Provider Scorecard 2025

Overview

The Provider Scorecard is a tool designed to help providers, Medical Directors, and leadership monitor and analyze provider performance through individual metrics.

The Provider Performance dashboard specifically highlights individual provider metrics, allowing providers to track their own performance, and enabling Medical Directors to review detailed data for each provider on their team. It helps your organization evaluate and monitor the performance of your providers. Also, it provides a visual representation of key performance indicators (KPIs) and metrics that are important for assessing the effectiveness and efficiency of the providers.

The data in the Provider Scorecard is protected using row-level security, ensuring each user only has access to the appropriate information. Providers can view only their own metrics, while Medical Directors can see the results for all providers on their teams.

The Provider Scorecard dashboard is available in the 'Value Based Care' section of the Insights Portal module.

Performance Summary Metrics:

The performance summary metrics are

Max 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.

Performance Rate: Is the percentage of points a provider has earned out of the Max Available Score, allowing for comparisons between providers with different maximums.

Metrics Overview

Provider Scorecard displays metrics for each provider based on their primary category. The scorecard includes ‘employee full-time’ providers and residents, who are ‘active’ and ‘on leave’.

Provider Categories

Providers are classified into the categories below, depending on their main practice type and patient audience. Based on this category, the corresponding metrics, goals, and weights are applied to each provider.

• Primary Care (includes residents)

• Primary Care Medicare-dedicated

• Pediatric Care

• Home Care

• Urgent Care

• Virtual Care (VMC providers with panel)

• Virtual Care On-Demand

Metrics are also calculated for Medical Directors and Regional Medical Directors, based on the data available for them.

Metric Categories

The dashboard includes 26 KPIs within the following categories:

• Patient Experience

• Operations

• Clinical Performance

• Population Health

The table below summarizes what metrics apply to each provider category. The 'Provider Scorecard 2025 Goals & Weights' managed table controls the metrics, goals, and weights applied to each provider based on their primary state and category.

Category	Metric	State	Data Source(s)	Primary Care	PC Medicare	Pediatrics	Home Care	Urgent Care	VMC	VMC On-Demand
Patient Experience	Net Promoter Score NPS & Provider Satisfaction Index	FL	Leap surveys	X	X	X	X	X	X	X
Operations	Timely Note Completion	FL	eCW appointments	X	X	X	X	X	X	X
Operations	Appointment Productivity	FL	eCW appointments + Daily/Monthly target	X	X	X	X	X	X
Operations	Chat Efficiency	FL	Google Chats							X
Operations	Video Consult Efficiency	FL	eCW appointments							X
Operations	Patient Cycle Time Efficiency	FL	eCW appointments + Wait times					X
Clinical Performance	Education Activities Completion	FL	HAOU / Risk Unit report	X	X	X	X	X	X	X
Clinical Performance	Clinical Audit Score - Clinical Care	FL	Medical Director audits	X	X	X	X	X	X	X
Clinical Performance	Clinical Audit Score - Documentation and Coding	FL	Medical Director audits	X	X	X	X	X	X	X
Clinical Performance	Clinical Audit Score - Quality	FL	Medical Director audits	X	X	X	X	X		X
Population Health	HCC Accuracy Audit	FL	External report with audits	X	X	X	X		X
Population Health	Chronic Patients Engagement	FL	Payer gaps report + Leap attribution + eCW appointments	X
Population Health	Breast Cancer Screening Rate	FL	Payer gaps report + Leap attribution + eCW appointments	X	X
Population Health	Cervical Cancer Screening Rate	FL	Payer gaps report + Leap attribution + eCW appointments	X
Population Health	Colorectal Cancer Screening Rate	FL	Payer gaps report + Leap attribution + eCW appointments	X	X
Population Health	Comprehensive Diabetes Care: HbA1c Good Control	FL	Payer gaps report + Leap attribution + eCW appointments	X
Population Health	High Blood Pressure Control	FL	Payer gaps report + Leap attribution + eCW appointments	X	X
Population Health	Kidney Health Management	FL	Payer gaps report + Leap attribution + eCW appointments	X
Population Health	Statin Medication Adherence	FL	Payer gaps report + Leap attribution + eCW appointments		X
Population Health	Annual Wellness Visit Completion	FL	Leap cohort + Leap attribution + eCW appointments		X
Population Health	Medical Loss Ratio (MLR)	FL	Health Analytics MLR report		X
Population Health	HCC Recapture Rate	FL	FLBL HCC recapture report		X
Population Health	BMI Assessment Completion	FL	eCW appointments + Diagnosis			X
Population Health	Hepatitis B Vaccine Completion	FL	eCW appointments + Immunizations			X
Population Health	Strep Test Compliance for Pharyngitis	FL	eCW appointments + Labs			X

Metric Definitions

Provider Visit and Task Metrics

Measures provider performance outcomes directly tied to their own completed patient visits and role tasks.

Patient Experience - Net Promoter Score (NPS)

Description: Measures the patient’s experience through Net Promoter Score (NPS) surveys, with the goal of optimizing patient satisfaction and loyalty.

Calculation definition: (# Promoters – # Detractors) / Total surveys

• Numerator: Total NPS scores of survey responses from patients seen by the provider

• Denominator: Total number of survey responses from patients seen

Data sources:

• Base data: survey data stored in the LEAP table "prod_leap_analytics"."rpt_patient_satisfaction_survey”

Data owner: Lucerna

Frequency: Data refreshes daily

Technical details:

• It includes only surveys answered within the first 30 days after the appointment

• It includes only the first response

• Detailed data is available at survey level

• Metric is calculated at month and year level

Patient Experience - Provider Satisfaction Index

Description: Measures the patient’s experience through Patient Experience (PX) survey provider-specific questions with the goal of optimizing patient satisfaction and loyalty

Calculation definition: Surveys with top two favorable ratings on provider-related questions / Total surveys

Data sources:

• Base data: survey data stored in the LEAP table "prod_leap_analytics"."rpt_patient_satisfaction_survey”

Data owner: Lucerna

Frequency: Data refreshes daily

Technical details:

• It includes only surveys answered within the first 30 days after the appointment

• It includes only the first response

• Detailed data is available at survey level

• Metric is calculated at month and year level

• Top-two* most favorable points includes 4 and 5 scores

• All provider-related questions have equal weight

• Provider-related questions include:

  • Provider listened

  • Provider instructions satisfaction

  • Provider explanation satisfaction

  • Provider knowledge

  • Provider decision inclusion

  • Provider explained conditions

  • Provider RX review satisfaction

  • Would recommend provider

• Surveys with score equal to zero are excluded

Operations - Timely Note Completion

Description: Measures provider notes post-visit providing a critical indicator of timely and accurate risk assessment in healthcare.

Calculation definition: Notes closed within 72 hours (calendar days) / Total notes closed

Data sources:

• Base data 1: ECW appointment data stored in the LEAP table ‘prod_leap_analytics.fct_appointment_detail’

• Base data 2: Notes lock data from ECW is ingested into LEAP leveraging the ‘Sanitas ECW Replica - Leap / Appointment Log Notes Status - OJ - Custom Insights’ orchestration job

Data owners:

• Base appointment data: owned by Lucerna

• Notes lock data: owned by Sanitas Data Team (Diego Rojas)

Frequency: appointment and notes lock data are ingested daily

Technical details:

• Detailed data is available at appointment level

• The metric is calculated at month and year level

• The metric only includes appointments with checked-out status (appointment_status = 'Fulfilled’)

• Both the numerator* and denominator** include all appointment types for checked-out appointments (appointment_category in ('Primary Care Visit', 'Urgent Care Visit', 'Telehealth Video', 'Telehealth Phone', 'Telehealth Not Scheduled')). It excludes lab, diagnostic imaging (DI), and procedures

• Only workdays days (qualified days) are considered. A qualified day is defined as a day on which the provider had at least one checkout visit

Operations - Productivity & Effectiveness

Description: The productivity or effectiveness metric measures the efficiency and effectiveness of healthcare providers in delivering patient care, serving as a key indicator of operational performance and resource utilization. Productivity applies for providers who have scheduled patients and Urgent Care providers. Effectiveness applies for Medical Directors.

Calculation definition:

• Primary Care, Medicare, Pediatrics, Home Care, VMC:

  • Completed checkout appointments / Target appointments per day

• Urgent Care:

  • Completed checkout appointments / Target appointments per month

• Medical Directors:

  • Completed checkout appointments / Total check-in appointments

Data sources:

• Base data 1: ECW appointment data stored in the LEAP table ‘prod_leap_analytics.fct_appointment_detail’

• Base data 2.1 Provider directory: 'Daily Visit Target' defined for each provider

• Base data 2.2 'Provider Scorecard 2025 Urgent Care Monthly Targets' managed table to control the monthly appointment goals for UC providers

• Base data 2.3 'Provider Scorecard 2025 Resident Daily Targets' managed table to control the daily appointment goals for residents

Data owners:

• Base appointment data: owned by Lucerna

• Provider directory: Provider Management team (Monica Pinzon)

• 'Urgent Care Monthly Targets' managed table: Health Analytics (Tiffany Rivero)

• 'Provider Scorecard 2025 Resident Daily Targets' managed table: Health Analytics (Tiffany Rivero)

Frequency: appointment data is refreshed daily

Technical details:

• Detailed data is available at appointment level

• Metric is calculated at month and year level

• The numerator includes all appointment types for checked-out appointments, excluding lab, diagnostic imaging (DI), and procedures, as mentioned in the section ‘Base appointment data’

• For the numerator*, only appointments with checked-out status are considered (appointment_status = 'Fulfilled’)

• Only workdays days (qualified days) are considered. A qualified day is defined as a day on which the provider had at least one checkout visit

Operations - Chat Efficiency

Description: Chat efficiency measures how well providers handle demand-based activities by comparing the number of chat appointments each provider manages to the expected average per provider. This average is based on the total number of chat appointments and the number of available providers each hour.

To make the results easier to interpret, scores are adjusted using a Gaussian transformation, which creates a bell-shaped curve. This helps highlight top performers and identify areas that may need improvement.

Applies to VMC On-Demand providers only.

Calculation definition:

• Gaussian transformation of chat efficiency performance

  • Chat efficiency performance = % of provider’s time blocks meeting or exceeding average chats per provider

    • Numerator: Time blocks meeting or exceeding average chats per provider per hour

    • Denominator: Total time blocks per provider

Data sources:

• Base data: Google Chats ingested into LEAP leveraging the ‘ES Google Chats - Consumer Google Chats - OJ - Custom Insights’ orchestration job

Data owners:

• Google Chats data: owned by Sanitas Data Team (Sebastian Patino)

Frequency: Google Chats data are ingested weekly

Technical details:

• Each time block currently represents one hour

Operations - Video Consult Efficiency

Description: Video consult efficiency measures how well providers handle demand-based activities by comparing the number of video appointments each provider manages to the expected average per provider. This average is based on the total number of video appointments and the number of available providers each hour.

To make the results easier to interpret, scores are adjusted using a Gaussian transformation, which creates a bell-shaped curve. This helps highlight top performers and identify areas that may need improvement.

Applies to VMC On-Demand providers only.

Calculation definition:

• Gaussian transformation of video consult efficiency performance

  • Video consult efficiency performance = % of provider’s time blocks meeting or exceeding average on-demand video consults per provider

    • Numerator: Time blocks meeting or exceeding average on-demand video consults per provider per hour

    • Denominator: Total time blocks per provider

Data sources:

• Base data: ECW appointment data stored in the LEAP table ‘prod_leap_analytics.fct_appointment_detail’

Data owners:

• Base appointment data: owned by Lucerna

Frequency: appointment data is refreshed daily

Technical details:

• Each time block currently represents one hour

• It includes only checked-out not-scheduled telehealth appointments (appointment_status = 'Fulfilled' and appointment_category in ( 'Telehealth Not Scheduled' ))

Operations - Patient Cycle Time Efficiency

Description: It measures how effectively providers keep their average cycle time below the target. The metric considers all the time from the check-in to the discharge.

Applies to Urgent Care providers only.

Calculation definition: Target patient cycle time / Provider’s average patient cycle time

Data sources:

• Base data 1: Wait time data ingested into LEAP leveraging the ‘Wait Times Sanitas - Custom Insights’ orchestration job

• Base data 2: ECW appointment data stored in the LEAP table ‘prod_leap_analytics.fct_appointment_detail’

Data owners:

• Base wait time data: owned by Sanitas Data Team (Sebastian Patino)

• Base appointment data: owned by Lucerna

Frequency: appointment data is refreshed daily

Technical details:

• It includes only checked-out urgent care visits (appointment_status = 'Fulfilled' and appointment_category in ( 'Urgent Care Visit' ))

• The current target patient cycle time is 1 hour

• Only appointments with valid and available start and end times are included

• Appointments lasting longer than 2 hours are excluded from the metric

Clinical Performance - Education Activities Completion

Description: It measures the completion and proficiency of courses among healthcare providers, ensuring regulatory compliance and enhancing patient care standards.

Calculation definition: # Completed education activities, modules, or tasks / Total assigned education activities, modules, or tasks

Data sources:

• Base data: External Excel file stored in the SFTP and ingested into LEAP leveraging the ‘Provider Scorecard - Education Activities - Leap’ data mapping

• Managed table: the ‘Provider Scorecard Education Activities Courses and Scores’ managed table controls the courses that qualify to calculate the metric.

Data owners:

• Base data: Sanitas Risk Unit - Daniel Castrillon’s team (Laura Maya)

• Managed table: Health Analytics (Tiffany Rivero)

Frequency: The data is ingested on-demand, based on assigned courses, symposiums, tasks, and other updates provided by the Sanitas Risk Unit team

Technical details:

• The Sanitas Risk Unit manually consolidates data from different training systems into one Excel file. Additionally, data must be manually processed to add the provider NPI.

• Data is available at year level

• Courses not listed in the managed table are ignored

Clinical Audit Metrics (Sample-Based)

Quality evaluation based on sampled clinical audits conducted by medical directors and audit teams.

Clinical Performance - Clinical Audit Score

Measures the evaluations done by Medical Directors to providers in their teams, auditing clinical processes. The data comes from completed surveys by a medical director and within each category, the different questions are weighted differently.

Details:

• For PC, Medicare, Home Care, and Pediatric providers clinical audits are divided into three metrics: ‘Clinical Care’, ‘Documentation and Coding,’ and ‘Quality’.

• For Urgent Care providers all clinical audits questions are grouped into one metric called 'Charts.'

• For Virtual Care Panel providers, clinical audits are grouped into two categories: ‘Clinical Care’ and ‘Documentation and Coding.’ The ‘Documentation and Coding’ category includes all audit questions, while ‘Clinical Care’ is divided into three questions.

• For Virtual Care On-Demand providers, audits are grouped into three categories: ‘Clinical Care,’ ‘Quality,’ and ‘Documentation and Coding.’ As with VMC Panel providers, all audit questions fall under ‘Documentation and Coding,’ while ‘Clinical Care’ includes three questions and ‘Quality’ includes four questions.

• Each metric has different sets of questions and maximum scores depending on the primary provider type.

• Providers may have audit log data across multiple provider types. The final score for each provider and metric is calculated as the average of all available data, regardless of their primary provider type.

Calculation definition: Average score received per category / Maximum possible score per category

Data sources:

• Base data:

  • External data is originally stored on Google Sheets. The Data Team loads it into BigQuery as a bridge.

  • Data is ingested into LEAP leveraging multiple orchestration jobs and data mappings:

    • Bigquery - Audit Logs - Care at Home - FL - DM - Custom

    • Bigquery - Audit Logs - High Touch Model - FL - DM - Custom

    • Bigquery - Audit Logs - Pediatric - FL - DM - Custom

    • Bigquery - Audit Logs - Primary Care - FL - DM - Custom

    • Bigquery - Audit Logs - Telehealth - FL - DM - Custom

    • Bigquery - Audit Logs - Urgent Care - FL - DM - Custom

  • Data is consolidated by provider type using the ‘Audit Log - Custom Insights’ orchestration job

• Managed table: the ‘Provider Scorecard 2025 Audit Logs Categories’ managed table controls the questions and max scores by provider type and metric.

Data owners:

• Base data: owned by Sanitas Data Team (Sebastian Patino)

• Managed table: Health Analytics (Tiffany Rivero)

Frequency: Data from BigQuery is ingested weekly on Sundays

Technical details:

• The metrics are calculated at month level based on the questionnaire key date

Population Health - HCC Accuracy Audit

Description: It measures how effectively providers are capturing and documenting HCC conditions for accurate risk adjustment.

Calculation definition: Total accurate HCC codes confirmed in audits / Total HCC codes audited

• Values are pre-calculated in the base data

Data sources:

• Base data: HCC audit data comes from an Excel file and ingested into LEAP leveraging the data mapping ‘Provider Documentation Audit - FL - DM.’ Then, the data is unified in the table ‘prod_custom.provider_documentation_audit_all’ by the orchestration job ‘Sanitas SFTP - Leap / Provider Documentation Audit - All’

Data owners:

• Base data: Health Analytics (Tiffany Rivero)

Frequency: the data is loaded on-demand into LEAP by the Data Team

Technical details:

• Data is available at quarter level

• Metric is calculated at quarter and year level

• To calculate the yearly metric, the score is weighted based on the number of charts per provider per quarter

Assigned Patient Panel and Seen Patient Metrics

Population health metrics that measure preventive and chronic care outcomes among assigned patients in the provider panel. Only patients who have had at least one visit with any provider are included. Patients who have never been seen are excluded, as engagement of these patients is managed by the operations team.

For the Pediatric metrics, only patients who have had at least one visit with the provider are included.

Population Health - Annual Wellness Visit Completion

Description: It measures the number of annual wellness visits completed relative to the total eligible patient population.

It applies to Medicare-dedicated providers only.

Calculation definition: # Assigned Medicare patients completing AWV* / Total assigned Medicare patients eligible**

Data sources:

• Base data: cohorts, ECW appointment data in LEAP, and attribution

Data owners:

• Base data: Lucerna

Frequency: data refreshes daily

Technical details:

• Base data is available at patient level

• Metric is calculated at year level

• Numerator*: Patients are considered AWV seen if they have been flagged by the corresponding cohort (awv_claims_by_cpt_codes = 1) during a 2025 appointment

• Denominator**: Only ‘Medicare’ patients are considered

Population Health - Chronic Patient Engagement

Description: 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.

Calculation definition: Chronic patients seen* / Total assigned chronic patients eligible**

Data sources:

• Base data 1: external Florida Blue Wise Ways Excel File ingested into LEAP (PHM factor) with the ‘Sanitas SFTP - Leap / PHM - FB MYB WISE WAYS - Leap (New)’ orchestration job

• Base data 2: ECW appointment data in LEAP and attribution

Data owners:

• Base data 1: Health Analytics (Tiffany Rivero)

• Base data 2: Lucerna

Frequency: Florida Blue Wise Ways Excel File is received monthly

Technical details:

• Base data is available at patient level

• Metric is calculated at year level

• Numerator*: Patients are considered seen if they had an appointment during 2025

• Denominator**: Patients are considered chronic if they have been flagged in the PHM factor table (payer_health_status like '%chronic%’) and were active during 2025

Population Health - HEDIS Metrics

General description: Measures closed gaps and adherence to recommended preventive care. HEDIS metrics include:

• Breast Cancer Screening Rate: Measures adherence to recommended preventive care for breast cancer to maintain or improve quality measures, including closing care gaps and achieving early detection for better outcomes. It includes 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.

  • Calculation definition: # Assigned patients with completed breast screening / Total assigned patients eligible

• Cervical Cancer Screening Rate: Measures adherence to recommended preventive care for cervical cancer screening to maintain or improve quality measures, leading to early detection and improved outcomes for women's health. It includes female members, 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

  • Calculation definition: # Assigned patients with completed cervical screening / Total assigned patients eligible

• Colorectal Cancer Screening Rate: Measures adherence to recommended preventive care for colorectal cancer screening to maintain or improve quality measures, leading to early detection and improved outcomes in colorectal health. It includes members, aged 45-75, who had an appropriate screening for colorectal cancer.

  • Calculation definition: # Assigned patients with completed colorectal screening / Total assigned patients eligible

• Comprehensive Diabetes Care (HbA1c): Measures 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. It includes 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%).

  • Calculation definition: # Assigned diabetic patients with controlled HbA1c / Total assigned diabetic patients eligible

• High Blood Pressure Control: Measures 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. It includes members, aged 18-85, with a diagnosis of hypertension and whose blood pressure was adequately controlled (<140/90) during the measurement year.

  • Calculation definition: # Assigned patients with controlled blood pressure / Total assigned patients eligible with hypertension

• Kidney Health Management: Measures

  • Calculation definition: # Assigned patients with kidney care gaps closed / Total assigned patients eligible

• Statin Medication Adherence: Measures

  • Calculation definition: # Assigned patients with diabetes or cardiovascular conditions adherent to statins / Total assigned patients eligible

Data sources:

• Base data 1: external gaps in care Excel Files ingested into LEAP using the orchestration jobs 'GAPS IN CARE - FL - IND/EMP - ACO - OJ - Leap' and 'GAPS IN CARE - FL - MEDICARE - OJ - Leap' Data is unified into the ‘PHM Quality Tall’ table

• Base data 2: FLBL Roster

• Base data 3: ECW appointment data in LEAP

• Base data 4: LEAP attribution

Data owners:

• Base data 1: Health Analytics (Tiffany Rivero)

• Base data 2: Sanitas Data Team

• Base data 3 and 4: Lucerna

Frequency: FLBL gaps in care files are updated monthly.

Technical details:

• Base care gap data is available at patient level

• Metrics are calculated at year level

Patient-Provider Crosswalk Rules for Assigned Patient Metrics

HEDIS and some Population Health metrics are patient-based, so patients must be associated to providers in order to calculate metrics at the provider level. To do this, patients are evaluated based on the following rules to create a crosswalk and assign them to providers:

• The patient has been active during 2025

• The patient has been seen by any provider in a ‘Primary Care Visit’ at least once before Dec-31-2025

• The patient has been reported with the gap during 2025

• The patient is currently attributed to the provider and was assigned before Dec-31-2025

The attributed patient-provider crosswalk applies to the following metrics:

• Annual Wellness Visit

• Chronic Patients Engagement

• HEDIS Metrics:

  • Breast Cancer Screening

  • Cervical Cancer Screening

  • Colorectal Cancer Screening

  • Comprehensive Diabetes Care: HbA1c Good Control

  • Controlling High Blood Pressure

  • Kidney Health Management

  • Statin Medication Adherence

Population Health - Pediatric Care Metrics

General description: Measures pediatric patient specific aspects to ensure the quality of care. These metrics include:

• BMI Assessment Completion: It measures the percentage of patients who have had their BMI assessment performed during the current year.

  • Calculation definition: # Pediatric patients with documented BMI assessments / Total pediatric patients seen and eligible

• Hepatitis B Vaccine Completion: It measures the percentage of pediatric patients who have been seen in the current year and have had the Hepatitis B immunization.

  • Calculation definition: # Pediatric patients completing Hep B vaccination / Total pediatric patients seen and eligible

• Strep Test Compliance for Pharyngitis: It measures the percentage of pediatric patients diagnosed with pharyngitis for whom a provider ordered a strep test before making the diagnosis.

  • Calculation definition: # Pediatric patients diagnosed with pharyngitis tested for strep / Total pediatric patients diagnosed with pharyngitis

Data sources:

• Base data BMI: ECW diagnosis data ingested with the 'Diagnosis - OJ - Custom Insights' orchestration job

• Base data Hepatitis B: ECW immunization data ingested with the 'Immunizations - OJ - Custom Insights' orchestration job

• Base data Strep Test: ECW lab data ingested with the 'Labdata - OJ - Custom Insights' orchestration job

• Base data 2: FLBL Roster

• Base data 3: ECW appointment data in LEAP

Data owners:

• Base data for diagnosis, immunization, lab data, and FLBL roster: Sanitas Data Team

• Base data 3: Lucerna

Frequency: Diagnosis, immunization, and lab data are updated daily.

Technical details:

• Base care gap data is available at patient level

• Metrics are calculated at year level

Patient-Provider Crosswalk Rules for Seen Pediatric Patient Metrics

The pediatric Population Health metrics are patient-based, so patients must be associated to providers in order to calculate metrics at the provider level. To do this, patients are evaluated based on the following rules to create a crosswalk and assign them to providers:

• The patient has been active during 2025

• The patient has been seen by the specific provider in a ‘Primary Care Visit’ at least once before Dec-31-2025

The seen patient-provider crosswalk applies to the following metrics:

• BMI Assessment Completion

• Hepatitis B Vaccine Completion

• Strep Test Compliance for Pharyngitis

Population Health - Medical Loss Ratio (MLR)

Description: 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.

It applies to Medicare-dedicated providers.

Calculation definition: Total medical expenses incurred / Total Medicare funding received

Data sources:

• Base data 1: Excel file stored in the SFTP and ingested into LEAP leveraging the ‘Sanitas SFTP - Leap / MLR Score - FL - Medicare - OJ’ orchestration job and ‘MLR Score - FL - Medicare - DM’ data mapping

Data owners:

• Base data 1: Health Analytics (Cristina Silgo)

Frequency: data is ingested on-demand

Technical details:

• The report is manually processed to provide the Excel file

• The metric is available at monthly and yearly level

Population Health - HCC Recapture Rate

Description: It measures the rate at which providers capture recurring HCC diagnosis on an annual basis.

It applies to Medicare-dedicated providers.

Calculation definition: # Assigned patients with HCC conditions recaptured (closed) / Total assigned patients with HCC conditions

Data sources:

• Base data: Excel file stored in the SFTP and ingested into LEAP leveraging the ‘Members Recapture Rate - FL - Medicare - OJ’ orchestration job and ‘Members Recapture Rate - FL - Medicare - DM’ data mapping

Data owners:

• Base data: Health Analytics (Tiffany Rivero)

Frequency: data is ingested monthly

Technical details:

• Base data is at patient level

• Metric is calculated at year level

Data Processing

Overview

Data is refreshed daily leveraging the ‘Provider Scorecard 2025’ orchestration job, and metrics are updated based on the frequency of each data source. The orchestration job generates multiple tables for each metric, starting from the most detailed data. It then aggregates the data, applies business rules step-by-step, and consolidates the final scores for all metrics into two tables, one for yearly results and another for monthly results. However, monthly data is available for certain metrics only.

Additional Key Data Inputs

Provider Directory

‘Provider Directory’ is essential to identify providers, their status, main facility, patient audience, among other attributes. Additionally, the Provider Directory is fundamental to determine the Medical Directors-Facilities-Providers hierarchy. The directory is managed by the Provider Management team (Monica Pinzon).

Attribution

The ‘Attribution’ process is fundamental to create the patient-provider crosswalk, which is necessary to calculate all patient-based metrics. The attribution process is managed by Monica Pinzon and the Sanitas Data Team.

Goals & Weights

The ‘Provider Scorecard 2025 Goals & Weights’ managed table controls the metrics, goals, and weights applied to each provider based on their primary state and category. This table is managed by the Health Analytics Team (Tiffany Rivero).

Audit Logs Categories

The ‘Provider Scorecard 2025 Audit Logs Categories’ managed table controls the questions and max scores by provider type and audit log metric. This table is managed by the Health Analytics Team (Tiffany Rivero).

Tabs Overview

Current Performance

Contains metrics that track the performance of an individual provider. Metrics displayed are:

• Max Available Score

• Total Weighted Score

• Performance Rate

• Regional Peers Rate

• Overall Peers Rate

Performance Breakdown is a pivot table that displays the the applicable Category, KPI, and Goal Name for each provider. Outputs shown are:

• Target

• Actual

• % of Target

• Weight

• Score

The grand total of the score column in the Performance Breakdown table corresponds to the Total Weighted Score displayed above.

Monthly Drilldown

Contains metrics that track the performance of an individual provider displayed monthly for the current year.

Metrics are broken down by the categories listed below, which can be selected at the top of the page. Metrics displayed are updated based each category selected:

• Primary Care - Pediatrics - Home Care

• Virtual Care

• Urgent Care

• Medicare

Metrics displayed are:

• Net Promoter Score (NPS)

• Provider Satisfaction Index

• Timely Note Completion

• Appointment Productivity

• Appointment Productivity - Virtual Care

• Clinical Audit Score - Documentation & Coding

• Clinical Audit Score - Clinical Care

• Clinical Audit Score - Quality

• Clinical Audit Score - Charts

• HCC Accuracy Audit

• Medical Loss Ratio (MLR)

• Video Consult Efficiency

• Chat Efficiency

• Patient Cycle Time Efficiency