This report shows performance of the primary care providers of members/patients represented in the population of records in the database. Performance can be filtered by Specialty, Score Type, and Panel Size.
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
Filtering by PCP provides information that supports a targeted approach to provider outreach, education and network management.
Physician 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.
Public and private health plan purchases are demanding more information about physicians and this can aid in presenting that information to clients or potential clients as well as supporting bids with Medicaid and Medicare Advantage plans.
Individual physicians as well as physician groups are interested in data which they believe represents their performance in a comparative manner. Using this report with physicians allows them an opportunity to validate and learn about the metrics in order to modify aspects of their practice.
Detail and Definitions
Valid “Specialty” selections are; Family Medicine, General Practice, Geriatric Medicine, Internal Medicine, Other Specialties, and Pediatrics. These specialties are driven by the taxonomy associated with a provider’s National Provider Identification (NPI) number. This is a single-select drop down control. 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. Panel Size selections specifies the range of patients in the provider’s panel. Value values are; 25 - 49, 50 – 99, and 100+. Overall score is calculated within the provider’s specialty and panel range.
- Overall Score (average)
- Avg Risk (Member)
- Avg PMPM
Provider Performance - Providers (within the selection group) are shown on the left side of the screen with the default sort being provider rank (high to low). A specific Provider Performance Report can be accessed by clicking on the hot linked provider name (in blue font).
- Provider Name
- Panel Size
- Percentile (Ranking)
Score vs KPI Metric (Graph) - Each provider in the selection group is represented in the scatter chart in the center of the screen. The Y axis reflects Provider Percentile Ranking, and the X axis shows the Average Member Risk. The solid lines represent the average, and the dotted lines represent a standard deviation. Each provider is represented by a bubble on the scatter plot. Pausing over a bubble will present identification information for that provider.
- Provider Percentile (Ranking)
- Average Provider Risk (Member Risk)
Percentile Ranking Trend (Graph) – Shows the Provider Percentile Ranking over the last 12 months. This shows the how the selected Provider has been trending compared to peers.
- Month and Year