RAND Corporation and Humana to Test Clinical QA Tools
RAND Office of Media Relations
(703) 413-1100, ext. 5117
November 9, 2004
RAND Health QA Tools bring a decade's worth of outcomes research into practice and significantly reduce the cost of assessing clinical care
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.
Humana Inc., headquartered in Louisville, Ky., is one of the nation's largest publicly traded health benefits companies, with approximately 6.6 million medical members located primarily in 18 states and Puerto Rico. Humana offers coordinated health insurance coverage and related services — through traditional and Internet-based plans — to employer groups, government-sponsored plans and individuals.
More information regarding Humana is available via the Internet at www.humana.com, including online:
- Copies of annual report to stockholders;
- Securities and Exchange Commission filings including the company's Form 10-K, Form 10-Qs, and proxy statement, Form 4s, Form 8-Ks and Form s-3s;
- Copy of the most recent investor presentation;
- Copies of quarterly earnings press releases;
- Audio archive of the most recent earnings release conference call;
- Calendar of events (includes upcoming earnings conference call dates, related conference call access number and planned participation in investor conferences).
Quality Monitoring System for Children and Adults
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