Utilization Tips for the 2022 Humana Quality Network

25 Jan

Utilization Tips for the 2022 Humana Quality Network

The Humana Quality Network provides participating pharmacies with specific details about their pharmacy’s performance via the My Programs tab in EQUIPP®.

Within the My Programs view for the 2021 program, your pharmacy can compare the performance score for applicable measures to performance thresholds in the program.

In addition, beginning on January 26th, 2022 Humana will have updated outliers for the program!

With the update processed on January 26, patients that:

  1. Did not meet the measure intent for the 2021 calendar year
  2. AND continue to be enrolled in an applicable Humana Medicare plan for 2022

Will be displayed as outliers for the Humana program.

It is recommended that pharmacies view the performance for their pharmacy and these outliers by navigating to the My Programs tab.

Recommended Action Steps:

Given that these patients listed did not meet the intent for a measure in 2021, these patients are candidates for appropriate interventions by your pharmacy staff early and often in the beginning months of 2022.

For patients that were nonadherent in 2021: review the medications and treatment goals with the patient. Identify with the patient if more cost-effective treatments are available, if they need a change in medication or dosing due to side effects, or if they need help with adherence by enrolling in refill reminders or a medication synchronization (med sync) program.

For patients that have not filled a statin (and are eligible for either the Statin Use in Persons with Diabetes and/or Statin Use in Persons with Cardiovascular Disease) pharmacist should review the appropriateness of initiating a statin with the patient and relevant prescriber.

These actions will help your pharmacy take meaningful steps in the beginning of the year that help your patients maintain their health.

Starting in April, Humana will begin to update these outliers based on the patient’s filling history for the 2022 calendar year. Until that time, use this current patient list to help focus your patient outreach efforts.

For additional information on the measures in EQUIPP® and how they are calculated, view the Resources Tab in EQUIPP®. Our monthly Refresh Notice will also provide notes of what is new and what data your pharmacy should be reviewing.

If your team is looking for additional information check out the PQS Youtube Page which includes many short form videos or listen to the PQS Quality Corner Show podcast where we discuss Quality Improvement strategies.