rewards paid through July 31, 2024).

Health Risk Assessment (HRA)

• Overall, we completed 56,875 HRAs for members of all ages, of which 6,461 were for members diagnosed with diabetes, asthma, serious mental illness, and pregnancy which we report to AHCA quarterly. 
  • Eligible members identified with asthma and/or diabetes were referred to Humana’s disease management programs with the goal of improving health outcomes by assessing their needs and implementing interventions to assist members with complex medical needs. 
  • Eligible members identified as pregnant were referred to our HumanaBeginnings^® program where they engage with case managers to help improve birth outcomes and encourage prenatal and postpartum visits.
  • Eligible members diagnosed with serious mental illness are referred to behavior health specialists who assess their needs and implement interventions and services to assist in managing behavioral health and mental health needs.

Well-Child Visit Program

• The Well-Child Visit Program is designed to encourage and reward all members who are under 18 years to visit their PCP for an annual/wellness check-up, preventive screening, and necessary immunizations.When comparing full year 2022 vs 2023 data, we saw a 7.1% increase in Well-Child Visits.

Adult Well-Visit Program

• The Adult Well-Visit Program is designed to encourage and reward members who are 18 years and older to visit their PCP for screening, examination and assessing of medical needs.
  • When comparing full year 2022 vs 2023 data, we saw a 0.4% increase in Adult Well Visits.

HumanaBeginnings Program^v

• The HumanaBeginnings Program is designed to provide health education and care management to pregnant members 13 years and older to decrease the likelihood of pregnancy complications, including preterm delivery associated with high-risk pregnancy. 
  • Members engaged in the HumanaBeginnings Program had an 10.9% preterm delivery rate when compared to the general population which had a 12.4% preterm delivery rate.^vi
  • Members enrolled in the HumanaBeginnings Program have less hospital readmissions (1.6 per thousand members) when compared to the general population (7.8 per thousand members).^vii

Mammogram Screening

• The Mammogram Screening Program is designed to increase compliance and identify potential risk for breast cancer.  Finding breast cancer early reduces your risk of dying from the disease by 25-30% or more^viii.
  • Compared to the prior fiscal year, there was a 25% increase in Mammogram Screenings by members enrolled in the Healthy Behaviors program.

Cervical Cancer Screening

• The Cervical Cancer Screening Program is designed to increase compliance with testing to identify potential risk for cervical cancer.  If cervical cancer is caught at its earliest stage, the chance of survival is more than 85%^ix.
  • Compared to the prior fiscal year, there was a 20% increase in Cervical Cancer Screenings by members enrolled in the Healthy Behaviors program.

Colorectal Cancer Screening

• The Colorectal Cancer Screening Program is designed to increase compliance with testing to identify potential risk for colorectal cancer.  Many colorectal cancers can be prevented through regular screening and when found early, colorectal cancer is highly treatable.^x
  • Compared to the prior fiscal year, there was a 12% increase in Colorectal Cancer Screenings by members enrolled in the Healthy Behaviors program.

Tobacco Cessation/Weight Management programs/Substance Use

Because smoking, substance abuse, and weight management can cause adverse health outcomes and complications years or even decades after the successful completion of a program, measuring program efficacy is difficult during a 12-month period. To encourage long term behavior change and sustainability of efficacy, we increased health outcome education regarding the consequences of these conditions for members as they enroll and complete any of these  three programs.

Tobacco Cessation Program^xi

• The Tobacco Cessation Program is designed to treat tobacco/nicotine dependence through counseling and/or the use of medications (nicotine replacement products) as part of the overall therapeutic process.
  • 65 Members completed the Tobacco Cessation Program in Fiscal Year 2023 – 2024. Of the 65 members, 11 members participated in a telephone survey. The findings of the survey included:
    • 10 (90%) of the 11 members reduced their smoking the number of cigarettes smoked daily from an average of 9.1 cigarettes per day to an average of 4.2 cigarettes per day.
      • Of the 10 members who reduced their smoking, 4 quit entirely.
    • 39.1% indicated they gained more tools and skills needed to achieve their tobacco cessation goals.
    • 13.5% reported an increase in their confidence and ability to reach/stay smoke-free or vape-free because of the program.
    • 4.6% reported an increase in motivation to become smoke-free or vape-free because of the program.

Weight Management Program

• The weight management program provides ongoing supervision by a physician and may include the use of prescription drugs/supplements depending on the needs and goals of the enrollee, along with diet, exercise, etc.
  • Compared to the prior fiscal year, there was a 6% program completion rate increase by members enrolled in the Weight Management Program.
  • 98 Members completed the Weight Management Program in Fiscal Year 2023 – 2024.  Of the 98 members, 42 members completed a telephone survey. The findings of the survey included³:
    • 62% of the 42 members lost an average of 4.46 pounds.
    • 33% of the 42 members lost 10 or more pounds.
    • 30.7% of the members surveyed reported they have gained more tools and skills needed to achieve their weight management goals because of the program.
    • 9.5% reported an increased confidence level in their ability to reach/stay at a healthy weight because of the program.
    • 6.8% reported increased motivation to reach a healthy weight because of the program.

Substance Abuse Program

• The medically approved alcohol or substance abuse recovery program is an evidence-based approach to provide effective treatments and methods such as medically assisted detoxification, medication and behavioral therapy, and treatment and relapse prevention as part of the overall therapeutic process.
  • Compared to the prior fiscal year, there was a 39% increase in member enrollment in the substance abuse program.

Next steps

To  continuously promote member engagement and improve health outcomes, we have increased efforts to promote and enroll members into the Healthy Behaviors program via year-round, robust, multimedia approach, including a member welcome kit, email, text, social media, webpage, outbound calls, educational flyers, and videos. We also continue to collaborate with the Agency for Health Care Administration, vendors, and other community engagement programs to help improve the health and well-being of our members.

At Humana Healthy Horizons^® in Florida, we continuously look for opportunities to help our members live and lead healthier lives.  We do this by incorporating members’ feedback into existing Healthy Behaviors Programs and adding new programs.

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References

¹ All product names, logos, brands, and trademarks are property of their respective owners, and any use does not imply endorsement.

¹ Chart information reflects program enrollment and completion between July 1, 2023, thru June 30, 2024 (the Agency for Health Care Administration’s fiscal year).

¹ Completion percentages are calculated using the member’s original program enrollment date, which could occur in a prior reporting period.

¹ Humana Healthy Horizons in Florida is required to ensure that health risk assessments are completed within sixty (60) days of enrollment for enrollees who are identified as being pregnant or diagnosed with a serious mental illness, asthma, or diabetes. Required percentages vary by diagnosis.

¹ Members enrolled in the HumanaBeginnings Program have higher comorbidities, such as hypertension and behavioral health issues, than those who are not enrolled. In addition, enrollment in the HumanaBeginnings Program increases members’ timeliness of prenatal and postpartum visits which is noted above, helps to close gaps with social determinants of health, assesses behavioral health needs and provides access to behavioral health providers.

¹ General population is defined as only our Humana FL Medicaid member who meet the criteria for inclusion in the program but did not participate or complete the program.

¹ Same as vi reference

¹ Mammography: Benefits, Risks, What You Need to Know (breastcancer.org)

¹ Cervix-Screening-Fact-Sheet-English.pdf (bccancer.bc.ca)

¹ Colorectal Cancer | Early Detection and Screening | CancerCare

¹ Humana Wellness Coaching Internal Analysis based off members who completed the program and answer survey questions during the first and last call of their coaching.

¹ Humana Healthy Horizons in Florida is required to ensure that health risk assessments are completed within sixty (60) days of enrollment for enrollees who are identified as being pregnant or diagnosed with a serious mental illness, asthma, or diabetes. Required percentages vary by diagnosis.