About the Report
The data in this report was administered by The P² Collaborative of Western New York under a grant project funded by the New York State Department of Health that ended in December 2009. To apply for the grant, The Western New York Quality Measurement Collaborative (WNYQMC) was formed by the region's three full-service health plans - BlueCross/BlueShield of Western New York, Independent Health and Univera Healthcare.
A steering committee, comprised of key stakeholders of the initiative, worked together to provide overall project planning, decision-making and fiduciary responsibilities. Three project work groups were convened -- Data Governance, Physician Advisory and Operations - to provide expertise.
Initially, the results of the data compilation were to provide primary care physicians, through a private portal, of their quality measurements for 19 metrics. For purposes of this consumer portal, the diabetes quality measurements were extracted for primary care physicians treating adults above the age of 18. The data as measured on the website is not currently used for pay-for-performance or any other incentive programs by the P² Collaborative of Western New York or the health plans who contributed the data to this initiative.
How We Measured Care
This report provides quality metrics on four (4) diabetes measures that were reported by the three health plans within the 2010 calendar year.
The Quality Metrics Published:
- Comprehensive Diabetes Care: Hemoglobin A1c (HbA1c) testing
- Comprehensive Diabetes Care: LDL-C screen
- Comprehensive Diabetes Care: Eye exam (retinal) performed
- Comprehensive Diabetes Care: Medical attention for neghropathy
Each of the measures is based on generally-accepted national guidelines for quality endorsed by The National Committee for Quality Assurance (NCQA), a private, 501(c)(3) not-for-profit organization dedicated to improving health care quality. Since its founding in 1990, NCQA has been a central figure in driving improvement throughout the health care system, helping to elevate the issue of health care quality to the top of the national agenda.
The Comprehensive Diabetic Care (CDC) quality metrics are part of NCQA's HEDIS (The Healthcare Effectiveness Data and Information Set) tool created used by more than 90 percent of America's health plans to measure performance on important dimensions of care and service.
For more specifics on how the CDC quality metrics were computed, visit www.p2quality.com.
The Measures We Used
Number of Doctors in this Report:
Approximately 500 adult primary care physicians from the eight counties of Western New York
Year Under Review:
The data in this report is made up of pharmacy and medical claims data submitted to the three health plans -- BlueCross/BlueShield of Western New York, Independent Health and Univera Healthcare -- by primary care physicians treating adults. The product lines represented include commercial products (HMOs, PPOs, POS) and government programs (managed Medicaid and Medicare).
How Physicians Were Selected:
Physicians who were selected must have filed insurance claims (to any and/or all of the three plans) to treat diabetes on a minimum of 30 patients during the 2010 calendar year. The fact that a physician does not appear on this report does not mean that the physician does not perform services on diabetic patients. He or she may have had an insufficient number of claims submissions to meet the 30 or more patient threshold.
Determining which quality measures to be used and how to assign patients to a specific doctor was performed by the Physician Advisory Team convened by the WNYQMC. This team is comprised of local physicians and the medical directors of the three regional health plans.
For more information about how members were assigned to physicians and other issues relating to data methodology, visit "My Quality Counts!" at www.p2quality.com. "My Quality Counts!" is a web portal that allows area physicians to review their own quality metrics in an on-line setting. The data from "My Quality Counts!" was used as the basis for this consumer report.