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BlueCompare Frequently Asked Questions
- What is BlueCompare?
BlueCompare is a component of the online Provider Finder® tool. BlueCompare includes Evidence Based Measures information about participating physicians in the BlueChoice® and BlueChoice Solutions networks (including physicians who service HealthSelect, UT Select and other group accounts). Information for HMO Blue® Texas and ParPlan is not available.
The BlueCompare tool is provided for informational purposes only. BlueCompare information is available to assist members and non-members in the selection of a health care provider. It is not intended to be a recommendation to consumers. Selection of a health care physician is a personal choice, and consumers should not base decisions solely on Evidence Based Measures (EBM) information displayed in BlueCompare. BlueCompare is based on claims from Blue Cross and Blue Shield of Texas (BCBSTX) PPO and POS and membership records and may not be indicative of the physician’s overall practice
- What modifications were made to BlueCompare for 2009?
The modifications to the BlueCompare update in 2009 include
- There is only one ribbon color (dark blue) which will be used for all physicians who either meet or exceed expected performance.
- Physicians with insufficient data to score will receive an EBM Report and Patient List.
- Three informational measures (not used to evaluate any physician’s EBM performance this year) have been added to the EBM Reports. This information is provided as performance feedback only.
- Changes have been made to the list of measures and specialties evaluated. View a complete list of measures and specialties evaluated.
- Physicians who did not meet the threshold for recognition must submit a written response regarding their performance. More information can be found in their BlueCompare letter and on our Web site "How to Request Reviews and Make Inquiries."
- We apply EBM indicators to physicians only. We do not display BlueCompare symbols for other professional providers
- What are Evidence Based Measures (EBM)?
Evidence Based Measures use claims and enrollment data to assess adherence to recognized clinical guidelines. Health Benchmarks, Inc (HBI) maintains expert Scientific Advisory boards to advise on the specifics of indicator construction and development. BCBSTX contracts with Health Benchmarks, Inc. (HBI) to run claims data against selected indicators which cover significant areas of preventive care in diabetes, cardiovascular disease, health services, and others. Performance on the indicators is attributed to physicians based upon their involvement in treating the qualifying patients.
Information about the EBM guidelines, such as the clinical intent and sponsoring organizations, can be found in the 2009 Evidence Based Measures
- How are Evidence Based Measures being used by BCBSTX to evaluate performance?
BCBSTX uses a model to recognize physicians for performance on Evidence Based Measures that cover significant processes of care in diabetes, preventive screenings, cardiovascular disease, and others. Physicians are recognized for performance relative to specialty peers in Texas. View the complete list of each year’s Evidence Based Measures used.
All physicians within a common Practice Evaluation ID and specialty (i.e. physician group) are evaluated together and are given the same EBM information. For example, a group of physicians practicing under a common Tax identification number that is comprised of Internal Medicine, Family Practice, and Obstetrics-Gynecology specialties would receive three distinct evaluations. Physicians within each specialty within the group will be evaluated together regardless of the level of individual physician contribution.
A physician group is evaluated with only those indicators that are considered relevant to the specialty. A minimum of 30 denominator events must be attributed to the physician group to qualify for an evaluation. A group's performance is evaluated relative to other physicians in the same specialty within the BCBSTX BlueChoice/BlueChoice Solutions network. Performance is aggregated across measures. Each measure is weighted by the inverse of the variance of the measure. This results in a weighted average that reflects both the total number of denominator events and the variability of performance by peers. This method decreases the impact of differences in number of denominators that occur from practice to practice. The method summarizes performance on individual measures into a single EBM score.
The distribution of these scores across the specialty is categorized into multiple levels of performance. The highest are assigned dark blue ribbons. Where there are measures for a specialty and sufficient data is available, physicians at or above the threshold will be recognized with a dark blue ribbon. When the physician practices in a group, the EBM information reflects the performance of all the physicians in the same specialty within that group. The following EBM information will be shown for physicians where applicable: Specialty Not Measured, Not Enough Data or Voluntarily Declined.
- What is the specialty shown on my letters and reports?
The specialty shown on physician letters and reports is the specialty by which a physician is compared to his/her peers. BCBSTX uses information on our provider files to assign each physician, within a Practice Evaluation ID, to one single specialty. This assignment uses available information to group physicians who practice similarly together for evaluation purposes. When comparative analyses are performed, the physician is compared to peers that treat similar types of diseases and conditions.
- Which Specialties are evaluated for the 2009 EBM evaluation?
The following specialties are currently evaluated for EBM performance:
| Allergy-Immunology |
Cardiovascular Disease –
Non-interventional |
| Colon & Rectal Surgery |
Emergency Medicine |
| Endocrinology |
Family Practice |
| Gastroenterology |
General Surgery |
| Geriatric Medicine |
Internal Medicine |
| Nephrology |
Neurological Surgery |
| Neurology |
Obstetrics-Gynecology |
| Oncology |
Ophthalmology |
| Orthopedic – Spine |
Orthopedic Surgery |
| Pediatric Pulmonology |
Pediatrics |
| Physical Medicine & Rehabilitation |
Pulmonology |
| Urgent Care |
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- What does the BlueCompare EBM information mean?
The following are the BlueCompare EBM symbols and definitions for the 2009 update:
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Meets or exceeds expected performance compared to other doctors.
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This doctor requested that the BlueCompare EBM symbol not be shown.
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There is not enough data to measure performance or this doctor is new to the network. Re-evaluations are conducted periodically.
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Performance measures are not available for this specialty.
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- To whom is an Evidence Based Measure report available?
An EBM report is available for the following:
- Physicians that are in a measured specialty and have data for reporting
An EBM report is not available for the following:
- Physicians in a measured specialty with no data; or
- Physicians that practice in a specialty that is not measured for EBM performance
- Why did I receive several different reports and different EBM information?
The EBM information is assigned at the Practice Evaluation ID level. A physician who practices under multiple Tax identification numbers can therefore be assigned different EBM information for each group and specialty in which the physician is active.
- How can I order reports or get a copy of the report(s) from the BlueCompare Mailer?
Request copies of BlueCompare EBM reports by contacting your local Professional Provider Network office.
- What was the date range used for the 2009 BlueCompare evaluation?
Members are placed in the denominator based on services received in calendar years 2006 and 2007. For some measures, claims submitted over a 5 year period are used to define denominator exclusions and numerator events.
- Did the BlueCompare evaluation involve medical record reviews?
The evaluation included claims data available from Blue Cross and Blue Shield of Texas (BCBSTX) PPO and POS and membership records.
- When can or will EBM information change?
Currently, evaluations for EBM are typically performed annually.
New physicians who are added to an existing group will receive the same EBM information that is assigned to others in the group within the Practice Evaluation ID and the same specialty. A physician who contracts under a new Tax ID within the BlueChoice/BlueChoice Solutions network will display the symbol "Not Enough Data" in Provider Finder until the next annual evaluation.
EBM information can change as a result of a review that is conducted upon your written request. You can request a review of your EBM results at any time. View more information about inquires and reviews.
- Can a physician opt out and not display the BlueCompare information in Provider Finder?
A physician can opt out and choose to not display the EBM information in Provider Finder for calendar year 2009. If a physician practices in a group and the other physicians in the group also wish to opt out, each physician must fill out and sign the Opt out form and return the form via fax or mail it to the address indicated on the form.
- How long does it take to change BlueCompare information in Provider Finder?
All review requests will be processed and changes will be submitted as quickly as possible; updates are typically made on a daily basis.
- How does my BlueCompare information affect my participation status in the networks?
For those physicians who did not reach the threshold for recognition, the EBM evaluation results may have an impact on their network participation. Those physicians will receive a letter explaining this process.
- Who can I call if I have questions?
Please contact your local Professional Provider Network office.
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