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Physician Quality Measurement Program

April 20, 2012

BlueCross BlueShield of South Carolina and BlueChoice HealthPlan are participating in a new tool to help patients make informed decisions about their health care. Beginning July 1, 2012, patients will be able to access the Physician Quality Measurement program on www.bcbs.com as part of the Blue National Doctor & Hospital FinderSM. Participation in this program allows patients to view physician performance and furthers our commitment to consumer transparency. We have already contacted the first group of participating physicians. Only their data will display in the first phase of the program.

We have partnered with the South Carolina-based Outpatient Quality Improvement Network (OQUIN) to administer this quality initiative. This collaboration allows us to develop our transparency program together while focusing on improving patient care. OQUIN is a collaborative of physicians dedicated to improving patient health through quality measures and data-driven performance. Their proven methods collect and display data showing clinical quality for various conditions, including diabetes. Participation in the OQUIN network has many benefits, including free quality reports, CME credits, decision support tools and a quarterly newsletter with evidence-based information. OQUIN has collaborated with physicians for development of the Physician Quality Management program. Before any data is reported, each participating physician will have the opportunity to review the data and address any potential discrepancies.

The Physician Quality Management program measures physician quality scores based on Healthcare Effectiveness Data and Information Set (HEDIS®) standards. For this initiative, BlueCross and BlueChoice HealthPlan have chosen to display physician quality data in the diabetes category. The National Committee for Quality Assurance (NCQA) establishes measurement parameters for each HEDIS® measure. The diabetes set includes the percentage of members ages 18 to 75 years old with diabetes (type 1 and type 2) who had:

  • Hemoglobin A1c (HbA1c) testing
  • Eye exam (retinal) performed
  • LCL-C screening
  • Medical attention for nephropathy

Physicians participating in the Physician Quality Management program are measured on their performance in these categories. OQUIN’s database, coupled with NCQA standards, will determine a local comparison score for each measure and compare that to the actual physician score to determine star ratings. We will use a three-star display to communicate if an individual physician is below (1 star), meets (2 stars) or exceeds (3 stars) the performance level score for each HEDIS physician measure compared to the local average of physicians participating in the program. Local averages for the diabetic measures are:

Diabetic Measures
 More Than Five Percentage Points Below Local Average (1 star)
Within Five Percentage Points of Local Average (2 stars)
More Than Five Percentage Points Above Local Average (3 stars)
Metric 5 Percentage Points Below Minimum Standard
NCQA Minimum Standard – Within 5 Percentage Points   5 Percentage Points Above Minimum Standard
Retinal Eye Exam Performed  <55%  55–64%  =65%
HbA1c Testing  <80%  80–89%  =90%
LDL-C Screening  <65%  65–74%  =75%
Medical Attention to Nephropathy  <75%  75–84%  =85%

OQUIN has adapted these standards from the NCQA diabetes recognition program.

Here is what it will look like on the website:

The diabetes quality measure marks the beginning of our Physician Quality Measurement program. We plan to add other measures in the future, including women’s health, heart disease, immunizations, cancer screening, asthma care and back pain. All have the goal of improving patient care for our members.

Research shows that consumers value quality measurement information of doctors and hospitals. We are committed to working with you to deliver information and tools that can help patients assume a more active role in managing care for themselves and their families.

We welcome the opportunity to discuss the Physician Quality Management program with you. Please contact Brian Butler at 803-264-3235 or Brian.Butler@bcbssc.com for more information. Also, if you would like to be a part of this initiative through our efforts with OQUIN, please feel free to contact OQUIN at oquin@musc.edu.

BlueChoice HealthPlan of South Carolina is an independent licensee of the Blue Cross and Blue Shield Association.

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