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Quality Assessment:

When you go to see a doctor, the doctor should do certain things to help you stay healthy or manage a disease. Look at this list of Evidence Based Measures (EBM) that we use to measure a doctor’s performance and see why they can be important to you.

Do you have diabetes? What kind of tests do you need to get?
Regular blood sugar testing (HbA1c) for diabetics
Diabetics: regularly monitor and lower cholesterol and triglycerides
Have an annual diabetic eye exam

What tests should a woman ask her doctor about?
Annual mammogram
Cervical cancer screening

Are you age 50 or older and have you talked about colorectal cancer screening with your doctor?
Colorectal cancer screening

What you should know before you go to the doctor.
When should my doctor prescribe antibiotics?
How should my doctor examine my low back pain? Avoid ordering imaging tests

Do you have heart disease?
Heart disease: monitor and lower cholesterol

Do you have asthma?
Using drugs every day to control asthma and prevent asthma attacks

What are Evidence Based Measures?

When a patient goes to the doctor, doctors should do certain things to help the patient stay healthy or manage a disease. Scientific studies help discover the most effective ways for doctors to help patients. Experts look at the results of those studies and write summaries that help doctors treat patients effectively. These summaries are called evidence based guidelines. The experts also create ways to measure whether doctors follow the guidelines when patients come to see them. These measures are Evidence Based Measures.

We look at our enrollment information to find the people who may benefit if certain things are done. We use claims from doctors, labs, X-ray facilities, and hospitals to see if those things happened. You should know that we only use the claims and enrollment data for people who are members of Blue Cross and Blue Shield of Texas. That means we don’t count the things a doctor does for patients who are covered by other insurance plans. We also can’t count the times when doctors follow the guidelines in a way that we can’t see when we look at the claims information. Patients who don't do what the doctor recommended can make it look like the doctor didn't follow the guidelines.

Blue Physician Recognition (BPR):

Blue Physician Recognition

The Blue Physician Recognition (BPR) Program supports quality care. A BPR symbol is given to doctors who have earned a BlueCompare blue ribbon for quality. Details about BlueCompare Quality Assessment, including the specialties we measure, can be found on this page.

Cost Assessment:

How Do We Measure Cost Efficiency?

We also use BlueCompare to evaluate our network doctors on Cost Efficiency. We do this by measuring how those doctors manage costs while taking good care of their patients.

Importantly, we only measure Cost Efficiency on those doctors who earned a Blue Ribbon for the quality related component, namely EBMs. Then, those doctors are compared to doctors in their own specialty who are in the same part of the state, based on how they treat similar patients. The costs we look at include all types of services (labs, x-rays, hospital charges, etc.), not just office visit charges.

In measuring Cost Efficiency we are careful to be sure our measurements are an accurate representation of a doctor's practice. For example, we don't compare doctors who have treated very small numbers of patients because such results can vary so much. We "trim" the data so that unusual cases don't skew the results.

Here is what the BlueCompare symbols mean:

Image of Dark Blue Ribbon

Meets or exceeds expected quality related performance compared to other doctors.

Image of Two Dark Blue Ribbons

Meets or exceeds expected quality related and cost efficiency performance compared to other doctors.

Image of Not Enough Data Ribbon

There is not enough data to measure performance or this doctor is new to the network. Re-evaluations are conducted periodically.

Image of Specialty Not Measured Ribbon

Performance measures are not available for this specialty.

Image of Not Enough Cost Data

Meets or exceeds expected quality related performance compared to other doctors, but there is not enough BCBSTX claims data to measure cost efficiency performance.

Image of Voluntarily Declined Ribbon

This doctor requested to not participate in the BlueCompare program.

For doctors in BlueCompare, we compare how they performed to treat similar patients. We compare doctors in a practice to their peers in the same specialty. Here is a list of the specialties we review:

Allergy-Immunology

Nephrology

Cardiovascular Disease-Non-Interventional

Obstetrics-Gynecology

Cardiovascular Disease-Interventional

Pediatric Allergy-Immunology

Endocrinology

Pediatric Pulmonary Disease

Family Practice

Pediatrics

Geriatric Medicine

Pulmonary Disease

Internal Medicine

Additional information to help you understand some of the results you may see in Provider Finder:

  • BlueCompare results are based on the performance of all the doctors in the same specialty in the practice. Each doctor in that specialty will have the same BlueCompare symbol.
  • Some doctors have offices at different locations, and we may evaluate each of those locations separately and the results could be different for each office location. So for the same doctor, you may see a different BlueCompare symbol at the different office locations.
  • For evaluation purposes, a doctor is normally assigned to a single specialty. If the doctor receives a BlueCompare symbol and appears under other specialties, that symbol may also appear for all specialties under which the doctor is listed.

NOTE: We provide information on how doctors in a practice compare to other doctors to assist you in choosing a doctor. Since we can not count all the things that a doctor does, you should not make your choice using only this information. BlueCompare is not meant to tell you which doctor you should select. This is a very personal choice, and you should not decide based only on BlueCompare information.

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