The report is important to understand the PCP Group performances in a detailed and comparative format. A provider group score vs a KPI Metric is displayed graphically for comparisons of performance.
Target Audience for this Report
Chief Medical Officer, Finance Department and CFO, Leadership Team, Medical management/Care Management Department, Physician Relations, Quality Management, Utilization Management, and Sales and Client Relations.
Business Processes Impacted by this Report
All metrics for the groups offer trending and comparison used to identify any outliers and to understand overall cost and utilization for the health plan.
Physician group specific data in a format that allows comparison of like specialties and member populations are increasingly used as the basis for quality improvement efforts, contracting decisions, and financial incentives.
Physician groups are interested in data which they believe represents their performance in a comparative manner. Using this report with physician groups allows them an opportunity to validate and learn about the metrics in order to modify aspects of their practice.
Network strategies including the development of high performing networks are informed by this report.
Detail and Definitions
Valid “Score Type” selections are; Overall Score, Cost, Utilization, Quality, PMPM, % Level 4/5, ER Visits Per 1000, Prevention (%), Admissions per 1000, Readmissions Rate (%), ALOS, Paid/Claim, Paid/Admit, Lab/Radiology, Avoidable ER Visits, and Complications. This is a single-select drop down control. Statistics are a rollup of the individual statistics of the providers associated with the selected group.
Clinigence Health uses a proprietary scoring system to calculate the provider ranking and Percentile Rank:
- Categories are: Cost, Utilization, Quality, Prevention, Pharmacy
- Some of the sub-categories are specific to the specialty.
- Cost and Utilization categories are patient risk adjusted. This means that if a provider’s patients have a higher average risk score than the other providers in the same specialty/panel size, this will be weighed in the scoring.
Clinigence Health calculates provider ranking by:
- Provider Groups are ranked by the individual calculated PCP calculations.
- The Provider Group with the highest average scoring of individual PCP’s has a ranking of 1.
- Percentile Rank shows ranking by percentile of the Provider Groups within the peer groups.
The header information shown at the top of the screen are calculated values for the subject group that was derived from the criteria selected by the user.
Provider Groups (within the selection group) are shown on the left side of the screen with the default sort being provider group overall ranking (high to low). A specific Provider Group Performance Report can be accessed by clicking on the hot linked provider group name (in blue font). Each provider group in the selection group is represented in the scatter chart in the center of the screen. The Y axis reflects performance, and the X axis shows PMPM. The solid lines represent the average, and the dotted lines represent a standard deviation. Each provider group is represented by a bubble on the scatter plot. Pausing over a bubble will present identification information for that provider.
- Score Type
- Overall Score
- Avg Risk
- Avg PMPM
Provider Group Scores
- PCP Group ID
- Group Name
- Panel Size
- Percentile Rank
Overall Score vs KPI Metric
- Provider Group Percentile
- Average Provider Group Risk (Member Risk)