Investor Presentaiton
Appendix C: Insurer Level Performance
On Quality
Commercial Insurers' Performance on the ACO Core Measure Set
The three commercial insurers (BCBSRI, THP, and UHC) performed well on the
prevention, screening and behavioral health measures but not as well on the
diabetes care measures. The three insurers were above the National 75th percentile
for all measures, except THP for Comprehensive Diabetes Care: HbA1c Control
(<8.0%). The insurers were above the 90th percentile for all measures except UHC for
Comprehensive Diabetes Care: Eye Exam and all three insurers for Comprehensive
Diabetes Care: HbA1c Control (<8.0%). BCBSRI's performance compared favorably
to the other insurers on three measures: Breast Cancer Screening, Colorectal Cancer
Screening, and Comprehensive Diabetes Care: Eye Exam.
Table C.1: Commercial Insurers' Performance on the ACO Core Measure Set
Measure
National
Benchmarks
Above 75th Pctl?
Above 90th Pctl?
75TH
PCTL
90TH
PCTL
BCBSRI
THP
UHC
BCBSRI
THP
UHC
Breast Cancer Screening
73%
75%
Yes
Yes
Yes
Yes
Yes
Yes
86%
84%
78%
86%
84%
78%
Colorectal Cancer Screening
66% 70%
Yes
Yes
Yes
Yes
Yes
Yes
81%
73%
75%
81%
73%
75%
Comprehensive Diabetes Care: Eye Exam
54%
60%
Yes
Yes
Yes
Yes
Yes
No
71%
63%
60%
71%
63%
60%
Comprehensive Diabetes Care: HbA1c Control
60%
64%
Yes
No
Yes
No
No
No
(<8.0%)
62%
48%
64%
62%
48%
64%
Follow-Up After Hospitalization for Mental Illness
(7-Day)¹
53%
59%
ΝΑ
Yes
Yes
NA
Yes
Yes
75%
68%
75%
68%
Developmental Screening in the First Three Years
of Life²,3
57%
65%
Yes
ΝΑ
ΝΑ
Yes
ΝΑ
ΝΑ
85%
85%
Weight Assessment and Counseling - BMI
percentile
77%
83%
Yes
Yes
Yes
Yes
Yes
Yes
92%
88%
91%
92%
88%
91%
Weight Assessment and Counseling - Counseling
for Nutrition
72%
78%
Yes
Yes
Yes
Yes
Yes
Yes
90%
87%
89%
90%
87%
89%
Weight Assessment and Counseling - Counseling
69%
75%
Yes
Yes
Yes
Yes
Yes
Yes
for Physical Activity
89%
87%
88%
89%
87%
88%
Source: OHIC analysis of quality performance data submitted by commercial insurers in Rhode Island.
Note: NA = Not Applicable. Insurer did not submit performance on this measure. NHPRI is not included here because it does not have total cost of care contracts with ACOs for
their commercial members.
1 BCBSRI did not include Follow-Up After Hospitalization for Mental Illness in its 2021 PQIP Program, thus no data were reported for 2021.
2
THP was unable to report a MY 2021 rate for Developmental Screening in the First Three Years of Life. THP is working with a vendor and will report this measure for MY 2022.
3 UHC explained to OHIC that they could not report Developmental Screening in the First Three Years of Life at the plan level because it is not a HEDIS measure.
Annual Report: Health Care Spending and Quality in Rhode Island
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