This report is part of an effort by Premera Blue Cross Blue Shield of Alaska to share information with you about its provider network. Quality reports are one of many factors you may think about when choosing a physician. If you have questions about your healthcare, always ask your physician or another qualified healthcare professional.
Because this analysis is created based on billing information rather than a review of actual patient records, we recommend you consider the following in your interpretation:
- The report provides information related to several specific areas that measure performance on important dimensions of care and service. While the current analysis differs because it is based on billing information, it uses some of the same areas measured by more than 90% of America’s health plans, as part of a chart-review based analysis called HEDIS (Healthcare Effectiveness Data and Information Set), to compare performance of health plans on a standardized basis.
- In this report, members are “attributed” to a specific provider group if they have received the majority of their care from that group. The report itself however, captures information from all billing data for the attributed member, regardless of where the member received the actual care. The report should not be interpreted to imply the group itself actually provided, or did not provide, the care being measured; rather, it reports on whether a service was performed by any provider at any location.
- Patient compliance with recommendations made by their doctor is important. This report does not and cannot measure a patient's choice to refuse recommended care. Here are two examples:
- An internal medicine group may refer patients to a gynecologist because they do not directly provide pap smears for their female patients. If these patients choose not to follow-up with the recommended care, the report may show a deficiency in that care for the primary care group even though they recommended it be done.
- Some provider groups offer a large number of urgent-care services. Even if a recommendation has been made by a clinic for a member to establish a primary care physician for their comprehensive health needs, if members do not follow through with this, the clinic they are using for urgent care services could receive a lower rating.
- Having enough data to analyze is important for this analysis. Certain physician groups did not have enough measurement data to compare to national standards for care. Absence of a score or an entire report for a group simply means Premera did not have adequate data to create an analysis. Premera will add reports for groups whenever we are able to obtain enough measurement data to create an annual report.
- This report is generated from pooled data on a group, rather than an individual provider basis. Because of this, it does not distinguish between individual providers within a clinic and all providers within a practice will have the same rating.