At Blue Cross & Blue Shield of Rhode Island (BCBSRI), it’s important to us that we help our members make more informed decisions about their healthcare. One of the tools we’re providing to members for that purpose are performance ratings for our network primary care providers (PCPs). These ratings recently became available to members within our Find a Doctor tool on bcbsri.com upon logging in to the site. Each network PCP received their individual rating in advance of it becoming available to BCBSRI members.
As you probably know, these ratings are based on an evaluation of each PCP’s quality and cost efficiency measures compared to their peers. In terms of quality, the ratings represent metrics such as how often diabetic patients are successfully treated and how often providers perform preventive screenings for diseases such as breast cancer. Cost efficiency measures look at the average cost-per-patient for PCPs compared to their peers. Because some patients obviously need more care than others, we adjusted this measure based on the disease burden each provider treats.
As a BCBSRI network provider, you play a critical role in not only keeping our members healthy, but in helping share the full picture of their health with them. Part of that responsibility involves creating more transparency into members’ care experiences and the performance of their providers, and that’s one of the goals of the performance rating program. And transparency into provider performance helps members take an active role in deciding where they receive care.
Besides our individual provider performance ratings, we also recognize high-performing hospitals as Blue Distinction Centers, which are nationally designated facilities that demonstrate improved patient safety and better health outcomes.
We look forward to partnering with you and your practice to provide additional education around quality incentives, identifying gaps in care, and identifying opportunities to continue making it easier for our members to understand—and be active participants in—their health and their healthcare.