Your Quality Score is calculated by comparing your compliance with a series of quality measures to that of peer providers practicing in your specialty, adjusting for measure, patient, and sample size effects. The highest-quality providers have quality scores closest to one.
See the RHI Statistical Model for an explanation of the statistical model RHI used to assess practice quality for FY17.
See the RHI quality measures used for the FY17 assessment, along with citations from the literature supporting these measures.
Your use of health care services (office visits, labs, medications, etc.) in treating patients with particular clinical conditions is compared to the resource use of other physicians in your specialty treating patients for similar conditions. Individual episodes are assigned to physicians based on an evaluation of the claims data to determine which physician provided the overall management of the care of the patient during the course of his or her treatment for a particular clinical condition
The efficiency score is created by comparing the consumption of resources (using a proxy cost) in treating your patients to the resource use of your peers treating patients with similar clinical conditions, adjusted for the severity of your patient case mix. The most efficient providers have low efficiency scores; less-efficient providers have higher scores.
- Cost-efficiency scores are developed by VIPS using ETGs, a product of Symmetry that is well known and widely used by health insurers and physician groups
- Claims are bundled into Episode Treatment Groups (ETGs) and contract-neutral prices (proxy prices) are applied
See the Symmetry Episode Treatment Groups document for technical details
Tiering Method by Health Plan
For details on each GIC health plan’s tiering assignments, see the CPI Section of their website:
This information provided by the Group Insurance Commission.