As of early May, Humana has enhanced the types of outliers being provided in the EQuIPP dashboard. As part of this enhancement, there are key details associated with the Humana-provided outliers that PQS would like to make you aware of:

There are two potential outlier types for Humana 

(e.g. "Outlier" & "Late Refill")

1. Outlier (Outlier Type in EQuIPP)

NOTE: this is a change in display from what Humana was providing in the past whereby the outlier type was listed as "Priority".

Adherence/PDC measures

• Beginning in Early April, 2017 the adherence outliers listed are those patients who are non-adherent based upon 2017 claims data only and do not reflect the data date range displayed on the 6 month trend in EQuIPP. 

• HRM - First Fill HRM outliers will be resume being displayed starting later in May 2017 and will be based on only 2017 data. Pharmacies should use this outlier display to proactively address patient medication profiles and consider alternative therapies.

• Humana Outliers can be associated with both the "Humana Quality Network" and Non-Quality network and will be defined within the outliers table in the "Provided by" column and will display as the following. 
• "Humana Qlty Net"
• "Humana Non-Qlty Net"

Humana is targeting to update outliers as frequently as weekly - it is recommended that pharmacies view their dashboard each week to identify new outliers

Please note that if you do not receive outliers associated with one or both of these patient populations, it may be due to the fact that you do not currently have any patient outliers at your pharmacy.

2. "Late Refill"

• This is a new outlier "type". The outlier type will display as "Late Refill" NOT "Outlier" since these patients would not actually be outliers during the measurement period that is evaluated.
• These outliers will be determined using 2017 data ONLY and will only display for 30 days

• This will let pharmacies know of patients who are or were late to refill, in which Humana defines as 11-17 days past due.
• NOTE: Pharmacies should not expect the exact number of outliers based on current performance score due to Late Refill outliers being listed
• These outliers may be helpful to remind pharmacies of patients that are due for a refill and help you keep them from becoming non-adherent.

Designations & Individual PDC Rates

• New Outlier designations and patient-specific PDC rates for Humana patients will be displayed starting today. The new designations are as follows:

90 Day Outlier Designations

• Available for PDC measures only.  Will highlight non-adherent patients where the most recent fill for a medication applicable to the PDC measure is less than a 60 day supply.  Patient Outliers for the PDC measures with the 90 Day Opportunity designation can be sorted within the pharmacy Patient Outlier table allowing for pharmacy users to quickly bring all 90 Day Opportunities to the top of their case list. 

Low Income Subsidy (LIS) Outlier Designations

• Designation provided where pharmacies would be able to easily identify unique member populations within the health plan who are eligible for a Low Income Subsidy. The designation will help identify that the member may be eligible for additional services or reduced co-pays or require advanced clinical support.  

"No Impact" Outlier Designations

• Designation whereby the patient cannot achieve a proportion of days covered of at least 80% with the days remaining within the calendar year.  The "No Impact" outlier designation shall bear a clear indication to pharmacies to help understand which patients are negatively impacting performance scores. This represents patients who do not have the potential to become adherent within the current calendar year. 

"Actionable Impact" Outlier Designations

•  Designation whereby the patient can achieve a proportion of days covered of at least 80% or greater with the days remaining within the calendar year.  The "Actionable Impact" outlier designation shall bear a clear indication to pharmacies to help understand which patients are currently negatively impacting performance scores but have the potential to become adherent within the current calendar year.  

• As a reminder, if your pharmacy has any outliers listed, they will be found by clicking on the outliers button under the Gap column of the specific measure that you are viewing.  

If you have any questions, please click on the Support button located in the top right corner of your EQuIPP dashboard or  CONTACT US.

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