The Provider Performance Measurement System (PPMS) allows you to identify physicians who deliver both high-quality and efficient care. In addition, this system identifies the best way to encourage your population to use these providers and helps you support physicians in meeting clinical guidelines. PPMS helps identify root causes and formulate solutions, so you can implement meaningful interventions to change provider behavior, such as network structure and payment mechanisms. The system can also be used to construct benefit plans that encourage patients to use selected providers.

HDAS’ methodology and clinical insights using Unwarranted Variation® Analytics expands beyond the limitations of existing grouper-based methods, including those that use an episode grouping logic. Unlike other metrics proposed to measure provider quality and efficiency, our system of population-based measures capture both the decisions about which types of treatment are being recommended and the efficiency of delivery after that decision has been made. These measures incorporate both facility (e.g., use of ER and hospital) and professional services (e.g., physician visits, consults, use of imaging studies, and laboratory studies).

Through the use of our Provider Performance Measurement System, payors can achieve the following outcomes:

• Improved Network Design and Management—the identification of high-performance providers and the interventions needed to increase their use over lower-performing providers.
• Improved Quality and Cost Performance—results in declining per-member/per-month (PMPM) costs by working with all providers to improve quality of care in all three categories of unwarranted variation and resource allocation.
• Improved Benefit Plan Design—the creation of incentives that lead patients using inefficient providers to choose the “preferred provider,” further decreasing pmpm costs.

In effect, clients are able to build incentives to sustain the “right” behavior, motivate members to utilize high quality and highly efficient providers, and encourage inefficient providers to emulate “best practices.”