Physician Quality Measurement

Available on www.bcbsa.com, July 1, 2012, and www.bcbsla.com early 2013

The Physician Quality Measurement (PQM) program is a resource program to assist Blue members NATIONWIDE in selecting quality physicians.

This program:

  • Features a core set of National Quality Forum-endorsed, HEDIS® Physician Quality of Care measures
  • Integrates local results into a consistent national display
  • Displays results at the individual level

PQM is the basis of practice improvement efforts and highlights the commitment of a physician or group practice to provide safe and evidence-based care and it:

  • engages and empowers consumers to make informed healthcare decisions
  • complements your practice improvement efforts
  • highlights your commitment to providing safe, effective and patient-centered care in your community
  • works toward improving care through measuring data, promoting ongoing practice improvements and recognizing you as a champion of care delivery

Physician Performance Reports
Part of this program includes mailing “report cards,” to our physicians on their performance measures. It also includes an online rating system that can be viewed by members nationwide. The online rating system is based on the same data presented on the report cards mailed to our network physicians.

PQM results are displayed on the Blue Cross and Blue Shield Association’s Blue National Doctor & Hospital Finder, available at www.bcbsa.com > Find a Doctor or Hospital.

Currently, PQM data is displayed for the following physician specialties:

  • Family Practice
  • General Practice
  • Internal Medicine
  • Pediatrics

PQM helps Blue members understand how their doctor performs compared to local norms. These results are based on locally calculated measures and comparisons and are displayed consistently using a “star” rating system.

★★★Exceeds local benchmarks
★★Meets local benchmarks
Below local benchmarks

This is the overall compliance rate for all physicians in a specialty type in Louisiana, without regard to the minimum episode or opportunity thresholds.

This comparison is based on claims sets for same-specialty peers participating in our networks.