Web-Based Reporting
As part of participation in PGIP, you will be asked to review reports about the care your BCBSM patients are receiving. These reports will be mailed to you quarterly, as well as be available via the web. You will be asked to attend occasional meetings to discuss these reports, along with what your office and IPA/PHO can do to continuously improve the care our community receives. You will also be invited to adopt e-prescribing and disease registry technologies. In the quality component, we will work to ensure that our patients with diabetes, heart failure, coronary artery disease and asthma receive basic services identified in the consensus of medical evidence.
Data Reporting
Success in PGIP depends upon timely reporting of performance, at the consortium,physician group, and individual physician level. CIPA has engaged MAG to collect, analyze, and synthesize pharmacy claims data from BCBSM. MAG has developed pharmacy performance reports that help physicians understand their baseline performance in each of the target areas and their improvement over time. The reports focus on three levels:
(1) Overall CIPA performance
(2) Respective physician organization performance vis-a-vis other CIPA physician organizations
(3) Individual performance vis-a-vis your physician peers in your respective physician organization.
The Medical Management Committee (MMC) is the primary venue at which MAG communicates with the respective physician groups. MAG consultants meet quarterly with each physician group at the MMC. The purpose of these meetings is to report on PGIP developments, communicate performance to-date, and facilitate delivery of MAG reports to physicians. More specifically, the quarterly reports include:
- Level of Analysis
- CIPA-level Reports
- "Big picture" reports to monitor overall performance
- IPA/PHO-level Reports
- Compare performance against other PGIP participants and non-PGIP control group
- Specialty-level Reports
- Identify areas of strong/weak performance
- Control for differences in prescribing by PCP type
- Allow physicians to compare performance against peers
- Individual Physician Reports
- Detailed physician prescribing profiles
- Differentiate strong/weak physician performance
- Identify physicians for more detailed reporting
- Report Type
- Current Point-In-Time
- Snapshot of organization, specialty, and individual performance in most recent quarter
- Benchmark to other groups to compare performance and identify areas of strength and weakness
- Trend
- Track organization, specialty, and individual performance over time
- Measure progress toward program goals
- Opportunity
- Identify high cost and high utilization areas
- Identify opportunities for focused intervention