Consumer-Directed Health Care Case Study

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Consumer-directed healthcare continues to gain momentum, yet the navigation tools and provider directories consumers use to select individual physicians do not offer comprehensive information about physicians. Also, the current physician ranking systems being used in the marketplace weigh physician rankings on varying methodologies. This makes it difficult to compare the rankings of physicians by other health plans. Horizon BCBSNJ must also respond to the President's 2006 Executive Order 13410 "Promoting Quality and Efficient Health Care in Federal Government Administered or Sponsored Health Care Programs." The Executive Order outlined four cornerstone requirements. 1. Supporting health IT 2. Providing quality information 3.…show more content…
Stakeholder Requests: 3.2.1. Quality Ratings for Provider Groups (COMSR1014) The Quality measures will be provided by the Horizon Informatics group. These measures have been developed by Horizon to rate their provider groups, and have been used to create the Physician Performance Reports, which are sent to groups every 6 months. These measures are calculated, and distributed for provider groups, and do not include any institutional providers. The lowest level of reporting of these measures is at the Tax-ID of the billing provider. This data will be made available to the QualScore application after an Informatics cycle is run, in an agreed upon format, and schedule, which is assumed to be semi-annually. 3.2.2. Cost and Efficiency Ratings for Provider Groups (COMSR1015) The cost and efficiency ratings will be calculated by the QualScore application. The data that will be used to calculate these cost measure will be provided by the Horizon Impact Analysis application. These measures are for physician groups, and do not include any institutional providers. The reporting of this information will be at the Provider Tax-ID level, and will not be used for any ranking of providers. This data will be made available to the QualScore application, each time a cycle needs to be
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