BlueCompare Frequently Asked Questions

1. 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 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.

2. What modifications were made to BlueCompare for 2008?
The modifications to the BlueCompare update in 2008 include:

• The affordability scale will no longer be displayed. BCBSTX has been a leader in providing information to consumers on physician performance on evidence based measures guidelines and relative cost of care.  As the market has matured, several organizations such as the National Committee for Quality Assurance (NCQA) and the National Quality Forum (NQF) are beginning to develop national standards for reporting of physician performance and we support these efforts.  Thus, we elected to discontinue the affordability scale (our physician and professional provider relative cost of care indicator) until the national standards are more clear and we assess our alternatives. 
• New Evidence Based Measures (EBM) symbols "Specialty Not Measured", "Not Enough Data", and "Voluntarily Declined" will be displayed for the appropriate physician(s)
• A BlueCompare column in Provider Finder

3. 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. These indicators were developed in collaboration with HBI and cover significant areas of care in diabetes, coronary artery disease, preventive 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 2008 Evidence Based Measures.

4. How are Evidence Based Measures being used by BCBSTX to assess 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 assessed 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 assessed 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 assessment. A group's performance is assessed 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 or light blue ribbons. Where there are measures for a specialty and sufficient data is available, physicians at or above the threshold will be recognized with either a dark or light 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.

5. 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 provider number to one single specialty. This assignment uses available information to group providers 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.

6. Which Specialties are evaluated for the 2008 EBM assessment update?
The following specialties are currently evaluated for EBM performance:

7. What does the BlueCompare EBM information mean?
The following are the BlueCompare EBM symbols and definitions for the 2008 update:

	Exceeds expected performance compared to other doctors.
	Meets expected performance compared to other doctors.
	This doctor requested that the BlueCompare EBM symbol not be shown.
	There is not enough data to measure performance or this doctor or provider is new to the network.  Re-evaluations are conducted periodically.
	Performance measures are not available for this specialty.

8. 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 sufficient data for reporting; or
• A physician (Practice Evaluation ID and specialty) who is being recognized for EBM performance and has either a dark blue or light blue ribbon; or
• A physician who has sufficient data for scoring, but is not being recognized at this time for BlueCompare EBM performance

An EBM report is not available for the following:

• Physician (Practice Evaluation ID and specialty) in a measured specialty but with insufficient data; or
• Physicians that practice in a specialty that is not measured for EBM performance; or
• Professional providers will not have a report available because EBM measures only physicians’ (MDs and DOs) performance

9. 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.

10. How can I order reports or get a copy of the report(s) from the BlueCompare Mailer?
Request copies of BlueCompare EBM reports.

11. What was the date range used for the 2008 BlueCompare assessment update?
Members are placed in the denominator based on services received in calendar years 2005 and 2006. For some measures, claims submitted over a 5 year period are used to define denominator exclusions and numerator events.

12. Did the BlueCompare assessment involve medical record reviews?
The assessment included claims data available from Blue Cross and Blue Shield of Texas (BCBSTX) PPO and POS and membership records.

13. What BlueCompare information will I see if I am displayed under more than one specialty in Provider Finder?
The Provider Finder search tool can display a physician multiple times. It depends on several factors such as the Practice Evaluation ID, Provider number and specialty/specialties. For the BlueCompare assessment, a unique provider number is assigned to a single specialty. If that unique provider number appears under multiple specialties in Provider Finder, the BlueCompare information may appear for all specialties under which the physician/provider is listed.

14. When can or will EBM information change?
Currently, assessments 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 UPIN or Tax ID within the BlueChoice/BlueChoice Solutions network will display the symbol "Not Enough Data" in Provider Finder until the next annual assessment.

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.

15. 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 2008. 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.

16. 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.

17. How does my BlueCompare information affect my participation status in the networks?

• BlueChoice: Your participation in the BlueChoice large PPO network is not affected by your BlueCompare information. Therefore, no action is required on your part to continue your participation.
• BlueChoice Solutions: The information used for BlueCompare may have an impact on your participation in the smaller BlueChoice Solutions PPO network. If you have any questions regarding participation criteria, please review the information on the BlueChoice Solutions Web page.

18. Who can I call if I have questions?
Please contact your local Professional Provider Network office.