Provider Performance Awards

The awards shown are based on an evaluation of each primary care provider’s (PCP) quality and cost efficiency measures compared to their peers. PCPs can be physicians, nurse practitioners, or physician assistants.

• Quality Award: This PCP performs better than their peers across multiple quality metrics. See the FAQ about quality,
• Cost-Efficiency Award: This PCP manages their patients’ overall healthcare costs better than their peers. See the FAQ about cost efficiency.

Frequently Asked Questions

You check out the performance of so many products and services, like restaurants and mechanics. We think your healthcare is even more important, so we have offered this feature to help you make informed decisions about your doctors.

BCBSRI’s Provider Performance Awards are just one thing you should consider in choosing a primary care provider (PCP), along with other details that matter to you, like location, special area of focus, or language spoken, among other factors.

How do you measure performance?

Providers can earn two types of performance awards: quality and cost efficiency. PCPs are measured against other providers like them.

How is quality measured?

We measure two things for quality performance:

• How often patients are successfully treated, which we call “successful clinical outcomes.”
• How consistently the doctor, nurse practitioner, or physician assistant follows best practices for things like:
  • Breast cancer screening
  • Controlling high blood pressure
  • Managing diabetes – hemoglobin A1C control
  • Well child counseling – body mass index assessment

We base this approach on nationally accepted quality measures developed or endorsed by a number of organizations, including the Centers for Medicare and Medicaid Services.

“Cost efficiency?” Does that mean how expensive a PCP is?

Not exactly. Cost efficiency measures the average cost-per-patient for each PCP compared to other PCPs like them. Some doctors have patients who need more care, so we adjust the measure based on the mix of patients the doctor, nurse practitioner, or physician assistant treats. We also don’t count high-cost cases, which we consider any cost-per-patient over $150,000.

Who counts as a patient for a provider?

A provider’s BCBSRI Performance Award is based on their patients who have their insurance through BCBSRI.

What do the awards mean?

• Quality Award: The provider performs better than their peers across multiple quality metrics. See the FAQ about quality,
• Cost-Efficiency Award: The provider performs better than peers on cost efficiency. See the FAQ about cost efficiency.

Sometimes if there is no award, we may not have enough data about that PCP to provide an award. Also, the provider may practice in a specialty that isn’t being measured.

How frequently are performance awards refreshed?

We measure PCP performance on an annual basis and will refresh the awards each year.