The report that profiles specialists is comprehensive and interactive to describe data in aggregate and detailed views.  Through a series of filters, the user can understand the entire specialist population and the associated KPIs – PMPM, Claims, Total Paid, and Patient Risk as well as a complete picture of each specialist and how they compare to their peers.  The provider is linked with the procedure and is further linked with the facilities to ensure the comparisons are valid and of the appropriate detail to be actionable.

 

 

 

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.

 

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 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.

 

Referral patterns and network strategies are developed based on this level of data where comparisons can be made to determine which specialists meets the standards of quality and efficiency.

 

Details and Definitions

“Specialty” is the taxonomy associated with servicing providers, with primary care taxonomies filtered.  Header information will change with the selection of a Specialty, or application of platform or page filters.

 

Selecting an individual provider in the “Specialist Providers” table will filter the “Procedures” to the procedures for that selected provider within the reporting period.

 

Clicking on the provider hotlink (blue font) in the “Specialist Providers” table will navigate to the detail report for that provider.

 

Header

  • Specialty
  • Total PMPM
  • Providers
  • Claims
  • Total Paid

 

Specialists Group Cost & Utilization (Graph)

  • Paid/Patient
  • Avg Risk

 

Specialist Providers

  • Provider NPI
  • Provider
  • Specialty
  • Paid Amount
  • Patients
  • Paid/Patient
  • Avg Risk

 

Procedures

  • Procedure
  • Patients
  • Total Paid
  • Paid/Claim
  • Avg Risk