How are providers reviewed for participation in Humana Preferred (BHCG)?
Physicians identified as efficient in 20 specialties were evaluated by statistical methods, which identified and measured episodes of care costs, including physician, hospital, ancillary, pharmacy, and laboratory costs. There were additional criteria applied to large physician groups. Not all Humana Preferred (BHCG) physicians were evaluated in the selected specialties or met the evaluation criteria. Some are included because they practice in a physician group practice which as a whole has met the criteria. Other physicians who have not been evaluated or meet the evaluation criteria are included in order to meet geographic access standards or practice in a unique sub-specialty needed in the network. If a currently contracted Humana provider did not have enough data available to evaluate, the provider was included in the high performance network plan offering; however Humana will continue to track the provider’s data every six months and once a sufficient number of episodes are realized
