Provider Performance Summary 2024
Overview
The Provider Performance Summary Dashboard is designed exclusively for Medical Directors. It offers an at-a-glance view of the performance metrics for the providers you directly oversee. With an emphasis on accountability, this dashboard aggregates key performance indicators (KPIs) and metrics across the following categories:
Patient Experience
Operations
Clinical Performance
Population Health/Quality
Best Practices for Medical Directors
Regular Monitoring: Review the dashboard frequently to stay informed about team performance and address any emerging issues promptly.
Data-Driven Interventions: Use the detailed metrics and drill-down reports to develop targeted coaching and quality improvement initiatives.
Team Discussions: Leverage the dashboard during team meetings to highlight successes, discuss challenges, and set performance goals.
Benchmarking: Compare your providers’ performance against established benchmarks and industry standards to drive continuous improvement.
Performance Summary Metrics:
The performance summary metrics are
Total Available Score: Is the total number of points that a provider can earn based on the performance metrics that apply to their patient population. It only includes metrics where there are qualifying patients to evaluate the provider’s performance.
Total Weighted Score: Represents the sum of all points a provider has earned across applicable metrics, with each metric adjusted based on its assigned importance or weight.
Total Bonus Points: The bonus is weighted by each KPI. See the weight of each metric below. For the weight of each metric, use the Performance Breakdown table to identify the weight of each KPI.
Dashboard Metrics Overview
Pop. Health / Quality
FL/TN
Payer gaps report + Leap attribution + eCW appointments
X
Pop. Health / Quality
FL/TN
Payer gaps report + Leap attribution + eCW appointments
X
Pop. Health / Quality
FL/TN
Payer gaps report + Leap attribution + eCW appointments
X
Pop. Health / Quality
FL/TN
Payer gaps report + Leap attribution + eCW appointments
X
Pop. Health / Quality
FL/TN
Payer gaps report + Leap attribution + eCW appointments
X
X
Pop. Health / Quality
FL/TN
Payer gaps report + Leap attribution + eCW appointments
X
Pop. Health / Quality
FL/TN
Payer gaps report + Leap attribution + eCW appointments
X
Pop. Health / Quality
TN
Payer gaps report + Leap attribution + eCW appointments
X
Dashboard Metrics Definitions
Patients Seen by the Provider Metrics
The denominator includes patients who have had a visit with the provider. Includes NPS/PX surveys, provider evaluation, and productivity visits (locked notes).
NPS
Measures the patient’s experience through Net Promoter Score (NPS) surveys, with the goal of optimizing patient satisfaction and loyalty.
Numerator: Total NPS scores of survey responses from patients seen by the provider
Denominator: Total number of survey responses from patients seen
Provider Evaluation
Measures the patient’s experience through Patient Experience (PX) survey provider-specific questions with the goal of optimizing patient satisfaction and loyalty
Numerator: Sum of percentages for the top two most favorable points on the provider survey's related Likert questions (Provider Listened, Provider Instruction Quality, Provider Explanation Quality) with equal weight
Denominator: Total number of survey responses from patients seen
Notes Closed
The percentage of notes closed within 72 hours from the completed visit. Measures provider notes post visit providing a critical indicator of timely and accurate risk assessment in healthcare.
Numerator: Notes closed within 72hrs (calendar days) for all types of checked-out visits (except lab, DI, and procedures)
Denominator: Total Closed Notes
Productivity
This is for all providers but Urgent Care providers. Measures the efficiency and effectiveness of healthcare providers in delivering patient care, serving as a key indicator of operational performance and resource utilization. Each provider has a fixed daily goal of check-out visits and the providers are measured on how well they meet the goal. Not every single day is considered. Only the days that have at least one appointment check-out.
Numerator: Average Daily Checked-Out Appointments
Average Daily Check-Out = Total Checkouts / Number of Workdays
Workdays = Count of days with at least 1 Check-Out visit
Denominator: Standard Daily Target
Standard Daily Target is pre-set based on Practice Type, Employment Type and Care Model in Leap's Provider 360 app
Effectiveness
For Urgent Care providers only. Measures the efficiency and effectiveness of healthcare providers in delivering patient care, serving as a key indicator of operational performance and resource utilization. Effectiveness does not have a fixed daily goal and the metric is measured against the number of check-in visits each day with total check-out visits. Not every single day is considered. Only the days that have at least one appointment check-out.
Numerator: Volume of Checkout Urgent Care Visits
Denominator: Volume of Check-In Urgent Care visits
Panel-Based Metrics
For care gaps, the denominator includes patients attributed to the provider's panel who have been seen by anyone, excluding new members with care gaps.
Breast Cancer Screening
HEDIS metric that measures how well providers managed adherence to recommended preventive care for breast cancer, cervical cancer, and colorectal cancer to maintain or improve quality measures, including closing care gaps and achieving early detection for better outcomes.
Numerator: The percentage of female members aged 50 through 74 who had a mammogram to screen for breast cancer during measurement year or 15 months prior to measurement year
Denominator: Total assigned and eligible patients
Cervical Cancer Screening
HEDIS metric that measures how well providers managed adherence to recommended preventive care for breast cancer, cervical cancer, and colorectal cancer to maintain or improve quality measures, including closing care gaps and achieving early detection for better outcomes.
Numerator: The percentage of women, aged 21-64, who were screened for cervical cancer using either of the following criteria
Women, aged 21-64, who had cervical cytology screening performed within the past 3 years.
Women, aged 30-64, who had cervical high-risk human papillomavirus (hrHPV) testing or cervical cytology hrHPV performed within the past 5 years
Denominator: Total assigned and eligible patients
Colorectal Cancer Screening
HEDIS metric that measures how well providers managed adherence to recommended preventive care for breast cancer, cervical cancer, and colorectal cancer to maintain or improve quality measures, including closing care gaps and achieving early detection for better outcomes.
Numerator: Percentage of members, aged 45-75, who had an appropriate screening for colorectal cancer
Denominator: Total assigned and eligible patients
Comprehensive Diabetes Care: HbA1c Good Control
HEDIS metric that Measures how well providers managed adherence to recommended preventive care for comprehensive diabetes management to maintain or improve quality measures, focusing on achieving good control of HbA1c levels for better health outcomes.
Numerator: Percentage of Members, aged 18–75, who were diagnosed with Diabetes (type 1 and type 2) and Hemoglobin A1c (HbA1c) testing in current measurement period with HbA1c control (<8.0%)
Denominator: Total assigned and eligible patients
Controlling High Blood Pressure
HEDIS metric that measures how well providers managed adherence to recommended preventive care for controlling high blood pressure to maintain or improve quality measures, focusing on achieving and maintaining optimal blood pressure levels for better health outcomes.
Numerator: Percentage of members, aged 18-85, with a diagnosis of hypertension and whose blood pressure was adequately controlled (<140/90) during the measurement yea
Denominator: Total assigned and eligible patients
Antidepressant Medication Management, Initial Phase
HEDIS metric that measures how well patients diagnosed with depression are managed during their treatment with antidepressant medications. The Initial Phase of AMM focuses on ensuring that patients are consistently taking their prescribed antidepressant medication during the defined timeframe of the initial phase.
Numerator: Closed GAPS with the name: Antidepressant Med Mgmt, Initial Phase
Denominator: Total all eligible GAPS with the name Antidepressant Med Mgmt, Initial Phase
Chronic Patients Seen
Measures the frequency and quality of healthcare visits for patients with chronic conditions, providing insight into the effectiveness of ongoing care management and patient outcomes in chronic disease management.
Numerator: The percentage of female members aged 50 through 74 who had a mammogram to screen for breast cancer during measurement year or 15 months prior to measurement year
Denominator: Total assigned and eligible patients
Annual Wellness Visit
The percentage of eligible patients assigned to a Medicare provider with a completed Annual Wellness Visit within the year.
Numerator: All Medicare patients with CPT Codes G0438, 0439, 0402
Denominator: All Active Medicare Roster patients assigned to the provider
EPSDT (Early and Periodic Screening Diagnosis and Testing)
Percentage of pediatric patients who are eligible for EPDST screening and are assigned to a Medicare provider with a completed EPSDT visit within the year.
Numerator: Total gaps for pediatric patients that are eligible and are assigned to the Medicare provider with a complete EPSDT
Denominator: Total pediatric patients who are eligible for EPDST screening and are assigned to a Medicare provider
Provider-Based Metrics
The data used for these metrics comes directly from Sanitas and is not calculated or determined by Lucerna. Includes e-learning course completions, MA MLR per provider, and HCC audits.
E-Learning Courses
Measures the completion and proficiency of e-learning courses among healthcare providers, ensuring regulatory compliance and enhancing patient care standards.
Numerator: E-Learning courses completed + Symposiums completed
Denominator: Total # of E-Learning courses assigned + Total # of symposiums assigned
Provider Audit - Clinical Care / Doc and Coding / Quality
Measures the evaluation done by the Medical Director of all providers that audit clinical processes. The data comes from a completed survey by a medical director and within each category, the different questions are weighted differently.
Numerator: Average scores for each audit question conducted for the provider across the following categories: Clinical Care, Documentation & Coding, and Quality
HCC Audit
Measures the accuracy of diagnostic coding and risk adjustment related to the Hierarchical Condition Categories (HCC) system. HCC audit is used to ensure that healthcare providers and insurers correctly document and report patient diagnoses, which directly impacts reimbursement rates and compliance with regulatory standards.
Numerator: The calculated value is provided by Sanitas
MLR (Medical Loss Ratio)
Measures the percentage of premium revenue spent on medical claims and healthcare quality improvement activities versus administrative costs and profits. MLR is used as a measure of efficiency and accountability, ensuring that a substantial portion of premium dollars goes toward patient care rather than operational costs or profits.
Numerator: The calculated value is provided by Sanitas
Dashboard ABCs
Tabs
Upon opening a dashboard, you will be directed to the first tab by default, which is typically a national view for Sanitas USA users who need to see all states consolidated into one tab. To see a monthly trend you should navigate to the additional tab.
Controls
Controls allow you to filter or refine the data displayed within a dashboard. Utilize the down arrow to expose all available control options for a dashboard. Once selected, controls will remain set even if you navigate to a different tab.
Reset Controls
Utilize the reset arrow located above the controls to reset the options before navigating to a new tab or attempting to apply new criteria.
Downloading Pages
Each page can be downloaded by clicking on the export icon in the top right corner of the page. This will create a PDF document that can be downloaded or printed.
Downloading Individual Charts, Tables or Data
You can also download individual charts, tables or data. To do so, click on a chart to display the ellipsis (three dots) in the top right corner. Clicking on this ellipsis will allow you the option to download in cvs and/or excel formats.
Scroll
Most dashboards and visuals extend beyond the available area exposed on a user's window. Dashboards and visuals are scrollable, don't forget to utilize the navigation bars or your middle mouse wheel to do so.
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