SixPerformanceMeasures-Infographic-110524
PROVIDER CLAIMS INSIGHTS & ADEQUACY
PROVIDER PERFORMANCE
Without comprehensive information, are your provider network gaps really filled? Make sure you are filling gaps with providers that are clinically active in the right specialty and line of business.
For example, if you look at the state of Iowa below, there are four counties with gaps. If we focus in on Fayette County, we see that there are gaps in four specialties:
- Primary Care Physicians (PCP)
- Pediatrics
- Cardiology
- OB/GYN
GAPS
| Specialty | Providers |
|---|---|
| Primary Care Physicians | Dr. Salcido, Dr. Nguyen, Dr. Campbell, Dr. Atwood, Dr. Villareal |
| Pediatrics | Dr. Lai |
| Cardiology | |
| OB/GYN |
PROVIDER ADEQUACY GAPS
- Dr. Salcido Effectiveness (Quality)
- Provider Claim activity (PCA)
- Medicare Efficiency (Cost)
- Top Procedures
- Top Conditions
USING QES ADEQUACY
You can identify providers to fill the PCP network gap. Simplify provider selection with powerful data insights.
There are 6 providers that meet the need and your network criteria for your primary care gap. Based on this information, which provider would you choose? To truly build a strong network, you need comprehensive data.
PROVIDER PERFORMANCE MEASURES
| Provider | Core Effectiveness | Efficiency | Quality Measures |
|---|---|---|---|
| Dr. Nguyen | 5 out of 5 | 3 out of 5 | Office Visit |
| Dr. Campbell | 5 out of 5 | 4 out of 5 | Type 2 Compound |
| Dr. Atwood | 4 out of 5 | 2 out of 5 | Asthma |
| Dr. Villareal | 5 out of 5 | 4 out of 5 | Allergies |
| Dr. Lai | 5 out of 5 | 4 out of 5 | Depression |
The optimal provider to fill the adequacy gap for primary care is Dr. Atwood.
BOTTOM LINE
Using the additional data provided by Provider Claims Insights, if you were to contract with Dr. Atwood for Primary Care in Fayette County, you will no longer have a gap. More importantly, your network will have a provider that will mitigate your regulatory risk, increase member satisfaction while lowering your medical spend and administrative costs.
PROVIDER CLAIMS INSIGHTS
Revolutionize your network design strategy using data-driven decisions for optimal performance. Elevate your network’s quality, lower costs and ensure compliance while gaining a competitive advantage and enhancing your members’ experiences.