RAND Health QA Tools Bring a Decade's Worth of Outcomes Research Into Practice
and Significantly Reduce the Cost of Assessing Clinical Care
LOUISVILLE, Ky., Nov. 9 /PRNewswire/ -- Humana Inc. (NYSE: HUM) will be
the first health benefits company to test QA Tools -- software that scans and
analyzes health claims data -- developed by the RAND Corporation to ascertain
whether consumers are receiving appropriate care, Humana and RAND announced
today.
The "RAND QA Tools" derive from a landmark study of the quality of health
care in the United States published in late 2003 by Elizabeth McGlynn, Ph.D.
and colleagues at RAND Health. The study found that adults in the U.S. are
receiving the care recommended by clinical expert guidelines for many serious
clinical conditions only about half the time. These findings surprised many
in the health care industry and sent employers, consumers and health plans
searching to find efficient ways to determine whether consumers are receiving
recommended care.
The study abstracted data from medical records for thousands of patients,
looking at 439 clinical indicators for 30 common chronic and acute health care
problems as well as preventive care. The indicators were selected by a
national panel of physician experts, based on accepted standards of care.
"All the work done over the past 20 years to codify expertise about what
works in medicine has not made its way into the average clinical practice,"
said McGlynn, the study's principal investigator. "We were frankly surprised
by low adoption rates of well-established clinical practices."
RAND Health has since developed a method for screening common
administrative claims data to ascertain whether recommended or contraindicated
care is being provided. This method will focus on a subset of about
160 important measures derived from major causes of illness or reasons for
seeking care that can be accurately assessed without the costly review of
detailed medical records. The ability to screen large quantities of data
means that clinical performance may be more efficiently assessed than would be
possible using labor-intensive medical record review.
"This work will make it possible to obtain concrete, actionable
information about clinical practices that can be used to help consumers find
more effective care," McGlynn said.
RAND Health has entered into a partnership with Humana Inc., one of the
nation's largest health benefits companies, to pilot test this new method on
its claims data. RAND Health will make available the software programs to run
the clinical algorithms (titled the "RAND QA Tools") on Humana data to produce
quality of care scores for individual physicians in multiple specialties.
RAND Health and Humana staff will then jointly determine how well the software
works and how such a screening can be used in a commercial insurer setting.
"We're eager to see how well these tools work," said John Bertko, FSA,
Humana's chief actuary and a member of MedPAC, the congressional oversight
commission that makes recommendations on the future of the Medicare program.
"We all need practical, evidence-based methods to find out how well suppliers
of health services are doing based on nationally recognized, clinically
accepted standards."
About the RAND Corporation
The RAND Corporation is a nonprofit research organization providing
objective analysis and effective solutions that address the challenges facing
the public and private sectors around the world. RAND Health is the nation's
largest independent health policy research organization, with a broad research
portfolio that focuses on health care quality, costs, and delivery, among
other topics. More information on RAND is available at http://www.rand.org .
About Humana
Humana Inc., headquartered in Louisville, Kentucky, is one of the nation's
largest publicly traded health benefits companies, with approximately
7 million medical members located primarily in 15 states and Puerto Rico.
Humana offers a diversified portfolio of health insurance products and related
services -- through traditional and consumer-choice plans -- to employer
groups, government-sponsored plans, and individuals.
Over its 43-year history, Humana has consistently seized opportunities to
meet changing customer needs. Today, the company is a leader in consumer
engagement, providing guidance that leads to lower costs and a better health
plan experience throughout its diversified customer portfolio.
More information regarding Humana is available to investors via the
Investor Relations page of the company's web site at http://www.humana.com ,
including copies of:
-- Annual report to stockholders;
-- Securities and Exchange Commission filings;
-- Most recent investor conference presentation;
-- Quarterly earnings press releases (including detailed description of
unusual items, where applicable);
-- Audio archive of most recent earnings release conference call;
-- Calendar of events (includes upcoming earnings conference call dates,
times, and access number, as well as planned interaction with
institutional investors);
-- Corporate Governance Information.
SOURCE Humana Inc.
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Related links:
http://www.humana.com
http://www.rand.org
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CONTACT:
RAND Office of External Communications,
+1-703-413-1100, ext. 5117, or +1-310-451-6913, or oec@rand.org ;
or Dick Brown of Humana Corporate Communications,
+1-502-580-3683, or dbrown4@humana.com
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