Included providers
Providers (medical groups or hospitals) are included in the cost and quality ratings if they meet the following requirements:
- They offer primary care or selected specialty care if a medical group; or maternity or medical/surgical care if a hospital. The selected specialties are cardiology, ear, nose and throat, obstetrics/gynecology and orthopaedics. These specialties are chosen based on frequency of use and availability of measures.
- They care for enough HealthPartners members so that sufficient data are available for analysis. This is defined as having a minimum number of attributed members for primary care and a minimum number of episodes of care for specialties.
- They are a provider that members can make appointments with directly, without a referral.
- They are a provider that treats a broad base of patients, rather than a community-based clinic focused on Medicaid patients.
- The scope of services they provide is representative of the specialty.
For purposes of displaying cost and quality ratings, a medical group’s rating is displayed in connection with the individual clinics and physicians within the medical group. HealthPartners does not rate clinics or physicians separately.
Not all providers receive a cost and quality rating
Providers with ratings represent more than 70 percent of all episodes of care for HealthPartners members. HealthPartners assigns a cost or quality rating based on extensive data and analysis. Some providers do not have a sufficient number of HealthPartners patients to accurately assign a cost or quality score. Additional providers will be rated when the volume of data is sufficient.
Ratings for cost and quality depend on the availability of data. In the Minnesota region, we have a significant volume of claims data to rate our providers and facilities. Currently, there is no comprehensive national source for cost and quality information for primary and specialty care. National sources currently offer information only about hospitals. In addition, this national source cost data is currently limited to billed charge data, which does not take into consideration health plan negotiated discounts.