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How do you stack up? The cost & quality equation

October 3, 2019


Have you Googled your practice or providers lately? Chances are your patients have, and when they did, they were likely inundated with cost and quality ratings to aid them in their decision making as healthcare consumers. Going forward, information and reputation management are an increasingly important part of the job. What’s out there? What does it mean to me? What can I do about it? And how are our patients/consumers going to use this information?

More than just Google searches, the majority of payors are using some sort of tiering or designation status to rank providers and facilities on cost and quality measures. Quality measures are adopted from the National Quality Forum (NQF), National Committee for Quality Assurance (NCQA) and the Ambulatory Quality Alliance (AQA) and include such categories as preventive care, appropriate care and appropriate care outcomes. While the quality comparisons are based on nationally recognized measures, the cost comparisons are done within like specialty groups in a regional geographic area.

It is important to understand the information that payors are displaying in their provider look up tools because you have the right to review the data upon which you were measured and also to dispute it if it’s not accurate. Dispute and reconsideration procedures are typically outlined on the payor’s website.

Why should we care what’s said about us on the Internet? The main reason in this particular case is that payors are incentivizing patients to see higher quality and lower cost providers by offering them copay and out-of-pocket expense breaks. Would YOU choose a provider based on having a lower copay?

Check out your providers and your competition today:


Program Overviews:

Blue Cross & Blue Shield of North Carolina Program Overview
Blue Cross & Blue Shield of North Carolina Physician Quality Measurement
United Healthcare Program Overview
Cigna Program Overview

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