Shows a detailed comparison of the selected provider vs all other providers within the selected specialty by, KPIs, Procedures and Diagnosis.

 

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

Comparisons are used to identify any outliers and to understand overall cost and utilization for the health plan.  

 

Physician specific data allows peer specialty comparison of member populations and 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

KPI, Diagnosis and Procedure level comparisons for selected provider to all other providers within the specialty.

Header

  • Provider Name
  • Specialty
  • Location
  • Tax ID
  • Incur From – Detailed data period.

 

Provider’s Major KPIs

  • KPI
  • Values

 

Procedures for Selected Provider

  • Procedure
  • % of Claims
  • Frequency
  • Paid/Procedure
  • Total Paid

 

Diagnosis for Selected Provider

  • Diagnosis
  • % of Claims
  • Frequency
  • Total Paid

 

Specialty Major KPIs

  • KPI
  • Values

 

Procedures – Same Specialty All Providers

  • Procedure
  • % of Claims
  • Frequency
  • Paid/Procedure
  • Total Paid

Diagnosis – Same Specialty All Providers

  • Diagnosis
  • % of Claims
  • Frequency
  • Total Paid