In the January Provider Update, Gus Manocchia, M.D., BCBSRI’s executive vice president and chief medical officer, wrote about BCBSRI’s commitment to meeting the needs of those who purchase health insurance and those who use it. One of the ways that BCBSRI is doing that is by introducing performance ratings for primary care providers (PCPs) in 2019.  These ratings will be based on cost and quality data, much of which has been provided to our network PCPs annually for several years now.

Performance rating program goals

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

Important dates

By the end of February, all BCBSRI participating PCPs will receive their individual performance rating. These ratings will be made available to BCBSRI members upon logging on to bcbsri.com, in the mid-May timeframe.

To ensure providers are informed of the methodology and their performance rating, performance ratings are being shared with all PCPs in advance of the ratings being released to BCBSRI members.

Additionally, this methodology will serve as the foundation for a tiered-network product, although it will not be the only factor in tier designation. Our tiered-network product launch is scheduled for mid-May in support of a July effective date.

Reviewing your performance rating

We understand there may be conditions that necessitate the reconsideration of your performance rating. You can request the formal review of your rating by sharing new data that may add to the accuracy of the measurement process. To do so, please submit to ProviderRequests@bcbsri.org.

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

In addition, there will be a webinar available to all PCPs on 21 de março, 2019, to review the Performance Ratings and answer any questions.

All questions, requests for additional support from the above mentioned teams, rating review requests, or if you would like to sign up for the webinar, please contact ProviderRequests@bcbsri.org.