HealthPartners offers ratings of providers - medical groups and hospitals - with a goal of providing meaningful insight into performance based on cost and quality. Our intent is to present an approach that is easy to explain and understand, while balancing the different perspectives of consumers, providers and employers.
The following principles are used in developing the cost and quality ratings:
- Use measures that are relevant and clear to consumers
- Use measures that are accurate, valid, reliable and obtainable
- Use established measures, those endorsed nationally or generally accepted national standards
- Draw on a range of measures from a variety of sources, where possible, for a robust overall rating methodology
- Apply consistent measurement approaches and use scoring that avoids or minimizes subjectivity
- Disclose the methodology so it is transparent to providers, consumers and employers
- Share results with providers before the information is released publicly
Which providers are included?
Providers (medical groups or hospitals) are included in the cost and quality ratings if they meet the following requirements:
- They are located in the 11-county Twin Cities metro area or, for hospitals, in a large market outside the Twin Cities that has competing providers. These markets include Duluth and Rochester, Minnesota; Fargo, North Dakota; and Sioux Falls, South Dakota.
- For providers in other parts of the country, limited quality and cost information is available for some hospitals.
- They offer primary care or selected specialty care if a medical group, or maternity or medical/surgical care if a hospital. The selected specialties are cardiology, ENT, obstetrics/gynecology and orthopedics. These specialties are chosen based on frequency of use and availability of measures.
- They care for enough HealthPartners members so that sufficient data are available for analysis, which is defined as having a minimum number of episodes. For primary care and OB/GYN, this means providers treated at least 600 illnesses or injuries or provided another type of care in at least 600 cases involving HealthPartners members. For other specialties, the minimum number of episodes to be included is 300. These cases may have needed more than one visit and a range of services.
- They are a provider that members can make appointments with directly, without a referral.
- They are a provider that treats a broad base of patients, rather than a community-based clinic focused on Medicaid patients.
- The scope of services they provide is representative of the specialty.
For purposes of displaying cost and quality ratings, a medical groups rating is displayed in connection with the individual clinics and physicians within the medical group. We do not rate clinics or physicians separately.
What are the ratings based on, in general?
Quality ratings are based on two key components:
- Patient experience: Through surveys, HealthPartners members rate the quality of care and service they receive from their providers.
- Clinical quality: HealthPartners collects quality data from clinics and hospitals throughout our regional network to assess the effectiveness of the care provided to our members. In addition, we draw on reputable third party sources for national data on clinical quality. These measures are based on standards established by organizations such as the National Quality Forum and the Institute for Clinical Systems Improvement.
Overall cost ratings for providers in the 11-county Twin Cities metro area and select markets across the region (see above) allow members to compare providers to one another and are based on the costs for treating episodes of care rather than fees for specific services. Cost ratings are adjusted so that providers who serve patients with chronic or more complex health needs are not adversely affected.
Overall cost ratings for hospitals in other parts of the country are based on hospital billed charges, which does not factor in negotiated discounts with HealthPartners. This currently is the only data available about these hospitals. In addition, for primary and specialty care, there is no comprehensive national source of cost information.
What are quality measures?
Measures of clinic quality are based medical standards defined by the Institute of Clinical Systems Improvement and organizations such as JCAHO, which accredits hospitals; Leapfrog, which monitors patient safety; and Quest Analytics, which analyzes hospital quality and safety.
What are the requirements for quality measures to be included?
HealthPartners' policy on Measuring and Reporting Provider Performance provides guidance on selecting quality measures. Key points in the policy include:
- Use standardized measures as available. If standardized measures are not available, measures may be developed using criteria such as clinical importance and scientific acceptability.
- Measures address a range of clinical conditions
- Measures must be based on sufficient cases to provide valid and reliable information. For each measure, providers are included if they meet an established minimum number of population-based measures or sample size requirements.
- Results are distributed to providers before being displayed publicly.
How is quality measured?
HealthPartners uses a quality index as the basis of the quality component in provider tiering. HealthPartners also uses the quality index to inform our members and purchasers about relative quality among providers. The quality index compares measurement results for patients cared for by each provider group or hospital.
Quality information is presented at three levels:
- Overall quality rating, represented by one to four stars. An overall quality rating is provided for primary care medical groups and hospitals but not for specialties.
- Quality ratings for each cluster, also represented by one to four stars. Clusters are subgroupings of quality.
- Actual results for individual quality measures, such as Seeing the doctor of your choice or Care for back pain.
Learn more about quality scoring
To determine star ratings for quality clusters, individual measures are scored against a benchmark or threshold established for each measure. Thresholds are typically the average, except to account for high performing measures or for measures that have thresholds established by external organizations, such as JCAHO or Leapfrog.
For each cluster, the percentages of measures at each performance level (above threshold, at threshold or below threshold) are totaled to produce an actual to expected quality score rating.
As an example, if a cluster includes four measures, the quality stars would be determined as follows:
2 measures above the threshold and the remaining measures at threshold
4 measures at threshold
3 measures at threshold and 1 below threshold
2 measures below threshold and the remaining measures at threshold
The approach is adjusted to reflect the number of measures in a cluster.
The star rating for overall quality is determined by weighting the actual to expected score for each cluster and summing the cluster scores to yield an overall weighted score. Star ratings are assigned as follows based on the weighted score:
Overall Quality Rating
Highest quality rating - equivalent of at least 50% better than thresholds
High quality rating - equivalent of 0-50% better than thresholds
Lower quality rating - equivalent of 0-50% below thresholds
Lowest quality rating - equivalent of 50% or more below threshholds
What is a cost rating?
Overall costs are assigned by analyzing the total cost of care for treating a condition, not just the fees for a particular service. The total cost of treating a condition includes lab tests, x-rays, care from additional physicians and hospital costs. The ratings show how effectively clinics and hospitals use resources for the unique group of patients they serve. This rating helps you compare the overall cost of care at one clinic or hospital to another.
The cost rating does not indicate that a provider charges less than other providers for each service provided. Fees for each service received may be higher or lower and are not directly tied to the overall cost rating.
Costs are calculated by using actual data submitted by providers that show diagnosis and corresponding treatment for HealthPartners members. Providers are compared to others who deliver similar types of care. Providers who are more efficient in diagnosing conditions, more efficient in treating those conditions and/or charge a lower fee for delivering care are lower cost compared to their peers.
How are cost ratings calculated?
HealthPartners uses the Total Cost Index (TCI) as the basis of the cost component in provider tiering as well as to inform our members and purchasers about differences in relative cost and efficiency among providers.
The TCI compares the total cost of care for patients seen and managed by each provider group. The TCI includes the efficiency, intensity and price compared to the average for similar providers (e.g., cardiologists compared to cardiologists). Costs for hospitals, professional and ancillary services, plus pharmacy costs, are included.
Learn more about cost calculations
Dollar signs ratings are assigned based on 10-percent intervals above or below average. A provider's TCI must be 10 percent better than average to receive the best cost rating (a one "$" rating).
Overall Cost Index
TCI is 10 percent above average
TCI is above average, but less than 10 percent above average
TCI is less than average, but not 10 percent better than average
TCI is 10 percent better than average
Frequently Asked Questions