What is Physician Profiling

Understand Practice Patterns and Variations in Care

Physician profiling creates a way to compare physicians with their peers. Physician profiling can allow payers to compare networks, groups and individual physicians with metrics that track quality, utilization, cost and prescribing practices against group, network and national benchmarks. Showing physicians how their performance compares to other physicians to improve clinical, quality and cost-related outcomes. Physician profiling can also be used to allocate funds generated by shared savings and other pay-for-performance payment models.

Transparent Results

It is essential that physicians find physician profiling data and analytic methodologies credible in order to have the desired effect on physician behavior. For example, physicians must be convinced that the payer has addressed the challenge of comparing physicians with disparate patient populations. This can be accomplished with risk-adjusted efficiency profiles for primary care providers (PCPs) and specialists that take into account that one physician's patients may have arrived sicker than another physician's patients.

Actionable Data

Multi-level drill down and companion reports make the physician metrics actionable, identify where physicians can improve, and can drive measurable change. Flexible configuration of PCP and specialist reporting hierarchies allow payers to generate reports for provider populations and to manage their networks in the manner most meaningful to them.

HMO and PPO Attribution

Where there is a mix of Health Maintenance Organization (HMO) and Preferred Provider Organization (PPO) plans, reports and profiles can be generated in aggregate, or by health plan, permitting the segregation of reporting for attributed and non-attributed primary care provider panels.

Episodes of Care

Specialist profiles are based on episodes of care attributed to specialists in the specialty being profiled. Risk-adjusted clinical performance guidance compares physicians to their specialty peers and regional and national benchmarks.

Clinical Care Guidelines

Clinical care guidelines are often used in physician profiling. These reports can be generated for PCPs based on their panels. Quality reports can also be produced based on the physician or physicians primarily responsible for the care specified by a specific guideline. For each guideline, each eligible patient is attributed to the appropriate treating physician(s) who can be a PCP and/or specialist depending on the specific guideline.

Credibility is Critical

It is essential that physicians find the profiling data and analytic methodologies to be credible. They must be convinced that the methodology addresses "My patients are sicker" assertion. They must be able to see where the data came from, and have access to the data throughout the year to identify opportunities for improvement.

Learn why McKesson Risk Manager is the ideal physician profiling solution for your organization.

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