One Dream One Team, One Humana. Humana Inc. One Dream One Team, One Humana.

Introduction The Clinical Innovations Quality Systems Integration Department at Humana Inc. processes Supplemental Data-data that does not come through the claims processing process in order to provide Humana with award winning Star ratings. Star ratings uses scores for the different measures each plan from a healthcare company offers. The Star ratings measure the overall quality of services offered by a healthcare company.

One Dream, One Team, One Humana Mission Statement One Dream, One Team, One Humana

Vision Statement Humana is committed to helping employers manage their healthcare costs, guiding consumers to make informed health and benefits decisions, and giving back to the communities we serve.

Values Inspire health, Cultivate Uniqueness, Rethink Routine, Pioneer simplicity , Thrive together 

Clinical Innovations Quality Systems Interrogation Clinical Innovations Quality Systems Integration (QSI) team handles clinical data at Humana Inc. The data the Clinical Innovations QSI team collects is usually referred to as Supplemental Data and is not accounted for on claims. So this data has to go through a supplemental data process, which is extremely manual so these files can go through Humana’s IT department and ultimately to our vendor where the information is prepared to count towards Humana Inc.’s HEDIS scores.

Internal Environment Humana has over 10,000 employees and thousands of members. As a result Humana has impressive revenue and a history of providing health care. Resources-Humana has history, customers, revenue, experience, presence in the community and a robust network of providers in the community.

SWOT Analysis Strengths: Partnerships with gyms, spas, Universities, communities that promote wellness and are recognized as wellness supporters. Weaknesses:-more experienced in the healthcare field vs. Wellness. Opportunity: -To develop wellness programs and increase membership which making existing membership healthier. Threats:-other healthcare companies and wellness companies.

Conclusion Star ratings are very important to healthcare companies especially since the passing of the Affordable Care Act (ACA) which limits the amount of profit a healthcare company can earn off of premiums charged to their members. The Clinical Innovations QSI team ensures that Humana Inc.’s data is processed accurately and timely in order to keep Humana rated highly among healthcare providers.

References https://www.humana.com/ https://www.facebook.com/HumanaCareers/posts/10151445749956741 https://www.humana.com/about/company-profile/ http://www.humanacsrreport.com/company_profile.html http://www.medicare.gov/find-a-plan/staticpages/rating/planrating-help.aspx