Provider Intelligence

CareJourney’s Provider Intelligence data asset is the first comprehensive resource to help you improve provider performance and referrals, grow your network, and build data-driven care teams.

Healthcare stakeholders have generally operated with insufficient data. Critical decisions regarding patient care, referrals, and provider performance have been made using incomplete, scattered, un-actionable datasets, resulting in patients and providers paying the price, both financially and with their most precious currency: patient health.

By providing insights into care variation, and ensuring the data is keyed on 5 levels like NPI, Facility, and Group, CareJourney’s Provider Intelligence enables increased focus on making critical data-driven decisions around finding and recruiting the best providers who deliver high-quality, low-cost care.

Data sources:
- CMS Medicare fee-for-service claims details
- Commercial claims details (add-on)
- CMS Physician Compare
- NPPES data
- QPP eligibility data

The following views are available as part of this listing:
- Health Care Practitioner
- Health Care Provider Organization
- Health Care Practitioner APM Affiliation
- Health Care Facility Practitioner Affiliation
- Health Care Provider Organization Practitioner Affiliation
- Health Care Provider Organization Facility Affiliation
- Health Care Practitioner Claim Activity
- Health Care Practitioner Cost and Utilization
- Health Care Provider Organization Cost and Utilization
- Health Care Practitioner Referral
- Health Care Provider PPI Rollup
- Health Care Provider PPI Rollup Commercial
- Health Care Provider PPI Episode Quality
- Health Care Provider PPI Episode Quality Commercial
- Health Care Provider PPI Medical Setting
- Health Care Provider PPI Medical Setting Commercial
- Health Care Provider PPI Episode Cost Breakdown
- Health Care Provider PPI Episode Complication
- Health Care Provider PPI Episode Complication Commercial
- Market Episode Variation

Sample fields include:
Demographic Metrics
- Provider ID (NPI)
- Geographic Details
- Year
- Practice Group Affiliation
- Hospital Affiliation
- Taxonomy (NPPES and CareJourney)
- Number of Patients

Performance Metrics
- Medical Codes (procedure and diagnosis)
- CareJourney Cost Index
- CareJourney Quality Index
- Allowed Amount
- Number of Claims
- Episode Type
- Count of Episodes
- Observed Allowed Amount
- Expected Allowed Amount
- Allowed Amount by Site of Service
- Episode Cost & Utilization
- Rate of Performance
- Probability of Performing Better
- Benchmarks
- Complications
- Episode Based Quality Measure Performance
- Referral data including specialty, number of patients, allowed amounts etc.