In the January Provider Update, Gus Manocchia, M.D., BCBSRI’s executive vice president and chief medical officer, confirmed BCBSRI’s commitment to meeting the needs of those who purchase health insurance and those who use it. One of the ways we’re doing that is by introducing PCP performance ratings.

All BCBSRI participating PCPs should have received an individual performance rating at the beginning of March. These ratings will be made available to BCBSRI members upon logging on to bcbsri.com beginning in mid-May.

As shared previously, this methodology will serve as the foundation for tiered-network products, although it will not be the only factor in tier designation. A tiered-network product will be made available to the market in late 2019.

PCP performance rating program goals:

• Provide comprehensive reporting to show performance compared to peers, based on existing programs and data made available to PCPs.
• Report out areas of strong performance and potential areas for improvement.
• Provide members with the information they need to ensure they have the ability to choose a provider who exceeds their expectations.
   

Reviewing your PCP performance rating

We understand there may be conditions that necessitate a review of your PCP performance rating. You can request a formal review of your rating by e-mailing ProviderRequests@bcbsri.org.

The BCBSRI Network Performance Team is available to help you identify opportunities for improvement and understand the PCP profile. The BCBSRI Quality Concierge program has a team of dedicated nurses who can provide additional education of the PCP Quality Incentive Program (PQIP), help identify current gaps in care, and identify areas of opportunity within each defined measure.

All questions, requests for additional support from the above mentioned teams, or rating review requests can be directed to ProviderRequests@bcbsri.org.