BlueCompareSM Frequently Asked Questions
BlueCompare is a component of the online Provider Finder® tool. BlueCompare adds quality related performance information about participating physicians in the BlueChoice® network. 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) BlueChoice® and BlueOptions PPO claims and membership records and may not be indicative of the physician's overall practice.
The modifications to the BlueCompare update in 2015 include:
- Changes have been made to the list of measures and specialties evaluated. View a complete list of measures and specialties evaluated.
- The date range used for the 2015 EBM evaluation is based on services received in calendar years 2012 and 2013.
- Changed the URL for the secure online portal from portal.revelationmd.com to txproviderportal.com.
Evidence Based Measures use claims and enrollment data to assess adherence to recognized clinical guidelines. BCBSTX contracts with Truven Health Analytics 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 current EBM guidelines, such as the clinical intent and sponsoring organizations, can be found in the 2015 Evidence Based Measures .
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 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 levels of performance. Where there are measures for a specialty and sufficient data is available, physicians at or above the threshold will be recognized with a 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.
The specialty shown on the 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 Evauation 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.
The following specialties are currently evaluated:
- Cardiovascular Disease-Interventional
- Cardiovascular Disease-Non-Interventional
- Colon-Rectal Surgery
- Family Practice
- Geriatric Medicine
- Internal Medicine
- Pediatric Allergy-Immunology
- Pediatric Pulmonary Disease
- Pulmonary Disease
The following are the BlueCompare symbols and definitions for the 2015 update:
Meets or exceeds expected quality related performance compared to other doctors.
Meets or exceeds expected quality-related and cost efficiency performance compared to other doctors.
Meets or exceeds expected quality-related performance compared to other doctors, but there is not enough BCBSTX claims data to measure cost efficiency performance.
There is not enough data to measure performance or this doctor is new to the network. Re-evaluations are conducted periodically.
Performance measures are not available for this specialty.
This doctor requested that the BlueCompare symbol(s) not be shown.
BCBSTX displays EBM/PCA Performance Reports in a secure portal online at txproviderportal.com . Your login information was mailed to you or the group practice's administrator. If you have any trouble logging in with the login information that was sent to you, please follow the instructions given to you at txproviderportal.com. Also, you can contact either your group practice administrator (if applicable) or your local Professional Provider Network office for assistance.
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
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.
In some cases, data in the Physician column will only appear when your data is different from the data displayed in the Practice column.
Members are placed in the denominator based on services received in calendar years 2012 and 2013. For some measures, claims submitted over a 5 year period are used to define denominator exclusions and numerator events.
The evaluation included claims data available from Blue Cross and Blue Shield of Texas (BCBSTX) BlueChoice and BlueOptions PPO claims and membership records.
Currently, evaluations for EBM/PCA are typically performed annually.
New physicians who are added to an existing group will receive the same EBM/PCA 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 network will display the symbol "Not Enough Data" in Provider Finder until the next annual evaluation.
EBM/PCA information can change as a result of a review that is conducted upon your written request. You can request a review of your EBM/PCA results at any time. View more information about inquires and reviews.
A physician can opt out and choose to not display the EBM information in Provider Finder for calendar year 2015. 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.
All review requests will be processed and changes will be submitted as quickly as possible; updates are typically made on a daily basis.
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.