Enhancement gives members additional insight as they make decisions about their healthcare

PROVIDENCE, RI – Blue Cross & Blue Shield of Rhode Island (BCBSRI) is helping its members make more informed decisions about their healthcare by providing insight into performance ratings for in-network  primary care providers (PCPs). The ratings, based on quality and cost-efficiency measures, are in BCBSRI’s online Find a Doctor tool.

“Primary care providers play a critical role in keeping patients healthy given their unique vantage point of seeing the full picture of their patients’ health," said Kevin Splaine, BCBSRI executive vice president of care integration and management. “Patients should feel empowered to choose a provider who has a proven track record of performance, in addition to weighing other details that matter to them, whether it be their location, the language they speak or recommendations from friends and family."

The ratings are based on an evaluation of each PCP’s quality and cost efficiency measures compared to their peers, or PCPs like them. On the quality side, the ratings represent how often patients are successfully treated and how often providers perform preventive screenings for diseases such as breast cancer and diabetes. On the cost efficiency side, the ratings signify the average cost-per-patient for each PCP compared to their peers. Since some PCPs have patients who need more care, BCBSRI adjusted the measure based on the mix of patients the provider treats.

“Transparency into provider performance is key in helping members play an active role in improving and maintaining their health, which so often starts with their primary care provider," said Matt Collins, M.D., BCBSRI vice president of clinical integration. “We’re hoping that by breaking down barriers and promoting transparency and accessibility, patients will feel a type of ownership or relationship with their PCPs, thinking of them as ‘their’ doctor or nurse practitioner."

Ideally, increasing transparency in healthcare will help to empower patients on their journey to a healthier lifestyle and being more proactive with their care overall. In addition to rating PCPs on performance, BCBSRI distinguishes high performing hospitals as Blue Distinction Centers, which are nationally designated facilities that demonstrate improved patient safety and better health outcomes. BCBSRI also honors select patient-centered medical homes with NCQA accreditation. BCBSRI members can view PCP performance ratings through the Find a Doctor tool on bcbsri.com.