Quality Ratings for Providers in VA

Overview:
Defining provider quality ratings is a complex task and sites such as Healthgrades, Ratemds, Vitals primarily rely on patient reviews to score physicians and generally these ratings are subject to opinions rather than true quality of care or treatment. Also, some may pay for promoting them - see article Data Quality Issues With Physician-Rating Websites: Systematic Review.

We have partnered with Snowflake and use the Snowflake Health Cloud to provide these ratings. The Snowflake Health Cloud is a HIPAA, HITRUST, GxP compliance secure cloud that is used by several large healthcare and life science companies - the likes of United Healthgroup, Anthem, Athena Health, Bayer and others to securely share data without the need for cumbersome ETL/ELT, data transfers etc.

Our “rating” module tracks and provides quality and cost rating scores for each NPI we are tracking. We use longitudinal data derived from our Health Data Bank from multiple payers to score providers – which also feeds our chronic disease prediction and intervention modeling (as part of our patient treatment optimization).

Longitudinal data allows health systems to build a continuum of care, and also to rank providers by cost and quality index scores – it can be used to
Build a roster of high-quality providers
- Identify procedures that are most appropriate for a given patient (we call this “Personal Health Plan”)
- Help resolve provider deviations away from the ideal flow of care (we call this “Patient Treatment Optimization”)
- Track quality and cost improvement measures over time and to see effectiveness of their efforts

The foundation of this ratings module comes from our Health Data Bank – the health data bank and associated “Personal Health Plan” module additionally features (these capabilities are not part of the provider ratings module):

• Prevention – predictive risk scores and timely actionable insights at early stages helps preventive measures
• Risk scoring models – any kind of model that can leverage claims data
• Complete interpretability of AI model prediction
• Modern technology architecture that integrates payer, provider and other data
• Connectivity to disparate sources of health data including social determinants of health such as ADI, SVI
• AI models that are trained and validated with larger volume of multi payers data
• Single, secure, and governed data source to support optimal outcomes for patients, customers, and business initiatives
• Provides health systems with a one-stop shop for all data and analytics needs

Tables Included:
- Healthcare Services Provider Ratings for state of Virginia, US
- Healthcare Services National Provider Identification
- 3 additional tables

Fields Included:
- NPI
- Origination Name
- Provider Last Name
- Provider First Name
- Primary Speciality
- Quality Category Score
- Cost Category Score
- PI Category Score
- 10 additional fields