Cost & Quality

What is it?

Outcomes Quality - A provider's overall outcomes quality score measures how the provider's outcomes are compared to those of clinicians treating similar types of patients. The score includes factors such as readmission rates, patient mortality rates, avoidable ER visit rates, etc.

Cost efficiency - A provider's overall cost efficiency score measures how expensive they are compared to providers treating similar types of patients. This measure includes elements of both "unit price" (how much they charge for a particular service) and utilization (how many services they prescribe per patient, compared to what other providers do under similar circumstances).

How is it measured?

Ribbon provides two scores for each provider - one for cost efficiency, and one for outcomes quality. Both scores range from 1 to 5, with a score of 5 being the best (higher quality or more cost-efficient) and a score of 1 being the worst (lower quality or less cost-efficient)

Unlike episode or procedure-specific scores, these metrics reflect the provider's overall performance across the different parts of their care for which we have data.

Methodology

Ribbon's provider cost and quality data comes from our channel partner, CareJourney. Currently, CareJourney is methodologically focused on the highest-cost specialties where coverage is much higher (cardiology and gastroenterology, for example). These are often the areas where having a score is most impactful because these specialists control so much spend – i.e. setting care paths that contribute to medical expense beyond just what they personally deliver to include care others deliver (like imaging, physical therapy, drug spend, and the positive and negative impacts of the patients’ outcomes). In particular, CareJourney struggles with coverage in specialties where major episodes of care are not attributed (such as anesthesiology, radiology, dermatology, and physical therapy).

FAQs

Why doesn't a provider have a cost and quality score?
-> A provider may practice a specialty that falls outside of CareJourney's current methodology. Alternatively, there may be a low number of available claims for the particular provider. Since there's no single unified claims dataset, any provider performance measurement is dealing with a variably incomplete view of a provider's overall practice.
What is a 'good' cost & quality score, and what score should I filter by in Ribbon's API?
-> The C&Q data is evenly distributed by quintile - 20% of doctors have a CJ score of 1, 20% have a 2, and so on. While there isn’t a specific threshold on the effectiveness of a provider at each level, it does indicate how they’re performing relative to their peers. The minimum threshold you set for these values depends on the tradeoff you’re looking to make between coverage and quality. We generally recommend setting a minimum threshold of 3 to filter out ‘lower’ quality providers but maintain a high enough coverage.