Provider Performance Awards
The awards shown are based on an evaluation of each specialist’s commitment to quality, cost efficiency, and adherence to practices common among their peers.
- Quality: This specialist has made a commitment to capture and report quality metrics.
- Cost Efficiency: This specialist manages their patients’ overall healthcare costs better than their peers, based on the type of patients they see.
- Practice Patterns: This specialist has similar practice patterns to their peers, based on the number of services they provide
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. Use these Specialist Performance Awards along with other factors that matter to you when choosing a specialist.
What specialties are covered by these awards?
Cardiology
Dermatology
Gastroenterology
Orthopedics
How do you measure performance?
Providers can earn three types of performance awards: quality, cost efficiency, and practice patterns. Specialists are measured against other providers like them.
How is quality measured?
Providers receive the Quality award by displaying a commitment to quality through their participation in national registries that track quality measures: the Merit-based Incentive Payment System (MIPS) through the Centers for Medicare & Medicaid Services (CMS) or another nationally certified registry.
“Cost efficiency?” Does that mean how expensive a specialist is?
Not exactly. Cost efficiency measures the average cost-per-patient for each specialist compared to other specialists like them. Some doctors have patients who need more care, so we adjust the measure based on the mix of patients the provider treats.
How is the Practice Patterns award determined?
We use a method called “practice pattern variation analysis” (PPVA). Basically, it measures whether a specialist is treating patients differently than their peers do. An example of this is how many office visits per patient the provider has. A high level of office visits could indicate a variation from common practices.
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: This specialist has made a commitment to capture quality metrics.
Cost Efficiency: This specialist manages their patients’ overall healthcare costs better than their peers.
Practice Patterns: This specialist has similar practice patterns to their peers, based on the number of services they provide.
If there is no award, the provider might practice in a specialty that is not covered under the awards. Also, we may not have enough data about that specialist to provide an award.
How frequently are performance awards refreshed?
We measure specialist performance on an annual basis and will refresh the awards each year.
BCBSRI provides these awards to help members make better-informed choices for their healthcare. The awards are a partial assessment of quality, cost-efficiency, and practice pattern variation, and have a risk of error, and should not be the sole basis for selecting a provider. The awards provided here are not an endorsement, referral, or recommendation of any provider. BCBSRI does not guarantee the quality or cost-efficiency of services provided by any provider or the treatment outcome. The fact that a provider does not have an award does not mean that they do not provide high-quality care, and the fact that a provider has an award does not guarantee that they will provide high-quality care. Moreover, some providers will not have an award if there is not enough data to measure. The methodology used to determine these awards is subject to change.