This year, BCBSRI will roll out a specialist-focused performance rating program to provide and share enhanced performance feedback to this group of providers. Some of our network cardiologists and orthopedists actually helped us develop this program, and we are ready to share it with our entire network of cardiologists and orthopedists. We’ll do this through a live, web-hosted event this spring – stay tuned for more details. After this event, BCBSRI network cardiologists and orthopedists will receive their individual performance ratings and supporting documentation.

The specialist performance rating is made up of three components: cost efficiency, practice pattern variation (PPV), and quality. Cost efficiency is comparing the cost of an episode of care with the average cost of peers. PPV data originates from commercially available Medicare claims that are analyzed to find specialist utilization patterns compared to peers. This allows for an evaluation of efficiency using price-neutral analytics. Quality is based on whether a provider participates in a Merit-based Incentive Payment System (MIPS) or a qualified registry.