Transparency is not unique to BCNEPA; consumers need to have cost and quality information available to them to guide them in their healthcare decisions. A number of external constituencies such as URAC, Federal and State Governments, employer groups and national accounts are requiring transparency.
Furthermore, BCNEPA, as a member of the Blue Cross Blue Shield Association (BCBSA), is required to follow the standards of the BCBSA whose strategy is to engage consumers in their personal healthcare decisions; thus, BCNEPA’s transparency initiative is underway.
BCNEPA’s goal is to provide clinical measures and subsequently cost metrics, with a peer group comparison that is fair, meaningful, and usable in a manner that assists in the healthcare decision-making process and helps raise the level of quality care. The cost of care and quality metrics can be found in BCNEPA's Doctor/Hospital Finder.
In keeping with these objectives, BCNEPA performed a 15-month evaluation of transparency software tools that are available in the marketplace. After careful consideration and evaluation, BCNEPA decided to utilize the Cave Consulting Group tool under the name of the CCGroup Marketbasket SystemTM. This software tool uses a predefined set of medical conditions for a specialty type derived from each respective practitioner’s First Priority Health (FPH) and First Priority Life Insurance Company (FPLIC) claims data and calculates episode of care statistics across the predefined set of medical conditions. BCNEPA found the CCGroup Marketbasket SystemTM to be the most reliable and consistent tool available.
The cost estimations and quality information generated for this tool are updated on a semi-annual basis and are based upon a moving three (3) years of FPH and FPLIC medical and pharmacy claims data.
Please contact your provider relations consultant for specific quality measures for the applicable specialty. All quality measures are nationally recognized measures and are approved by national organizations such as the National Quality Forum (NQF), National Committee for Quality Assurance (NCQA), and numerous other groups that have extensive physician representation and vetting.
Yes. BCNEPA began introducing the transparency and the CCGroup Marketbasket SystemTM early in 2010 to the provider community through focus groups consisting of a variety of practitioner specialties. Each individual practitioner will have an opportunity to review the quality measures and scores before data is posted on BCNEPA’s new provider directory tool.
When will quality results be posted on the web?
BCNEPA’s objective is to have the quality (effectiveness) metrics (results) available to our membership by the 1st quarter of 2011.
BCNEPA’s objective is to have the cost (efficiency) results available to our membership and posted on the web in the latter half of 2011.
An opportunity to discuss any disputed data with the appropriate BCNEPA representatives will be forthcoming.
BCNEPA has adopted participation in transparency as a contracting standard, which is currently in force for all physicians applying for participation. The current initiative is to bring our current networks into compliance with our new participation standards. Additionally, going forward, a physician will not be eligible to participate in any future BCNEPA incentive program.