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CARE HIGHLIGHT PROGRAM

A way to discuss what could be the right care for members.

An important part of human care is making sure that your members are happy with their providers. We want them to be comfortable. Respected. And greeted by name when they walk in the door.

The Care Highlight Program

Humana’s Care Highlight™ Program uses objective criteria to help identify doctors who have been proven to meet quality and cost-efficiency metrics. It’s built to increase transparency and help you have informed conversations about providers with members.

So your clients can get the clear advice they need, straight from the person they trust most. You.¹

Here’s how it works.

Certified by the NCQA

Care Highlight is a provider ratings program certified by the NCQA.²

 

Effectiveness & Efficiency Ratings

Providers in the program are assessed based on effectiveness and efficiency, receiving up to four hearts and badges.

Use Find a Doctor Tool

These ratings power the Find a Doctor Tool, helping Agents compliantly connect members with care by searching for providers that meet effectiveness and efficiency criteria.

And here’s how to make it work for you.

Ask your members if they’re satisfied with their current care.

If they are not, or express interest in seeking new care, proceed to step two.

If they are satisfied with their current doctor, ask if they would like to learn about Humana’s Care Highlights program. If they say yes, proceed to step two.

Explain the program.

Share that Humana’s Care Highlight™ program recognizes physician practices in certain states that meet quality and cost-efficiency guidelines.³

Search in the Find a Doctor Tool.

First, ask your member what they prefer in regards to gender, language spoken, location, etc. Use the website to show your clients the providers that meet this criteria. If those providers display badges and hearts, explain what each rating means. Answer any questions they may have using the information available to you in the Find a Doctor Tool.

High five!

You’ve helped your member select a new doctor (or dentist!) that they feel good about. Compliantly.

See for yourself.

Friendly Reminders

Like everything we strive to do, provider discussions should always be in the best interest of the member.

  • Always advise your members to think about what is important to them when selecting a doctor.
  • The ratings are only one consideration to keep in mind when helping them find care..They do have a risk of error.
  • Encourage your clients to discuss with their existing physicians before making a decision.
  • Also be sure to inform members that additional network providers are available. Ensure they always feel completely free to choose any provider in the network.

¹ Humana’s Care Highlight™ program ratings are only a guide to choosing a physician. Members should discuss with their existing physicians before making a decision, and given that such ratings have a risk of error, they should not be the sole basis for selecting a doctor. Humana does not give performance-based payments to physicians based on these ratings.

² https://www.humana.com/member/using-a-health-insurance-plan/care-highlight-program

³ At this time, the Care Highlight program is unavailable in the following states: AK, CA, CT, HI, NH, NJ, NV, NY, MA, ME, RI, VT and Puerto Rico and  for certain specialties. In addition, ratings are only available for physicians once a sufficient amount of data is available, therefore some physicians may not have ratings available at this time.

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